Failure to Thrive

What is Failure to Thrive?

Failure to thrive (FTT) is a phrase that is traditionally used to
describe children who have fallen short of their expected growth
and development. In our general practice, FTT is commonly used
for any child who fails to gain weight or height according to
standard medical growth charts. FTT occurs when your child is
either not receiving adequate calories or is unable to properly use
the calories that are given, resulting in failure to grow or gain
weight over a period of time. Using standard growth charts, a
child’s weight or height below the 3rd percentile for age or a
progressive decrease in the rate of gain of weight or height would
be considered as FTT.

How Common is FTT?

About 1% of all children admitted to any hospital and 3 to 5% of
all children admitted to a Children’s Hospital have failure to
thrive. About 10% of clinic visits in urban and rural outpatient
settings are for concerns about growth and development. Up to
16% of 0-4 year olds of low income families are "stunted."

Why Does FTT Happen?

Failure to thrive happens for many reasons, but the causes can be
divided into three categories: poor intake, poor utilization, or
increased calorie requirements.
Among the conditions that can cause your child to have ◆ poor milk supply for breastfeeding moms (due to the
inadequate calories for normal growth (decreased intake of mother being exhausted, under stress or in a poor
calories) include: nutritional state).
◆ refusal to eat from chronic medical problems, such as ◆ physical abnormalities that cause difficulty swallowing,
kidney disease, cancer, congenital heart disease, metabolic such as neurological disorders including cerebral palsy,
disorders, liver disease, HIV infection, or gastroesophageal trauma to the mouth, congenital abnormalities, or
reflux with esophagitis. disorders with motility or movement of the upper
◆ having a restrictive or fad diet gastrointestinal tract.
◆ dilute formula preparation ◆ poverty can lead to inadequate access to food.
Conditions that can cause an increased loss of calories include
the following:
SPECIFIC INSTRUCTIONS : ◆ illnesses that can cause persistent vomiting such as
intestinal obstructions or a brain tumor.
◆ conditions associated with malabsorption, usually with
diarrhea which can be foul smelling and oily, such as from
cystic fibrosis, allergies, celiac disease, inflammatory
bowel disease or parasite infestations or other intestinal
infections.
◆ diabetes mellitus (usually includes weight loss, increased
urination, and increased thirst and drinking),
◆ other metabolic conditions.
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FTT continued
Other children may have an increased requirement for calories In the event of difficulties with breastfeeding, a lactation specialist
because of a chronic infection, hyperthyroidism, congenital heart may be asked to help. It may be necessary to involve other
disease or chronic lung problems. specialists to assess the developmental stage of your child and/or
When children develop failure to thrive from an underlying med- your child’s feeding skills. If your child continues to have FTT,
ical condition, it is often referred to as organic FTT. Organic FTT your physician may admit your child to the hospital for further
refers to growth failure that results from acute or chronic medical monitoring and investigation. Sometimes an infant or child with
problems such as listed above. Non-organic FTT is applied to failure to thrive will be hospitalized for observation to help
children who have growth problems but do not have a specific determine the nature of the problem and to begin dietary therapy.
underlying disease or medical condition. Your physician will often tailor any blood tests or other laboratory
studies according to your child’s symptoms, physical findings and
Up to 80% of all children with FTT have non-organic type FTT. response to initial therapy.
Non-organic FTT most commonly occurs in situations where
there is inadequate food intake or there is a lack of environmental
stimuli. Examples of non-organic FTT include lack of food intake How is Failure to Thrive treated?
due to an inability to afford an appropriate formula, problems Treatment of failure to thrive depends upon the age of the child,
with feeding techniques, improperly prepared formula (over- the associated symptoms and the underlying reason for the poor
diluting the formula), or an inadequate supply of breast milk growth. The overall goal of treatment is to provide adequate
(due to the mother being exhausted, under stress or in a poor calories and any other support necessary to promote the growth
nutritional state). of your child. If your child has organic failure to thrive, additional
therapy may be needed to treat the underlying medical condition.
How does your health care provider know For example, intestinal disorders may cause poor absorption
(malabsorption) of the diet and lead to failure to thrive. In this
that your child is failing to thrive? instance, a special diet may be necessary.
Weight is the best indicator of nutritional status and your child’s Failure to thrive may also develop in twins or triplets, simply
weight should be monitored at each clinic visit. Obtaining your because multiple births are more difficult to care for and more
child’s height is also important; however a single measurement of demanding to feed. A baby born prematurely is more likely to
height is less valuable for the diagnosis of FTT than several height have failure to thrive because many of the body functions
measurements over time (linear growth). Linear growth may be necessary for the proper ingestion and digestion of the diet are
affected in children with malnutrition, but this usually indicates a immature at birth. Lung problems or heart disease, especially in
prolonged period of poor nutrition. very young infants, can make feedings more difficult and lead to
poor calorie intake and failure to thrive.
Most children with non-organic FTT present with growth failure
in the first year of life, and usually come to medical attention You should call your child’s healthcare provider if any of the
by 6 months of age. In children with organic FTT, the time of following occur:
presentation is more variable and is dependent on the child’s ◆ Increased amounts of vomiting or persistent projectile
underlying medical condition. When FTT is recognized, your (forceful) vomiting.
doctor will talk with you about your child’s symptoms, obtain a
◆ Vomiting of fluid that is green in color, or looks like coffee
dietary history and perform a physical examination.
grounds or blood.

What are the investigations for FTT? ◆ If your child experiences any difficulty breathing associated
with the vomiting or spitting.
Your doctor may request that you provide food records for your ◆ Pain related to eating, or food refusal causing weight loss or
child and will likely involve a dietician to assess your child’s food poor weight gain
intake and nutrition needs. Often, as a first step, an appropriate
◆ If your child develops trouble swallowing or painful
diet will be instituted with the help of a dietician to make certain
swallowing.
that adequate calories are provided to allow for “catch-up” growth
for your child. For more information or to locate a pediatric gastroenterologist in your
area please visit our website at: www.naspghan.org

LINKS : IMPORTANT REMINDER: This information from the North American Society for
Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is intended only to
http://kidshealth.org/parent/food/weight/failure_thrive.html provide general information and not as a definitive basis for
diagnosis or treatment in any particular case. It is very
www.magicfoundation.org important that you consult your doctor about your specific
condition.
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