What is failure to thrive?

Causes and Symptoms

Failure to thrive may be organic or inorganic; in many children, the etiology is
multifactorial. The onset of growth problems may be prenatal as a result of
maternal substance abuse, most notably alcohol use resulting in fetal alcohol
syndrome, or of maternal infection or undernutrition during
pregnancy. Chromosome problems, such as Down syndrome and Turner
syndrome, are also a medical cause of failure to thrive.
Other causes include gastrointestinal disease resulting in poor micronutrient
intake, endocrine disease, kidney disease, and heart and lung disease, all of
which may decrease a child's appetite and how they process food and thus impair
growth. Small size in infants secondary to prematurity resolves by two to three
years of age unless there are complications. Undernutrition during infancy or
childhood can also cause failure to thrive; undernutrition may result from
inadequate protein and energy intake due to food insecurity and poverty,
breastfeeding difficulties, or child neglect or
abuse.

Many children with failure to thrive are both stunted (height-affected) and wasted
(weight-affected). Assessing which of the two conditions predominates can be done
using the body
mass index (BMI), which is calculated by dividing weight in
kilograms by height in meters squared. A low BMI is a sign of malnutrition.
Children with environmental failure to thrive fall into this category.

A child who is small but has an appropriate BMI has short stature rather than failure to thrive. The two leading causes of short stature are familial short stature and constitutional delay.

Treatment and Therapy

The treatment for failure to thrive depends on the underlying disorder or cause.
The most common focus of the medical intervention with failure to thrive is to
ensure a nurturing environment and adequate nutrition.
Nutritional intervention can be achieved in many ways, such as by securing
adequate access to food for the family and offering concentrated formulas,
nutritional supplementation, and calorie-dense food, depending on the age of the
child. Developmental intervention should also be provided if delay is detected.
Likewise, family counseling, especially focusing on parenting skills, may be
indicated. Other treatment options include treating the underlying medical
condition that is contributing to failure to thrive, such as gastrointestinal
disease, kidney disease, or HIV and other infectious diseases.

Perspective and Prospects

The term “failure to thrive” originated in 1933; it replaced the term “cease to thrive,” which appeared in 1889. Initially, the condition was reported in institutionalized children, including those in orphanages. In the 1940s, however, it was recognized as a condition that could also affect children living at home with their biological or adoptive parents.

Although the list of conditions that can cause growth impairment in children is
quite extensive, a systematic approach using history and both physical and
psychosocial assessment will provide clues to the diagnosis. Intervention ensures
an adequate outcome, with improved prospects for physical growth and brain
development.

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