Failure To Gain Weight Failure To Thrive

Overview, Causes, & Risk Factors

Failure to thrive, also known as FTT, occurs when an infant ortoddler fails to gain weight and grow in a healthy manner. In some cases,the child may even lose weight.

What is going on in the body?

Usually discovered in infants and in children younger than2 years, failure to thrive describes a child’s lack of steady growth. It mayrefer to body weight and also to inadequate growth in height and headcircumference.

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. Acaregiver may not feed the child enough formula, or the home life may beone of abuse and neglect.
  • Most infants between 6 months and 1 year of age stopgrowing as rapidly as they did during the first few months of life. They will continueto eat well yet show no decrease in activity or development. Caregiversshould not mistake this healthy slowdown in growth for FTT.

    What are the causes and risks of the condition?

    The causes of FTT vary and are not always obvious. Certaindiseases or physical conditions can cause inadequate weight gain such as:

  • congenital heart disease
  • frequent infections
  • bowel or intestinal disorders, such as Hirschsprung disease
  • diabetes
  • liver disease
  • kidney disorder
  • cleft lip or cleft palate
  • A child may not be adequately fed if there is a bonding orbehavioral problem between the parent and child. Some infants may havedifficulty expressing hunger, a poor appetite, or intolerance for some foods.This makes feeding them harder, especially for a new parent.

    Symptoms & Signs

    What are the signs and symptoms of the condition?

    An infant with FTT does not gain weight at a rate consideredhealthy. If FTT is severe and prolonged, it can result in:

  • signs of malnutrition or inadequate food intake or absorption of food
  • delays in learning ability and psychosocial development
  • emotional and behavioral problems
  • Diagnosis & Tests

    How is the condition diagnosed?

    When diagnosing a failure to gain adequate weight, the healthcareprovider will take a thorough medical history and perform a physicalexamination. The provider will seek information about:

  • the pregnancy and newborn period
  • feeding patterns and development
  • the amount of calories being fed
  • the ability of the child to absorb calories being fed
  • the home environment
  • the complete blood count,also called a CBC
  • kidney function teststaken with a check of the urine
  • If a doctor does not have a diagnosis after the history,physical, and laboratory evaluation, he or she may order further studies. A feedingevaluation, usually done by an occupational therapist, can rule out thepresence of a subtle feeding disorder. A psychological and social serviceevaluation of the family may also be in order.

    Prevention & Expectations

    What can be done to prevent the condition?

    For some parents, a child’s failure to gain weight at a steady rate isobvious. Other parents may not recognize the signs and symptoms as easily.That’s why it’s important for an infant to be seen by a healthcare providerevery few months during the first year. The provider will chart the progress of growth.It would be helpful for parents or caregivers to be educated on infant care.Offering support systems to caregivers may also help prevent non-organiccauses of failure to thrive.

    What are the long-term effects of the condition?

    Rarely, the infant may die of malnutrition. In severe cases,children may show signs of:

  • diminished growth
  • delayed language development
  • low reading skills
  • social immaturity
  • frequent behavioral difficulties
  • What are the risks to others?

    FTT poses no direct risk to others. If the cause of FTT is aphysical condition, the child may require extra medical care, which canbe a burden on family members. If the cause is environmental, the caregiversmay need guidance.

    Treatment & Monitoring

    What are the treatments for the condition?

    If the underlying cause is organic, treatment for that disorderoften brings about healthy growth. To determine if the FTT cause is organic,the infant may be hospitalized and fed under controlled conditions. Insome cases of FTT, feedings may be given through a stomach tubethat is passed through the nose into the stomach. In extreme cases,a gastrostomy feeding tube is placed through the abdominal wall into thestomach.

    If the infant thrives and gains weight, the cause may not beorganic. The hospital setting also allows professionals to observe how theparent 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.

    What are the side effects of the treatments?

    If surgery is needed to place a gastrostomy tube throughthe abdominal wall into the stomach, possible side effects includeallergic reaction to the medicationsused during surgery or infection at the site of surgery.

    What happens after treatment for the condition?

    The outcome depends on the underlying cause of the FTT.Infants with specific physical disorders may need lifelong treatment forthe underlying disorder. Counseling and support may also prove usefulfor infants who fail to thrive because of feeding disorders or parental neglect.

    How is the condition monitored?

    The child’s healthcare provider should provide ongoingfollow up not only of the physical growth, but of the child’s cognitiveand psychosocial development to assure continued progress andprovide further intervention where needed. Any new or worsening symptomsshould be reported to the healthcare provider.

    Article type: xmedgeneral