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What is it? Failure to thrive or growth faltering are terms you might hear to describe growth that’s slower than expected in your child. This is common and treatable. Your child may need to take in more calories to get back on track. Or they might need treatment for an underlying condition. Failure to thrive (FTT) is a medical condition characterized by inadequate growth or weight gain in children, often indicating underlying health issues. Failure to thrive refers to a significant decline in a child's physical health, particularly in terms of growth and weight gain. It is typically defined as a weight below the 5th percentile for age and sex or a significant drop in weight percentile over time. The term is also increasingly referred to as "growth faltering" to emphasize the medical concern without implying failure on the part of the child or caregiver. How is it diagnosed? How old is the patient? What is the gender of the patient? How old are you? Weight-for-age Length/height-for-age Age-Specific Guidelines BMI is interpreted differently for children and adults. BMI Percentiles Underweight: below the 5th percentile Healthy weight: 5th to less than 85th percentile Overweight: 85th to less than 95th percentile Obese: 95th percentile or higher Causes What causes it? • Type I failure to thrive
Excessive loss of calories Increased metabolic demands • Type II failure to thrive
Genetic short stature Hypothyroidism Growth hormone deficiency Hypopituitarism Chronic malnutrition • Type III failure to thrive
Chromosomal abnormalities Prenatal exposure to toxins Type I Failure to Thrive • Inadequate caloric intake
Formula prepared incorrectly Decreased appetite or feeding dysfunction/refusal • Excessive loss of calories
Diarrhea/malabsorption • Increased metabolic demands
FTT can arise from various factors, which are generally categorized into two types: Organic FTT: This type is due to underlying medical conditions that affect nutrient absorption, calorie intake, or increase caloric needs. Examples include chronic infections, metabolic disorders, and congenital heart defects. Non-organic FTT: This type is often related to environmental factors, such as inadequate food intake, poor feeding practices, or psychosocial issues within the family. It accounts for the majority of FTT cases. Symptoms Children with FTT may exhibit several signs, including: Poor weight gain: Weight gain is significantly below that of peers. Short stature: Height may also be below the expected range for age. Delayed developmental milestones: Children may not reach typical growth and developmental milestones on time. Diagnosis Diagnosis of FTT typically involves: Growth monitoring: Regular tracking of weight, height, and head circumference against standard growth charts. Medical history and physical examination: Assessing dietary intake, family dynamics, and any underlying health issues. Treatment Treatment for FTT depends on the underlying cause and may include: Nutritional interventions: Adjusting the child's diet to ensure adequate caloric and nutrient intake, such as fortifying breast milk or introducing calorie-dense foods. https://shareourspare.org/ Addressing medical issues: Treating any identified medical conditions that contribute to FTT. Psychosocial support: Improving family dynamics and addressing any environmental factors that may affect the child's growth. Failure to thrive is a significant health concern that requires prompt attention and intervention. Early identification and tailored treatment can help ensure that affected children achieve healthy growth and development. If you suspect a child may be experiencing FTT, it is essential to consult a healthcare provider for a thorough evaluation and appropriate management. Standard Growth Charts and Failure to Thrive WHO growth standards (0–2 years): Based on longitudinal studies of healthy infants in optimal conditions (e.g., high socioeconomic status, breastfeeding, no smoking). WHO curves are faster in early infancy and slower after 3 months Texas Children’s+1. CDC growth charts (2+ years): Based on cross-sectional U.S. data from the 1970s–1990s; use 5th–95th percentiles for abnormality JU Medicine. Anthropometric z-scores are increasingly recommended for tracking malnutrition severity, as they allow comparison of a child’s growth to the mean for their age/sex AAFP. Clinical Use of Growth Charts 0–2 years: WHO charts are preferred to reflect physiological growth patterns in infancy JU Medicine. 2+ years: CDC charts are used JU Medicine. Percentile shifts (e.g., crossing 2 or more percentiles downward) indicate FTT. v Parental size, prematurity correction, and feeding method (breastfed vs. formula-fed) can influence chart interpretation. Causes of FTT FTT results from inadequate nutrition in one or more forms: Inadequate oral intake – poor feeding skills, GER/reflux, cleft lip/palate, short gut, gastroparesis, feeding refusal, social deprivation, neglect. Adequate oral intake but poor/no weight gain – underlying medical conditions (e.g., congenital heart disease, genetic syndromes, hypermetabolism), malabsorption, or caregiver misperception. Mixed causes – often the most common. Assessment and Management Initial workup: Detailed feeding history, physical exam, and monitoring of intake/output. Hospital admission is not routine; reserved for severe malnutrition, dehydration, suspected abuse/neglect, or failure to respond to outpatient plans. Nutritional support: Oral supplements, enteral formulas, lactation support, or NG feeds if needed. Specialist involvement: Nutritionist, gastroenterology, social work, or subspecialty consult for suspected disorders. Avoid unnecessary labs/imaging unless there are red flags for serious illness. Where do you go for further details? Take a look at this. How could this be prevented? Identify individuals at risk. Provide an enabling environment. Do not violate the rights of others. Do no harm. Identify harms the client is facing. Fix the underlying cause of the issues. |