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Failure-to-Thrive

Definition:
Failure-to-thrive is a term used to describe a child who is not growing as expected. But it is not the same as normal growth in a child who is small for his or her age. The exact definition is not completely agreed upon.

In general, failure-to-thrive means that a child:

  • Is at or below the 3rd to 5th percentile for height and weight; or
  • Has failed to gain weight as expected, as shown by dropping two growth percentiles (For example, the child goes from the 75th percentile to below the 25th percentile.)

Types include:

Organic Failure-to-Thrive – caused by some other medical condition

Nonorganic Failure-to-Thrive – occurs in children with no known medical condition

Mixed Failure-to-Thrive – occurs when the child has features of both organic and nonorganic failure-to-thrive

Causes:
Causes include:
  • Gastrointestinal disease
    • Reflux
    • Pyloric stenosis
    • Cleft lip and/or palate
    • Hirschsprung's disease
    • Hepatitis
    • Cirrhosis
    • Pancreatic insufficiency
    • Malabsorption
    • Milk protein intolerance
    • Breast feeding difficulties including insufficient milk supply syndrome
  • Kidney disease
    • Urinary tract infection
    • Kidney failure
    • Diabetes insipidus
  • Heart and lung disease
    • Congestive heart failure
    • Cystic fibrosis
    • Asthma
    • Heart or lung defects
  • Endocrine disease
    • Thyroid problems
    • Pituitary disease
    • Diabetes
    • Growth hormone deficiency
  • Infectious disease
    • HIV
    • Bacteria or parasites of the gastrointestinal tract
    • Tuberculosis
  • Chromosomal birth defects
  • Fetal alcohol syndrome
  • Lead poisoning
  • Cancer
  • Poverty
  • Child abuse, or negligence
  • Parental ignorance
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.
  • Untreated medical conditions
  • Poverty, including lack of available food
  • Poor parenting skills
  • Depression in the parent
Symptoms:
Symptoms include:
  • Slowed growth in a young child, including height, weight, and head circumference
  • Slowed development, including late rolling, sitting, crawling, standing, walking and talking
  • Small muscles
  • Weakness, low energy
  • Hair loss
  • Loose folds of skin
  • Other symptoms related to an underlying medical condition
Diagnosis:
Failure-to-thrive is diagnosed based on tracking a child's growth. The doctor will plot a child's weight, height, and head circumference on standard growth charts. If the child falls below a certain weight range or drops two percentiles on the growth chart, the doctor will evaluate the child further.

If a medical condition may be the cause, the doctor will order further tests. Tests may include:

  • Blood tests
  • Urine tests
  • Blood lead level
  • HIV test
  • Thyroid tests
  • Sweat-chloride test
  • Gastrointestinal x-rays

Sometimes, a child must be hospitalized for a period of time to find the cause of failure-to-thrive. During this time the doctor will:

  • Monitor the relationship between parent and child, paying particular attention to their behavior around feeding
  • Set up a feeding schedule with an adequate amount of calories
  • Make sure that an appropriate feeding technique is used

If the child can gain weight under these circumstances, this supports the diagnosis of nonorganic failure-to-thrive.

Treatment:
Treatment may include:Treating a Medical Condition

Treating the underlying medical condition may correct failure-to-thrive.

Providing Extra Calories

Children who are malnourished may need liquid supplements to help boost their weight and nutrition.

Parent Training
When a child is hospitalized for diagnosis, the hospital staff can also provide treatment. Nurses can teach parents appropriate feeding techniques and how to best interact with their child. If the child isn't hospitalized, parents can still have training sessions with a nutritionist or a nurse.

Counseling
Parents and children who are having difficulty with their relationship may benefit from counseling.

Prevention:
To help prevent failure to thrive:
  • Take children to the doctor regularly to have their growth checked. This helps detect and treat failure-to-thrive before it becomes severe.
  • Develop a good relationship with your child's doctor.
  • Ask the doctor about proper parenting and nutrition for early in a baby's life.
  • Encourage at-risk parents to attend parent-training sessions. At-risk includes:
    • Known depression in the parent
    • Lack of understanding about basic childcare issues
    • Poverty
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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