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Failure to thrive
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
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:
- Chromosome problems 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
Exams 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.
Outlook (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.
Possible Complications
Permanent mental, emotional, or physical delays can occur.
When to Contact a Medical Professional
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: 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
