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failure to thrive

Alternative Names
FTT, failure to gain weight, poor weight gain

An infant or toddler who has failure to thrive (FTT) does not gain weight normally or may lose weight.

What is going on in the body?
Usually discovered in infants and in children younger than 2 years, failure to thrive describes a child's lack of steady growth. It may refer to body weight and also to inadequate growth in height and head circumference.

FTT is generally classified as:
  • organic when it has a physical cause, such as a gastrointestinal or neurological disease
  • non-organic when no physical cause can be found. In this case, FTT is assumed to be due to environmental conditions. A caregiver may not feed the child enough formula, or the home life may be one of abuse and neglect.
Infants between 6 months and 1 year of age normally tend to slow their rapid growth. They will continue to eat normally yet show no decrease in activity or development. Caregivers should not mistake this normal slowdown in growth for FTT.

What are the signs and symptoms of the condition?
An infant with FTT does not gain weight at a rate considered normal. If FTT is severe and prolonged, it can result in:
  • signs of malnutrition or inadequate food intake or absorption of food
  • delays in learning ability and psychosocial development
  • emotional and behavioural problems
What are the causes and risks of the condition?
The causes of FTT vary and are not always obvious. Certain diseases or physical conditions can cause inadequate weight gain such as: A child may not be adequately fed if there is a bonding or behavioural problem between the parent and child. Some infants may have difficulty expressing hunger, a poor appetite, or intolerance for some foods. This makes feeding them more difficult especially for a new parent.

What can be done to prevent the condition?
For some parents, a child's failure to gain weight normally is obvious. Other parents may not recognise the signs and symptoms easily. That's why it's important for an infant to be seen by a doctor every few months during the first year. The doctor will chart the progress. It would be helpful for parents or caregivers to be educated on infant care. Offering support systems to caregivers may also help prevent non-organic causes of failure to thrive.

How is the condition diagnosed?
When diagnosing a failure to gain adequate weight, the doctor will take a thorough medical history and perform a physical examination. The doctor will seek information about:
  • the pregnancy and newborn period
  • feeding patterns and development
  • the amount of kilojoules being fed
  • the ability of the child to absorb kilojoules being fed
  • the home environment
  • the full blood count, or FBC
  • urine test for blood, protein, glucose
If a doctor does not have a diagnosis after the history, physical, and laboratory evaluation, further studies may be needed.

What are the long-term effects of the condition?
Rarely, the infant may die of malnutrition. In severe cases, children may show signs of:
  • diminished growth
  • delayed language development
  • low reading skills
  • social immaturity
  • frequent behavioural difficulties
What are the risks to others?
FTT poses no direct risk to others. If the cause of FTT is a physical condition, the child may require extra medical care, which can be a burden on family members. If the cause is environmental, the caregivers may need guidance.

What are the treatments for the condition?
If the underlying cause is organic, treatment for that disorder often brings about normal growth. To determine if the FTT cause is organic, the infant may be hospitalised and fed under controlled conditions. In some cases of FTT, feedings may be given through a stomach tube that is passed through the nose into the stomach, or, in extreme cases, a gastrostomy feeding tube is placed through the abdominal wall into the stomach.

If the infant thrives and gains weight, the cause may not be organic. The hospital setting also allows for some observation of how the parent interacts with the child. If the cause is environmental, a social work evaluation may also be done to offer support to the caregivers.

What are the side effects of the treatments?
If surgery is needed to place a gastrostomy tube through the abdominal wall into the stomach, possible side effects include allergic reaction to the medications used during surgery or infection at the site of surgery.

What happens after treatment for the condition?
The outcome depends on the underlying cause of the FTT. Infants with specific physical disorders may need lifelong treatment for the underlying disorder. Counselling and support may also prove useful for infants who fail to thrive because of feeding disorders or parental neglect.

How is the condition monitored?
The child's doctor should provide ongoing follow up not only of the physical growth, but of the child's cognitive and psychosocial development to assure continued progress and provide further intervention where needed.

Author: John Wegmann, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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