A description applied to children whose current weight or rate of weight gain is significantly below other children of similar age and sex.

Alternative Names

Growth failure; FTT

Causes, incidence, and risk factors

Failure to thrive in infants and children is usually noticed when they seem to be dramatically smaller or shorter than other children the same age. Teenagers, for example, may have short stature or appear to lack the usual changes that occur at puberty. However, there is a wide variation in normal growth and development . In general, the rate of change in weight and height may be a better indicator of a problem than the actual measurements. It is important to determine whether the failure to thrive results from medical problems with the child or from psychosocial factors in the environment, such as abuse or neglect. There are multiple medical causes of failure to thrive that will disturb the body's metabolism enough to result in delayed growth . These include:

Chromosome

abnormalities such as

Down syndrome and Turner's syndrome

Defects in major organ systems

Abnormalities of the

endocrine system, such as thyroid hormone deficiency, growth hormone deficiency or other hormone deficiencies

Damage to the brain or

central nervous system , which may cause feeding difficulties in an infant that result in delayed growth

Abnormalities in the cardiac and

respiratory systems, which can disrupt deliverly of oxygen and nutrients to the body

Anemia

or other blood disorders

Abnormalities in the gastrointestinal system, which may result in

malabsorption or absence of digestive enzymes, thus resulting in inadequate nutrition

Some diseases, such as

cerebral palsy , chronic gastroenteritis , and gastroesophageal reflux (usually temporary) Psychological and social causes may include emotional deprivation as a result of parental withdrawal, rejection or hostility. Economic factors can affect nutrition, living conditions, and parental attitudes. Environmental factors may also include exposure to infections, parasites, or toxins . Sometimes the cause is simply poor eating habits, such as eating in front of the television and not having formal meal times. Many times the cause of the failure to thrive is undetermined. Risk factors for failure to thrive are related to the causes and may include underlying undiagnosed diseases, poverty, negative emotional environments and crowded or unsanitary living conditions.

Signs and tests

A physical examination is done, including height, weight, and body proportions. A detailed history is taken, including prenatal, birth, neonatal, psychosocial and family information. A Denver Developmental Screening Test reveals delayed development. A growth chart including all growth parameters and trends since birth is plotted. The following laboratory tests may be performed:

CBC

(complete blood count) to detect

anemia

electrolytes (basic chemistries)

urinalysis

thyroid function tests

other hormone studies

hemoglobin electrophoresis to determine the presence of conditions such as sickle cell disease

X-rays to determine bone age

Treatment

The treatment depends on the cause of delayed growth and development. Delayed growth due to nutritional factors can be resolved by a well-balanced diet and education of the parents. If psychosocial factors are involved, treatment should include improving the family dynamics and living conditions. Parental attitudes and behavior may contribute to a child's problems and need to be examined. In many cases, a child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral, and psychosocial treatment plan. Do not give your child dietary supplements like Boost or Ensure without consulting your physician first.

Expectations (prognosis)

If the period of failure to thrive has been short, and the cause is determined and can be corrected, normal growth and development will resume. If failure to thrive is prolonged, the effects may be long lasting, and normal growth and development may not be achieved.

Complications

Permanent mental, emotional or physical delay(s) can occur.

Calling your health care provider

Call for an appointment with your health care provider if your child does not seem to be developing normally.

Prevention

The best means of prevention is by early detection at routine well baby examinations and periodic follow-up with school-age and adolescent children.