Understanding Failure to Thrive in Children

The first few years of a child's life are critical for physical and mental development. During these initial years, a child is rapidly growing and developing. Sometimes though, the child does not grow and develop at a normal pace. While many children deviate a little bit from the "normal" pace of growth, children who develop and grow at a significantly slower pace for an extended period of time may have a failure to thrive.

Failure to Thrive

Failure to thrive (FTT) isn't a specific disease. In fact, FTT isn't a disease at all, but a condition that describes a child's slow growth and development. The Merck Manual of Diagnosis and Therapy defines failure to thrive as:

"Weight consistently below the 3rd percentile for age; progressive decrease in weight to below the 3rd percentile; weight <80% of ideal weight for height-age; or a decrease in expected rate of growth based on the child's previously defined growth curve, irrespective of whether below the 3rd percentile."

Causes and Classification of FTT

The primary reason that children fail to thrive is inadequate nutrition. Depending on its causes, cases of failure to thrive are classified into one of three categories:

• Mixed Failure to Thrive: Mixed FTT describes infants and children who aren't growing at a normal pace due to a combination of organic and non-organic causes. Most children and infants with FTT fall into this category, as the organic and non-organic causes tend to overlap.An example of a mixed FTT case is a premature baby reluctant to feed who causes stress in worried parents who, in effect, transfer that stress to the baby, who is then even more reluctant to feed.
• Non-Organic Failure to Thrive: Non-organic FTT is the slow growth and development of the child as a result of social, psychological and economic reasons. Basically, children who aren't growing at a normal pace but have no underlying medical cause are suffering from non-organic FTT.Examples of non-organic FTT include infants in families too impoverished to feed the baby, depressed infants who refuse to eat or infants who are born to mothers who are unable to supply an adequate supply of breast milk. These aren't the only examples of non-organic FTT though, as a wide variety of causes may result in non-organic FTT.
• Organic Failure to Thrive: Organic FTT is the slow growth and development of the child due to an underlying disorder or medical complication. Conditions such as a premature birth or a swallowing disorder may interfere with the child's ability to get the necessary nutrients for proper growth, causing failure to thrive.

Symptoms of FTT

The primary symptom of failure to thrive is the lower-than-normal weight or lack of weight gain. Other symptoms of FTT include:

• abnormal fatigue
• avoiding eye contact
• delayed social and mental development
• excessive sleepiness
• irritability
• missing age-appropriate social responses (i.e., smiling, laughing).

Individual children have different symptoms for failure to thrive. If you suspect that your child has FTT, see the child's doctor for a thorough examination.

Diagnosing Failure to Thrive

If a baby does not gain weight for three consecutive months in the first year of life, the doctor will become concerned. Failure to thrive is normally diagnosed after a period of observation. The doctor analyzes the infant's growth charts, which record a child's weight, height and head circumference, during each well-baby check-up.

If failure to thrive is suspected, the doctor may look closely at the infant's medical and feeding history. Then he will perform a physical exam in which he may request that blood and urine tests be performed.

Treating Failure to Thrive

FTT treatment depends on the underlying cause of the particular case. If the cause is a medical/physical condition, the doctor will work towards treating the condition, which typically also treats the FTT. The doctor may also increase the infant's daily caloric intake so that the child has adequate amounts of nutrients for growth and development.

If the underlying cause of FTT is non-organic or mixed (involving social and/or mental problems), the doctor may refer the parents of the child to other individuals or institutions that can provide social and psychological support. Psychiatrists, social workers, nutritionists, parenting counselors and a variety of other specialists may be involved in the treatment process.

Most treatments can be carried out at the home with frequent check-ups. Hospitalization is rarely required, only occurring in the most extreme cases of FTT, when constant monitoring is required.

Tips for Parents: How to Cope with FTT

Failure to thrive is a common concern for parents, especially for first-time parents with little parenting experience. Seeing your child's slow growth and development can be distressing. If you have concerns about your child's development, see your child's pediatrician.

As with any doctor's appointment, make sure that you are prepared with the adequate information so that your doctor can make the proper diagnosis. Before your appointment, take note of:

• what you're feeding your child
• how often you're feeding your child
• any strange behaviors your child may be displaying
• any medical conditions your child may have.

The more information you provide, the better your doctor can diagnose the problem. If your infant does have failure to thrive, follow all directions your doctor gives you, whether it's to alter your feeding technique or to increase the amount of calories during each feeding.

If the doctor suggests that you take parenting classes or see a counselor, don't be offended, especially if you're a first-time parent. Parenting is a very difficult task, and no one is naturally born with all the skills and knowledge necessary for proper parenting. Much is learned through classes and experience.

Resources

Bassali, R. W. (updated 2004). Failure to thrive.

Beers, M. H.