Failure to Thrive

Alternative Names: Growth failure; FTT (Faltering Growth)

Definition:
Failure to thrive is a description applied to babies or children whose current weight or rate of weight gain is significantly below that of others of similar age and sex.

….…….CLICK & SEE

From the moment they’re born, a baby’s weight and height are closely monitored. Health visitors provide health record booklets that include growth charts to help with this…..CLICK & SEE

In general, failure-to-thrive means that a child:
Is at or below the 3rd to 5th percentile for height and weight, or
Has failed to grow as expected, as shown by dropping two growth percentiles (For example, the child goes from the 75th percentile to below the 25th percentile.)

Failure to thrive may be caused by a variety of factors. Some children who fit this category appear lethargic, pale and miserable, while others seem fairly well.

Causes, incidence, and risk factors:
In the Deloped countries where chronic disease in childhood isn’t common, failure to thrive in infants may be a result of poor feeding techniques.

In older children, unhappy home circumstances and emotional problems are often to blame.

Infants or children that fail to thrive seem to be dramatically smaller or shorter than other children the same age. Teenagers may have short stature or appear to lack the usual changes that occur at puberty. However, there is a wide variation in normal growth and development.

In general, the rate of change in weight and height may be more important than the actual measurements.

It is important to determine whether failure to thrive results from medical problems or factors in the environment, such as abuse or neglect.

There are multiple medical causes of failure to thrive. These include:

*Chromosome abnormalities such as Down syndrome and Turner syndrome

*Defects in major organ systems

*Problems with the endocrine system, such as thyroid hormone deficiency, growth hormone deficiency, or other hormone deficiencies

*Damage to the brain or central nervous system, which may cause feeding difficulties in an infant

*Heart or lung problems, which can affect how oxygen and nutrients move through the body

*Anemia or other blood disorders

*Gastrointestinal problems that result in malabsorption or a lack of digestive enzymes

*Long-term gastroenteritis and gastroesophageal reflux (usually temporary)
Cerebral palsy

*Long-term (chronic) infections

*Metabolic disorders

*Complications of pregnancy and low birth weight

Other factors that may lead to failure to thrive:

*Emotional deprivation as a result of parental withdrawal, rejection, or hostility

*Economic problems that affect nutrition, living conditions, and parental attitudes

*Exposure to infections, parasites, or toxins

*Poor eating habits, such as eating in front of the television and not having formal meal times

Some Other Causes:

*Problems with milk feeds
Breastmilk is the best choice for newborns and babies should thrive on it. But some new mothers and their babies struggle to latch on and get a good technique going. Health visitors can offer advice on this and appropriate formula feeds, if necessary.

If you’re formula feeding but your baby isn’t growing as they should, check you’re following the manufacturer’s instructions for making up the feed exactly (not too dilute) and that your baby is able to get the milk as fast as they need to (check the teat size).

*Dietary problems
Children may be unable to absorb food into their bodies because of problems with their gut, such as parasitic infections, malabsorption, liver disease or milk sensitivity (usually temporary).

 

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Coeliac disease, which causes diarrhoea with foul-smelling faeces and anaemia, is another explanation for failure to thrive. It’s caused by a reaction to gluten, a protein found in wheat and similar proteins in other grains.

*Genetic causes
There are many different inherited conditions that can mean a child fails to thrive, such as chromosomal problems.

The most common of all genetic factors isn’t an illness but simply the fact that the parents are also small, so it’s normal for that family. This is sometimes known as constitutional short stature and, of course, no treatment is needed.

What’s important is that the child is growing at a steady rate, following a line on the growth charts parallel to the average child, even if continually smaller than average.

*Problems in the womb
Some children born with a low weight as a result of some factor during pregnancy will continue to have problems catching up. This is more likely if the growth retardation happened early in the pregnancy.

If the mother has high blood pressure, smokes, drinks alcohol or takes certain medications it can affect her baby’s growth in the womb. Maternal infections, such as rubella and toxoplasmosis, can also result in low birth weight.

*Chronic or repeated illness
Any illness in a child temporarily slows growth. While many catch up, repeated illness, even coughs and colds, can affect growth in the long term.

Serious illness is more likely to affect growth, from chronic infections such as TB to major heart abnormalities, deficiencies of hormones such as thyroid or growth hormone, lung diseases such as cystic fibrosis, and kidney disease.

*Psychological problems
Sometimes there’s no apparent physical explanation for why a child is failing to thrive until home circumstances are carefully probed.

Social deprivation, especially if a child’s emotional needs are being neglected, can lead to growth problems even in the first few months of life.

Many times the cause cannot be determined.

Symptoms:-
Infants or children who fail to thrive have a height, weight, and head circumference that do not match standard growth charts. The person’s weight falls lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve.

The following are delayed or slow to develop:

*Physical skills such as rolling over, sitting, standing and walking

*Mental and social skills

*Secondary sexual characteristics (delayed in adolescents)

Signs and tests:-
The doctor will perform a physical exam and check the child’s height, weight, and body shape. A detailed history is taken, including prenatal, birth, neonatal, psychosocial, and family information.

A Denver Developmental Screening Test reveals delayed development. A growth chart outlining all types of growth since birth is created.

The following laboratory tests may be done:

*Complete blood count (CBC)

*Electrolyte balance

*Hemoglobin electrophoresis to determine the presence of conditions such as sickle cell disease

*Hormone studies, including thyroid function tests

*X-rays to determine bone age

*Urinalysis

Treatment:
The treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional factors can be resolved by educating the parents to provide a well-balanced diet.

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. In many cases, a child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral, and psychosocial treatment plan.

Do not give your child dietary supplements like Boost or Ensure without consulting your physician first.

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 delays can occur.

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.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/babies2.shtml
http://healthtools.aarp.org/adamcontent/failure-to-thrive/2
http://www.wrongdiagnosis.com/c/camfak_syndrome/book-diseases-4a.htm

http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=11872

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