Treatment of failure to thrive depends upon the age of the child, the associated symptoms and the underlying reason for the poor growth. The overall goal of treatment is to provide adequate calories and any other support necessary to promote the growth of your child.
- Failure to Thrive: A Practical Guide. - PubMed - NCBI.
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In the event of your child having organic failure to thrive, additional therapy may be needed to treate the underlying medical condition. For example, intestinal disorders may cause poor absorption malabsorption of the diet and lead to failure to thrive. In this instance, a special diet may be necessary. Failure to thrive may also develop in twins or triplets, simply because multiple births are more difficult to care for and more demanding to feed. A baby born prematurely is more likely to have failure to thrive because many of the body functions necessary for the proper ingestion and digestion of the diet are immature at birth.
Lung problems or heart disease, especially in very young infants, can make feedings more difficult and lead to poor calorie intake and failure to thrive. Conditions We Treat Failure to Thrive. Failure to Thrive Failure to thrive is a term that is traditionally used for children who have failed to develop and grow normally. What is Failure to Thrive? What Causes Failure to Thrive? Reasons to hospitalize a child for further evaluation include failure of outpatient management, suspicion of abuse or neglect, or severe psychosocial impairment of the caregiver.
A multidisciplinary approach to treatment, including home nursing visits and nutritional counseling, has been shown to improve weight gain, parent-child relationships, and cognitive development. The long-term effects of failure to thrive on cognitive development and future academic performance are unclear.
Failure to thrive FTT is a term used to describe inadequate growth or the inability to maintain growth, usually in early childhood. It is a sign of undernutrition, and because many biologic, psychosocial, and environmental processes can lead to undernutrition, FTT should never be a diagnosis unto itself. A careful history and physical examination can identify most causes of FTT, thereby avoiding protracted or costly evaluations. A combination of anthropometric criteria, rather than one criterion, should be used to more accurately identify children at risk of FTT.
An accurate, detailed account of a child's eating habits, caloric intake, and parent-child interactions should be obtained as a key step in determining the etiology of FTT. Routine laboratory testing identifies a cause of FTT in less than 1 percent of children and is not generally recommended. Hospitalization should be considered if a child is less than 70 percent of the predicted weight for length, a child fails to improve with outpatient management, suspicion of abuse or neglect exists, signs of traumatic injury are present, or severe impairment of the caregiver is evident.
Age-appropriate nutritional counseling should be provided to parents of children with FTT to help ensure catch-up growth. Multidisciplinary interventions, including home nursing visits, should be considered to improve weight gain, parent-child relationships, and cognitive development of children with FTT. For information about the SORT evidence rating system, go to https: Table 1 lists commonly used anthropometric criteria for diagnosing FTT. Criteria should be met on multiple occasions.
Failure to Thrive: An Update - - American Family Physician
Information from references 4 and 5. In , the World Health Organization released updated growth charts that incorporate data from six countries and set breastfeeding as the biologic norm. These charts are available at http: In comparison, the Centers for Disease Control and Prevention charts include formula-fed infants and reflect norms for heavier children http: Therefore, the growth of healthy breastfed infants may appear to falter on the Centers for Disease Control and Prevention charts after two months of age. There is no consensus on which specific anthropometric criteria should be used to define FTT.
In one study, 27 percent of infants met at least one definition for FTT during the first year of life. Newer growth indices from the World Health Organization use weight velocities http: Any weight change below the 5th percentile may indicate a child is at risk of FTT. Finally, some children who falter in growth parameters actually demonstrate a normal variant of growth, such as children of small parents who are growing to their full genetic potential, large-for-gestational-age infants who regress toward the mean, children with constitutional delay in growth, or premature infants whose growth parameters are normal when corrected for gestational age.
The prevalence of FTT depends mainly on the definition being used and the demographics of the population being studied, with higher rates occurring in economically disadvantaged rural and urban areas. In the United States, FTT is seen in 5 to 10 percent of children in primary care settings and in 3 to 5 percent of children in hospital settings. Traditionally, the causes of FTT were subdivided into organic medical and nonorganic social or environmental. There is increasing recognition that in many children the cause is multifactorial and includes biologic, psychosocial, and environmental contributors.
A practical way to categorize FTT is according to calories, including inadequate caloric intake, inadequate caloric absorption, or excessive caloric expenditure. Table 2 provides a differential diagnosis of FTT based on age using this categorization. Items are listed in approximate order of most to least common. Information from references 20 through Inadequate caloric intake is the most common etiology seen in primary care settings. In infants younger than eight weeks, problems with feeding e.
Family factors can contribute to inadequate caloric intake at any age.
Failure to Thrive
These include mental health disorders, inadequate nutritional knowledge, and financial difficulties. Poverty is the greatest single risk factor for FTT in developed and developing countries. Importantly, child neglect or abuse must be considered, because children with FTT are four times more likely to be abused than children without FTT.
Inadequate caloric absorption includes disorders causing frequent emesis e. Excessive caloric expenditure usually occurs in the setting of a chronic condition, such as congenital heart disease, chronic pulmonary disease, or hyperthyroidism. In these instances, FTT often develops during the first eight weeks of life. Alternatively, obtaining the weight of an undressed breastfed infant on a high-quality infant scale before and after feeding may provide insight as to the volume of milk the infant is consuming.
For formula-fed infants, caregivers should demonstrate their mixing technique during observation of a feeding. Observing a toddler's eating habits can be helpful in evaluating for picky eating or food refusal. Asking older children and adolescents, together with their parents, to maintain a food journal for three days can give the physician a way to measure caloric intake.
Physicians should also inquire about eating habits inside and outside of the home e. Taking a psychosocial history is essential for detecting maternal or patient depression, or identifying concerns about the caregiver's intellectual abilities or social circumstances. In children without obvious organic symptoms elicited on history, 92 percent were ultimately diagnosed with a behavioral cause of FTT.
The first consideration in examining a child with presumed FTT is ensuring accurate measurements. Height or length , weight, and head circumference should be measured correctly and plotted on an appropriate growth chart over time. The child should be undressed for a thorough examination. Although most children with FTT will have a normal examination, physicians should be alert for signs of physical abuse or neglect, such as recurrent, unexplained, or pathognomonic injuries.
Cardiac findings suggesting congenital heart disease or heart failure e. Information from references 20 , 23 , 25 , 26 , and Figure 1 outlines the testing that may be indicated to confirm certain diagnostic considerations. Information from references 20 , 23 , and In rare cases, hospitalization for observed feeding and further investigation may be helpful. If a diagnosis of FTT is made and no medical conditions are suggested on examination, appropriate guidance for catch-up growth should be made. Age-appropriate nutritional counseling should be provided to parents.
Toddlers should avoid excessive juice or milk consumption because this can interfere with proper nutrition. Nutritional supplements may be given until catch-up growth is achieved. Does the child appear sick, scrawny, irritable or lethargic? Evidence of loss of muscle bulk and subcutaneous fat stores; especially upper arm, buttocks and thighs.
Conduct a thorough examination with particular attention to potential underlying diagnoses. Look for signs of child abuse and neglect. For an otherwise healthy and normally developing child with no suggestive features on history or examination, no investigations are necessary at first.
If a particular diagnosis is suggested by the history or examination, investigate according to the features you have elicited. Simple first line investigations for a child where there is significant concern but no specific pointers to a medical cause:. Although the use of a growth chart is the most accurate indication of overall growth the use of average weekly weight gain for children who are followed up at frequent intervals may be required.
The table below is a guide to the expected average weight gain per week it is not the minimally acceptable weight gain. The Royal Children's Hospital Melbourne.
This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network.