Failure to thrive (FTT) refers to a child’s poor physical growth. The term has mostly been applied to infants and toddlers. An approach to FTT requires an understanding of children’s growth patterns, nutritional needs, diet and feeding behavior, possible medical contributors, and the psychosocial context.
It is not always straightforward establishing whether a child’s growth is adequate. Most important is to consider the child’s growth trend, rather than his or her growth at a single point in time. By carefully plotting a child’s weight for age, height for age, weight for height, and head circumference for age on the CDC (2000) growth charts, one can compare a child’s growth to the growth rates in a large sample of healthy children. FTT is generally diagnosed when the child’s weight for age or the weight for height falls below the fifth percentile. Height (or length) is affected later due to more protracted or severe problems, resulting in stunting. The head circumference (reflecting brain growth) is usually involved only late and under the worst circumstances.
The diagnosis of FTT is complicated by several circumstances. For example, prematurely born babies need to be plotted on special charts. Similarly, genetics plays a role, and so the average parental height should be considered in evaluating a short child. Fetal conditions may impede growth resulting in babies being born small for their gestational age; with time and depending on the cause, many of these infants will catch up. It is therefore important that a physician knowledgeable about growth evaluate whether the trend is really problematic.
There are many conditions and circumstances that can contribute to FTT. Traditionally these have been separated into “organic” and “nonorganic.” Organic refers to medical conditions such as cyanotic heart disease or Down’s syndrome. Nonorganic refers to psychosocial factors that may be at different levels: child (e.g., temperament), parent (e.g., a depressed mother), family (e.g., stress), community/society (e.g., inadequate food or poverty). Sometimes, there are both organic and nonorganic contributors. Many of these nonorganic factors directly or indirectly result in an inadequate food intake.
Ideally, a comprehensive and interdisciplinary evaluation is conducted by a pediatrician, nutritionist or dietician, and social worker. A thorough medical history and examination generally help detect whether there are organic contributors. Assessment of the child’s behavior and development is also important. Limited medical tests are needed to confirm concerns raised by the evaluation. Basic screening for anemia, lead poisoning, and a urinary infection may be done. A detailed evaluation of the child’s diet is essential as is an evaluation of the feeding or eating behavior. Direct observation of a parent feeding an infant can be valuable. A social worker can help clarify the parent–child relationship, and how the family, parent, and child are functioning.
Addressing Failure to Thrive
The approach needs to be tailored to the severity and the specific contributors to the FTT. Helping ensure an adequate diet is critical, but attention to other problems underpinning the FTT is also important. Most children with FTT (and their families) can be helped as outpatients. If the problem is severe or persistent, hospitalization may be needed. The FTT should be carefully monitored to ensure good progress. If growth continues to falter and there is a persistent inability to meet the child’s nutritional needs, child protective services can help with in-home and other community services, and their ability to closely monitor the situation.
1. Kessler, D. B., & Dawson, P. (1999). Failure to thrive and pediatric undernutrition: A transdisciplinary approach. Baltimore, MD: Paul H. Brookes.
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