Failure to thrive
Failure to thrive (FTT) is a medical condition characterized by insufficient growth in infants and children, evident through failure to meet established weight and height milestones. It can be classified as organic or inorganic, with various underlying factors contributing to its development. Prenatal issues, such as maternal substance abuse and infections, may lead to growth problems. Genetic conditions like Down syndrome and Turner syndrome, as well as gastrointestinal, endocrine, kidney, and respiratory diseases, can also hinder a child's growth and appetite.
Undernutrition, often stemming from food insecurity, neglect, or breastfeeding challenges, is another significant cause of FTT. Assessment often involves examining the child's body mass index (BMI) to differentiate between failure to thrive and short stature due to familial or constitutional factors. Treatment strategies focus on addressing the root causes, ensuring a nurturing environment, and providing adequate nutrition, which may include specialized formulas or calorie-dense foods. Overall, early intervention and comprehensive support can lead to improved growth outcomes and development in affected children.
Failure to thrive
Also known as: Growth impairment, stunting, wasting
Anatomy or system affected: Bones, brain, endocrine system
Definition: A disorder of early childhood that involves inadequate growth or the inability to maintain growth.
Causes and Symptoms
Failure to thrive refers to a condition in which infants and children fail to develop and grow normally, as indicated by their inability to achieve noted markers on medically-accepted weight and height growth charts. Failure to thrive may be organic or inorganic; in many children, the etiology is multifactorial. The onset of growth problems may be prenatal as a result of maternal substance abuse, most notably alcohol use resulting in fetal alcohol syndrome, or of maternal infection or undernutrition during pregnancy. Chromosome problems, such as Down syndrome and Turner syndrome, are also medical causes of failure to thrive. Other causes include gastrointestinal disease resulting in poor micronutrient intake, endocrine disease, kidney disease, and heart and lung disease, all of which may decrease a child's appetite and how they process food and thus impair growth. Small size in infants secondary to prematurity resolves by two to three years of age unless there are complications. Undernutrition during infancy or childhood can also cause failure to thrive; undernutrition may result from inadequate protein and energy intake due to food insecurity and poverty, breastfeeding difficulties, or child neglect or abuse.
Many children with failure to thrive are both stunted (height-affected) and wasted (weight-affected). Assessing which of the two conditions predominates can be done using the body mass index (BMI), which is calculated by dividing weight in kilograms by height in meters squared. A low BMI is a sign of malnutrition. Children with environmental failure to thrive fall into this category.
A child who is small but has an appropriate BMI has short stature rather than failure to thrive. The two leading causes of short stature are familial short stature and constitutional delay.
Treatment and Therapy
The treatment for failure to thrive depends on the underlying disorder or cause. The most common focus of the medical intervention with failure to thrive is to ensure a nurturing environment and adequate nutrition. Nutritional intervention can be achieved in many ways, such as by securing adequate access to food for the family and offering concentrated formulas, nutritional supplementation, and calorie-dense food, depending on the age of the child. Developmental intervention should also be provided if delay is detected. Likewise, family counseling, especially focusing on parenting skills, may be indicated. Other treatment options include treating the underlying medical condition that is contributing to failure to thrive, such as gastrointestinal disease, kidney disease, Human Immunodeficiency Virus, and other infectious diseases.
Perspective and Prospects
The term “failure to thrive” originated in 1933; it replaced the term “cease to thrive,” which appeared in 1889. Initially, the condition was reported in institutionalized children, including those in orphanages. In the 1940s, however, it was recognized as a condition that could also affect children living at home with their biological or adoptive parents.
Although the list of conditions that can cause growth impairment in children is quite extensive, a systematic approach using history and both physical and psychosocial assessment will provide clues to the diagnosis. Intervention ensures an adequate outcome, with improved prospects for physical growth and brain development.
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