Failure to Thrive

The diagnosis of failure to thrive (FTT) is made when weight is less than the 3rd and 5th percentile or there has been significant deceleration in the rate of growth and crossing of 2 major percentiles on the growth curve.Causes are nonorganic, which includes calorie deprivation that is often associated with neglect, and organic.Nonorganic FTT may be from financial constraints,lack of understanding of child feeding needs, poor feeding habits, or a combination of factors.Care of infants and children should include measures of growth at each clinical encounter.

                Growth is rapid during the first year of life and failure to gain weight requires early identification.Type I growth deficiency is associated with normal head growth and greater depression of weight than height.It usually results from an inadequate calorie intake but may also result from excessive loss or utilization of calories.Type II growth deficiency is accompanied by proportional reduction in heigth and weight with preservation of head growth.Causes incluce genetic disorders, endocrine disorders, as well as constitutional growth delay.Type III growth deficiency results in depression of height, weight, and head circumference.It is associated with central nervous system abnormanilities, chromosomal defect, and insults that occur during fetal life or the perinatal period.

                In most cases, the history and physical examination suggest the diagnosis.It is usual to avoid a costly work-up and a complete blood count, urinalysis, and electrolytes will serve as a good screen.If there is potential for physical abuse, a chest X-ray may be indicated.The principal causes of organic FTT include chronic renal disease, congenital heart disease, and thyroid disease.

                The best way to differentiate nonorganic FTT is to provide an appripiate environment and allow the child to feed a decent calorie intake.In all but the most severe cases, there will be weight gain.If the child returns to the same environment, close follow-up is indicated because relapse is likely.A multidisclipinary approach is beneficial in the management of FTT.