Failure to thrive

Answer 1

Definition

Failure to thrive is a description applied to children whose current weight or rate of weight gain is significantly below that of other children of similar age and sex.

Alternative Names

Growth failure; FTT

Causes, incidence, and risk factors

Infants or children that fail to thrive seem to be dramatically smaller or shorter than other children the same age. Teenagers may have short statureor appear to lack the usual changes that occur at puberty. However, there is a wide variation in normal growth and development.

In general, the rate of change in weight and height may be more important than the actual measurements.

It is important to determine whether failure to thrive results from medical problems or factors in the environment, such as abuse or neglect.

There are multiple medical causes of failure to thrive. These include:

• Chromosomeabnormalities such as Down syndrome and Turner syndrome
• Defects in major organ systems
• Problems with the endocrine system, such as thyroid hormone deficiency, growth hormone deficiency, or other hormone deficiencies
• Damage to the brain or central nervous system, which may cause feeding difficulties in an infant
• Heart or lung problems, which can affect how oxygen and nutrients move through the body
• Anemia or other blood disorders
• Gastrointestinal problems that result in malabsorption or a lack of digestive enzymes
• Long-term gastroenteritis and gastroesophageal reflux (usually temporary)
• Cerebral palsy
• Long-term (chronic) infections
• Metabolic disorders
• Complications of pregnancy and low birth weight

Other factors that may lead to failure to thrive:

• Emotional deprivation as a result of parental withdrawal, rejection, or hostility
• Economic problems that affect nutrition, living conditions, and parental attitudes
• Exposure to infections, parasites, or toxins
• Poor eating habits, such as eating in front of the television and not having formal meal times

Many times the cause cannot be determined.

Symptoms

Infants or children who fail to thrive have a height, weight, and head circumference that do not match standard growth charts. The person's weight falls lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve.

The following are delayed or slow to develop:

• Physical skills such as rolling over, sitting, standing and walking
• Mental and social skills
• Secondary sexual characteristics (delayed in adolescents)

Signs and tests

The doctor will perform a physical exam and check the child's height, weight, and body shape. A detailed history is taken, including prenatal, birth, neonatal, psychosocial, and family information.

A Denver Developmental Screening Test reveals delayed development. A growth chart outlining all types of growth since birth is created.

The following laboratory tests may be done:

• Complete blood count (CBC)
• Electrolyte balance
• Hemoglobin electrophoresis to determine the presence of conditions such as sickle cell disease
• Hormone studies, including thyroid function tests
• X-rays to determine bone age
• Urinalysis

Treatment

The treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional factors can be resolved by educating the parents to provide a well-balanced diet.

If psychosocial factors are involved, treatment should include improving the family dynamics and living conditions. Parental attitudes and behavior may contribute to a child's problems and need to be examined. In many cases, a child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral, and psychosocial treatment plan.

Do not give your child dietary supplements like Boost or Ensure without consulting your physician first.

Expectations (prognosis)

If the period of failure to thrive has been short, and the cause is determined and can be corrected, normal growth and development will resume. If failure to thrive is prolonged, the effects may be long lasting, and normal growth and development may not be achieved.

Complications

Permanent mental, emotional, or physical delays can occur.

Calling your health care provider

Call for an appointment with your health care provider if your child does not seem to be developing normally.

Prevention

The best means of prevention is by early detection at routine well-baby examinations and periodic follow-up with school-age and adolescent children.

Answer 2

Definition

Failure to thrive refers to children whose current weight or rate of weight gain is significantly lower than that of other children of similar age and gender.

Alternative Names

Growth failure; FTT; Feeding disorder; Poor feeding

Causes, incidence, and risk factors

It is important to determine whether failure to thrive results from medical problems or factors in the environment, such as abuse or neglect.

There are many medical causes of failure to thrive. These include:

• Chromosomeproblems such as Down syndrome and Turner syndrome
• Organ problems
• Thyroid hormone deficiency, growth hormone deficiency, or other hormone deficiencies
• Damage to the brain or central nervous system, which may cause feeding difficulties in an infant
• Heart or lung problems, which can affect how nutrients move through the body
• Anemia or other blood disorders
• Gastrointestinal problems that make it hard to absorbe nurtients or cause the body to have a lack of digestive enzymes
• Long-term gastroenteritis and gastroesophageal reflux (usually temporary)
• Cerebral palsy
• Long-term (chronic) infections
• Metabolic disorders
• Complications of pregnancy and low birth weight

Other factors that may lead to failure to thrive:

• Emotional deprivation as a result of parental withdrawal, rejection, or hostility
• Poverty
• Problems with child-caregiver relationship
• Parents do not understand the appropriate diet needs for their the child
• Exposure to infections, parasites, or toxins
• Poor eating habits, such as eating in front of the television and not having formal meal times

Many times the cause cannot be determined.

Symptoms

Children that fail to thrive seem to be much smaller or shorter than other children the same age. Teenagers may not appear to have the usual changes that occur at puberty. However, it's important to remember that the way children grow and develop varies quite a bit. See: Normal growth and development

Symptoms of failure to thrive include:

• Height, weight, and head circumference do not match standard growth charts.
• Weight is lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height.
• Growth may have slowed or stopped after a previously established growth curve.

In general, the child's rate of change in weight and height may be more important than the actual growth measurements.

Children who fail to thrive may have the following delayed or slow to develop:

• Physical skills such as rolling over, sitting, standing and walking
• Mental and social skills
• Secondary sexual characteristics (delayed in adolescents)

Babies who fail to gain weight or develop often have a lack of interest in feeding or a problem receiving the proper amount of nutrition. This is called "poor feeding."

Other symptoms that may be seen in a child that fails to thrive include:

• Constipation
• Excessive crying
• Excessive sleepiness (lethargy)
• Irritability

Signs and tests

The doctor will perform a physical exam and check the child's height, weight, and body shape. You will be asked questions about the child's medical and family history.

A special test called the Denver Developmental Screening Test will be used to show any delays in development. A growth chart outlining all types of growth since birth is created.

The following tests may be done:

• Complete blood count (CBC)
• Electrolyte balance
• Hemoglobin electrophoresis to check for conditions such as sickle cell disease
• Hormone studies, including thyroid function tests
• X-rays to determine bone age
• Urinalysis

Treatment

Treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional factors can be helped by showing the parents how to provide a well-balanced diet.

Do not give your child dietary supplements such as Boost or Ensure without talking to your health care provider first.

Other treatment depends on the severity of the condition. The following may be recommended:

• Increase the number of calories and amount of fluid the infant receives
• Correct any vitamin or mineral deficiencies
• Identify and treat any other medical conditions

The child may need to stay in the hospital for a little while.

Treatment may also involve improving the family relationships and living conditions. Sometimes, the parent's attitudes and behavior may contribute to a child's failure to thrive.

Expectations (prognosis)

Normal growth and development may be affected if a child fails to thrive for a long time.

Normal growth and development may continue if the child has failed to thrive for a short time, and the cause is determined and treated.

Complications

Permanent mental, emotional, or physical delays can occur.

Calling your health care provider

Call for an appointment with your health care provider if your child does not seem to be developing normally.

Prevention

Regular check-ups can help detect failure to thrive in children.

References

McLean HS, Price DT. Failure to thrive. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 38.

Reviewed By

Review Date: 08/02/2011

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc