Failure to thrive

Causes and Risks:
Failure to thrive in infants and children is usually noticed by failure to gain height and weight. In teenagers, short stature and lack of sexual development is present. There is a wide variation in normal growth and development , and in general, the rate of change may be a better indicator of a problem than the actual measurements.
An important factor is determining whether the failure to thrive results from problems intrinsic to the patient or from problems within the environment. Problems intrinsic to the patient are usually medical problems. Problems within the environment are usually psychosocial.
There are multiple causes of failure to thrive that will disturb the body's metabolism enough to result in delayed growth . Chromosome abnormalities such as Down syndrome and Turner's syndrome will delay growth. Defects in major organ systems also can delay growth. Abnormalities of the endocrine system such as thyroid hormone deficiency, growth hormone deficiency , or other hormone deficiencies can cause delayed growth or sexual development. Damage to the brain or central nervous system may cause feeding difficulties in an infant that result in delayed growth. Abnormalities in the cardiac and respiratory systems can result in disturbed mechanisms to deliver oxygen and nutrients to the body. Children with anemia or other blood disorders may have growth delay. Abnormalities in the gastrointestinal system may result in malabsorption or absence of digestive enzymes resulting in inadequate nutrition. Some diseases that can lead to this failure include cerebral palsy , chronic gastroenteritis , and gastroesophageal reflux (usually temporary).

Psychological and social causes may include emotional deprivation as a result of parental withdrawal, rejection, or hostility. Economic factors can affect nutrition, living conditions, and parental attitudes. Environmental factors may include exposure to infections, parasites, or toxins . Sometimes the cause is undetermined.

Risk factors for failure to thrive are related to the causes and may include underlying undiagnosed diseases, poverty, negative emotional environments, and crowded or unsanitary living conditions.

Prevention:

The best means of prevention is by early detection at routine well baby examinations and periodic follow-up with school-age and adolescent children.

Symptoms:
  • height, weight and head circumference in an infant or young child do not progress normally according to standard growth charts
  • physical skills such as rolling over, sitting, standing, and walking are slow to develop
  • mental and social skills are delayed
  • development of secondary sexual characteristics are delayed in adolescents



Signs and Tests:

A physical examination is done, including height, weight, and body proportions. A detailed history is taken, including prenatal, birth, neonatal, psychosocial and family information. A Denver Developmental Screening Test reveals delayed development.

The following laboratory tests may be performed:



Treatment:

The treatment depends on the cause of delayed growth and development. Delayed growth due to nutritional factors can be resolved by a well-balanced diet and education of the parents. If psychosocial factors are involved, treatment should include improving the family dynamics and living conditions. Parental attitudes and behavior may contribute to a child's problems and need to be examined.

Prognosis:

If the period of failure to thrive has been short, and the cause is determined and can be corrected, normal growth and development will resume. If failure to thrive is prolonged, the effects may be long lasting, and normal growth and development may not be achieved.

Complications:

Permanent mental, emotional or physical delay(s) can occur.

Call Your Healthcare Provider:

Call for an appointment with your health care provider if your child does not seem to be developing normally.