Failure to Thrive

Failure to thrive (FTT) is used to describe a delay in a child's growth or development. It is usually applied to infants and children up to two years of age who do not gain or maintain weight as they should. Failure to thrive is not a specific disease, but rather a cluster of symptoms which may come from a variety of sources.

Description

Shortly after birth most infants loose some weight. After that expected loss, babies should gain weight at a steady and predictable rate. When a baby does not gain weigh as expected, or continues to loose weight, it is not thriving. Failure to thrive may be due to one or more conditions.

Organic failure to thrive (OFTT) implies that the organs involved with digestion and absorption of food are malformed or incomplete so the baby cannot digest its food. Non-organic failure to thrive (NOFTT) is the most common cause of FTT and implies the baby is not receiving enough food due to economic factors or parental neglect, or do to psychosocial problems.

Causes and symptoms

Occasionally, there may be an underlying physical condition that inhibits the baby's ability to take in, digest, or process food. These defects can occur in the esophagus, stomach, small or large intestine, rectum or anus. Usually the defect is an incomplete development of the organ, and it must be surgically corrected. Most physical defects can be detected shortly after birth.

Failure to thrive may also result from lack of available food or the quality of the food offered. This can be due to economic factors in the family, parental beliefs and concepts of nutrition, or neglect of the child. In addition, if the baby is being breast fed, the quality or quantity of the mother's milk may be the source of the problem.

Psychosocial problems, often stemming from a lack of nurturing parent-child relations can lead to a failure to thrive. The child may exhibit poor appetite due to depression from insufficient attention from parents.

Infants and toddlers, whose growth is substantially less than expected, are considered to be suffering from FTT.

Diagnosis

Most babies are weighed at birth and that weight is used as a base line for future well-baby check-ups. If the baby is not gaining weight at a predictable rate, the doctor will do a more extensive examination. If there are no apparent physical deformities in the digestive tract, the doctor will examine the child's environment. As part of that examination, the doctor will look at the family history of height and weight. In addition, the parents will be asked about feedings, illnesses, and family routines. If the mother is breastfeeding the doctor will also evaluate her diet, general health, and well being as it affects the quantity and quality of her milk.

Diagnosis of FTT is confirmed by a positive growth and behavioral response to increased nutrition.

Treatment

If there is an underlying physical reason for failure to thrive, such as a disorder of swallowing mechanism or intestinal problems, correcting that problem should reverse the condition. If the condition is caused by environmental factors, the physician will suggest several ways parents may provide adequate food for the child. Maternal education and parental counseling may also be recommended. In extreme cases, hospitalization or a more nurturing home may be necessary.

Prognosis

The first year of life is important as a foundation for growth and physical and intellectual development in the future. Children with extreme failure to thrive in the first year may never catch up to their peers even if their physical growth improves. In about one third of these extreme cases, mental development remains below normal and roughly half will continue to have psychosocial and eating problems throughout life.

When failure to thrive is identified and corrected early, most children catch up to their peers and remain healthy and well developed.

Prevention

Initial failure to thrive caused by physical defects cannot be prevented but can often be corrected before they become a danger to the child. Maternal education and emotional and economic support systems all help to prevent failure to thrive in those cases where there is no physical deformity.