Failure to thrive, abbreviated as FTT, occurs when an infant or toddler fails to gain weight and grow in a healthy manner. In some cases, the child may even lose weight.
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. This occurs when FTT has a physical cause, such as a gastrointestinal or neurological disease.Non-organic. This means 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.
Most infants between 6 months and 1 year of age stop growing as rapidly as they did during the first few months of life. They will continue to eat well yet show no decrease in activity or development. Caregivers should not mistake this healthy slowdown in growth for FTT. Graphing the child's length (height) and weight on a standard growth chart can help make the distinction.
An infant with FTT does not gain weight at a rate considered healthy. If FTT is severe and prolonged, it can result in: signs of malnutrition or inadequate food intake or absorption of fooddelays in learning ability and psychosocial developmentemotional and behavioral problems
The causes of FTT vary and are not always obvious. Certain diseases or physical conditions can cause inadequate weight gain such as: congenital heart diseasefrequent infectionsbowel or intestinal disorders, such as Hirschsprung diseasediabetes (rare under 2 years ofage)liver diseasekidney disorder (such as urinary tract infection)cleft lip or cleft palate
A child may not be adequately fed if there is a bonding or behavioral 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 harder, especially for a new parent.
For some parents, a child's failure to gain weight at a steady rate is obvious. Other parents may not recognize the signs and symptoms as easily. Therefore, it is important for an infant to be seen by a healthcare professional every few months during the first year. The provider will chart the progress of growth and also educate the parents or caregivers about infant care. Offering support systems to caregivers may also help prevent non-organic causes of failure to thrive.
When diagnosing a failure to gain adequate weight, the healthcare professional will take a thorough medical history and perform a physical examination. The healthcare professional will seek information about: the pregnancy and newborn periodfeeding patterns and developmentthe amount of calories being fedthe ability of the child to absorb calories being fedthe home environmentthe complete blood count, also called a CBCkidney function tests taken with a check of the urine
If a healthcare professional does not have a diagnosis after the history, physical, and laboratory evaluation, he or she may order further studies. A feeding evaluation, usually done by an occupational therapist, can rule out the presence of a subtle feeding disorder. A psychological and social service evaluation of the family may also be in order.
Rarely, the infant may die of malnutrition. In severe cases, children may show signs of: diminished growthdelayed language developmentlow reading skillssocial immaturityfrequent behavioral difficulties
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.
If the underlying cause is organic, treatment for that disorder often brings about healthy growth. To determine if the FTT cause is organic, the infant may be hospitalized 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. 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 professionals to observe how the parent interacts with the child. If the cause is thought to be environmental, a social service evaluation may also be done to offer support to the caregivers.
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.
The outcome depends on the underlying cause of the FTT. Infants with specific physical disorders may need lifelong treatment for the underlying disorder. Counseling and support may also prove useful for infants who fail to thrive because of feeding disorders or parental neglect.
The child's healthcare professional 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. Any new or worsening symptoms should be reported to the healthcare professional.
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