Ailmemts & Remedies Pediatric

Failure to Thrive

Alternative Names: Growth failure; FTT (Faltering Growth)

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).

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.

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


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.

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.

Permanent mental, emotional, or physical delays can occur.

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.


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Ailmemts & Remedies

Growth Disorders

Growth is one of the complex and amasing facts of life that most people take for granted, but it can be a cause for concern for parents who have a child who’s shorter than others of the same age and doesn’t appear to be growing any taller.

Children of the same age vary greatly in height due to factors such as diet, genetics, and ethnic background. In most cases, tall or short stature is not abnormal and is due to a family tendency to be taller or shorter than average or to reach final height later than usual. Tall or short stature is a cause for concern only if the child’s height is well outside the average range for his or her age. Abnormally short or tall stature may be caused by a number of disorders.

What are the types?
Normal growth depends on a nutritionally adequate diet and good general health and is controlled by specific hormones. disruption of any of these three important factors may lead to a growth disorder that results in a child having abnormally short or tall stature.
short stature:
A child may be shorter than normal if his or her diet is inadequate. a chronic illness, such as cystic fibrosis or severe asthma, may also result in poor growth. crohn’s disease, a type of inflammatory bowel disease, is another example of a chronic illness that may lead to short stature. babies who have intrauterine growth retardation may reach a shorter than average height i later life.

Sometimes, short stature is caused by insufficient production of the hormones that are necessary for normal growth. in some children, the pituitary gland does not produce enough growth hormone. insufficient production of thyroid hormones is another cause of poor growth.

short stature is also a characteristic feature of tuner syndrome, a genetic disorder that only affects girls. in addition, short stature may occur as a result of a skeletal abnormality such as achondroplasia, an inherited disorder in which the bones of the legs and arms are shorter than normal.

Tall stature:
children may be temporarily taller than others of the same age and sex if puberty occurs early. however, in such children, the final height is usually normal. in very rare cases, exaggerated growth caused by the overproduction of growth hormone results in excessive height known as gigantism. the overproduction may be due to pituitary gland tumor. boys with the chromosome disorder klinefelter syndrome may also grow taller than normal at puberty.

Causes of delayed growth:
There are a large number of medical, genetic and external factors that can delay or inhibit normal growth. These include conditions such as Growth Hormone Deficiency (GHD) in children, Turner’s syndrome, Down’s syndrome, achondroplasia (defective growth of cartilage cells in the bones of the limbs) and various malfunctions of the endocrine system.

Chronic diseases and illnesses can also have a detrimental effect on growth including Inflammatory Bowel Disease IBD, chronic renal insufficiency and heart disease, as too can factors such as malnutrition, drug and alcohol abuse, neglect, chronic stress and lack of exercise. However, in many cases the cause of delayed or restricted growth is not known.

Many children are smaller than average during childhood yet end up reaching a normal adult height. But for some, a more normal adult height will not be achieved without treatment with supplemental human growth hormone (hGH). These include children with GHD and Turner’s syndrome.
A more common growth disorder is growth hormone deficiency (GHD). This is the condition of having too little GH. There are several possible explanations for its occurrence:

You may click to see the pictures

A child can be born with GHD.
The condition also may arise because of damage to the hypothalamus or pituitary gland as a child or adult because of a tumor, an infection, or radiation to the brain — usually for the treatment of a tumor.
A deficiency in GH may also have an undefined cause. (In this case, it is said to be of idiopathic origin.)
Pituitary disorders, such as GH excess or GHD, are evaluated and treated by endocrinologists — medical specialists in hormone-related conditions. Because the diagnosis and treatment of such disorders require special expertise, primary care physicians who suspect patients have GH abnormalities should refer them to an endocrinologist.

One out of 2,500 to 5,000 children is born with a deficient growth hormone production resulting in impaired physical development, and another one in 2,000 to 2,500 girls are born with the genetic defect Turner’s syndrome. Both disorders may result in decreased final height, which may be improved by supplemental somatropin.

Growth Hormone Deficiency (GHD):-

In children
A child with an inadequate production of growth hormone (reduced or non-existent) may have a normal height and weight at birth, but the child’s physical development following birth is severely impaired.

The under-secretion of human growth hormone during childhood and puberty slows bone growth and teeth development, and also causes the growing plates of the long bones to close before normal height is reached. In addition, other organs of the body fail to grow and the body proportions remain childlike.

Without treatment the child with GHD risks the development of a range of complications, as well as having a short stature.

Turner’s syndrome
Turner’s syndrome is a common genetic defect that affects girls and women and occurs in about one out of every 2,000 to 2,500 female births.

In Turner’s syndrome all or part of one of the two X-chromosomes is missing, but the reason why this happens is not known. This defect can cause a number of physical and medical problems and in some cases creates educational and behavioural concerns.

Characteristics of Turner’s syndrome
As the extent of the defect to the chromosome varies, every case of Turner’s syndrome is individual and each affected girl may have only a few of the possible characteristics that can be associated with the syndrome.

Short stature is a common characteristic of Turner’s syndrome resulting in a decreased final adult height and is generally accompanied by a failure of the ovaries and infertility.

Growth failure in Turner’s syndrome
The reasons for the growth retardation in Turner’s syndrome are not entirely understood, but patients are generally not deficient in growth hormone. The pituitary gland produces adequate amounts but the long bones do not respond.

The growth plates appear to be resistant to the action of the body’s GH, yet the hormone functions normally in controlling metabolism and organ development. By treating with supplemental hGH the resistance can be overcome, creating growth in the long bones. Female hormones may need to be given as well.

Being a genetic problem the affected individual will be faced with the consequences of the syndrome all her life, but can expect to lead a healthy life with appropriate care and treatment.

Growth Hormone Excess:
Excess growth hormone (GH) in children (gigantism) is extremely rare, occurring in fewer than 100 children in the United States.

Excess GH in adults (acromegaly) most commonly occurs in middle-aged men and women. Approximately 60 out of every million Americans have acromegaly.

Very infrequently, GH excess may run in families, or be one manifestation of a number of rare syndromes.

Frequent Sign & Symptoms:

The signs and symptoms depends upon the type of growth disorder. A child with a growth problem needs to be evaluated by a health care provider to determine the underlying health issues involved.

How is it diagnosed?
Your child’s height will be measured during routine checkups. if his or her height is consistently either lower or higher than the normal range, he or she will need to be measured frequently. If growth rates continue to be normal, tests may be performed to check hormone levels and to look for underlying disorders, such as genetic abnormality. in some cases, maturity of a child’s bones may be assesses by taking x-rays of the hand and wrist.

What is the treatment?
Treatment for growth disorders is most successful if started well before puberty when bones still have the potential for normal growth. short stature caused by an inadequate diet usually improves if the diet is modified while the child is still growing. If the growth disorder is a chronic illness, careful control of the illness can sometimes result in normal growth. growth hormone deficiency is usually treated by replacement of growth hormone. hypothyroidism is treated by replacing thyroid hormone.

Abnormal early puberty may be treated using drugs to halt the advancement gland tumor may be treated by removal of the tumor.

Treated early, most children with a growth disorder reach a relatively normal height, but, if treatment is delayed until puberty, normal height is more difficult to achieve. Abnormal stature may cause a child to be self-conscious and unhappy, and he or she may need support such as counseling.

Growth Hormone Excess: Treatment Options
Because excess GH — acting alone or together with excess IGF-1 — produces adverse health effects, reducing the levels to normal is desirable. Surgery, medication and/or irradiation of the pituitary gland may be appropriate to achieve these goals.

Growth Disorders Lifestyle and Prevention:
For children:
Because growth hormone is taken for years, it is good for parents of children with GHD to be aware of some safety precautions:

Carefully follow the directions for taking GH
Tell all doctors who care for your child that he or she is taking growth hormone
Make sure your child takes any other prescription drugs exactly as prescribed
Contact your child’s doctor immediately if you have any questions about treatment or signs or symptoms which suggest a complication of GH treatment.
In addition, encourage your child to have a healthy lifestyle. Eating a variety of healthy foods will help your child to grow and respond to growth hormone treatment. Be sure that your child gets regular exercise and plenty of sleep, too.

For adults:

Adults receiving GH treatment should also eat a balanced diet, get regular exercise, and plenty of sleep.

Some adults find their lives are much better after taking GH alone. Others may find they still need some help, particularly with the psychological symptoms of GHD. You may need medication to control anxiety or lift your mood.

Counseling may be helpful too. Some forms of therapy, such as cognitive-behavior therapy, can allow you to correct negative thoughts you may be having. You also may want to join a support group with other adults who have GHD. Talking to others who have been through the same thing can be healing.

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.


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