Failure to Thrive: Causes, Symptoms and Treatment
Failure to thrive describes inadequate physical growth and insufficient weight gain in infants and young children. It can have organic or non-organic causes and requires early medical evaluation.
Things worth knowing about "Failure to Thrive"
Failure to thrive describes inadequate physical growth and insufficient weight gain in infants and young children. It can have organic or non-organic causes and requires early medical evaluation.
What is Failure to Thrive?
Failure to thrive (FTT) is a term used to describe inadequate physical growth in infants, toddlers, or older children who do not gain weight appropriately or who fall behind age-appropriate developmental norms. The diagnosis is typically based on standardised growth charts, where a child's weight consistently falls below the 3rd percentile or shows a significant downward crossing of two or more major percentile lines.
Failure to thrive is not a disease in itself, but rather a clinical sign that may point to a variety of underlying causes. It most commonly occurs during the first year of life but can affect older children as well.
Causes
The causes of failure to thrive are traditionally divided into two main categories:
Organic Causes
- Gastrointestinal disorders: e.g., coeliac disease, Crohn's disease, gastro-oesophageal reflux, cow's milk protein allergy
- Congenital heart defects: increased energy demands due to heart failure
- Chronic lung disease: e.g., cystic fibrosis
- Kidney disorders: renal tubular acidosis, chronic kidney insufficiency
- Metabolic disorders: inborn errors of metabolism, hypothyroidism
- Infectious diseases: chronic infections such as HIV or tuberculosis
- Neurological conditions: swallowing and feeding difficulties associated with neurological disorders
Non-Organic Causes
- Insufficient caloric intake: inadequate breastfeeding, incorrect formula preparation, dietary errors
- Psychosocial factors: neglect, poverty, parental mental health issues, disrupted parent-child bonding
- Feeding disorders: sensory processing difficulties, food refusal
Symptoms
In addition to the primary sign of inadequate weight gain, the following symptoms may be observed:
- Slowed linear growth and reduced head circumference gain
- Developmental delays (motor, language, and cognitive)
- Nutritional deficiencies and signs of malnutrition (pale skin, hair loss, fatigue)
- Increased susceptibility to infections
- Irritability, apathy, or withdrawal behaviour
- Reduced activity and lack of energy
Diagnosis
Failure to thrive is typically diagnosed by a paediatrician during routine well-child visits. Key diagnostic steps include:
- Anthropometric measurements: weight, height, and head circumference compared to age-appropriate growth charts
- Comprehensive history: dietary history, family history, psychosocial background
- Physical examination: assessment for signs of underlying organic disease
- Laboratory tests: full blood count, inflammatory markers, thyroid function, kidney and liver values, electrolytes, ferritin, and vitamin levels
- Further investigations: depending on clinical suspicion -- ultrasound, stool analysis, echocardiography, or genetic testing
Treatment
Treatment depends on the underlying cause and typically requires a multidisciplinary approach:
Nutritional Therapy
In most cases, optimising caloric intake is the primary focus. This may include a high-calorie diet, specialised infant formula, dietary counselling for parents, or in severe cases, enteral tube feeding (nasogastric tube or PEG tube).
Treatment of Underlying Organic Conditions
If an organic cause is identified, targeted treatment is essential -- for example, a gluten-free diet for coeliac disease, enzyme replacement therapy for cystic fibrosis, or surgical correction for congenital heart defects.
Psychosocial Support
When non-organic causes are involved, social support, parent training, counselling services, and in some cases psychotherapy are key components of treatment. Close collaboration between paediatricians, social workers, psychologists, and dietitians is strongly recommended.
Regular Follow-Up
Frequent weight checks and developmental assessments are essential to monitor treatment progress and make adjustments as needed.
References
- Olsen E. M. et al. - Failure to Thrive: The Case for Environmental Etiology. In: Pediatrics, 2007.
- Shields B. et al. - Failure to Thrive: A Systematic Review. In: Archives of Disease in Childhood, 2012.
- World Health Organization (WHO) - Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children, 2009.
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