Failure to thrive
Growth failure; FTT; Feeding disorder; Poor feedingFailure to thrive refers to children whose current weight or rate of weight gain is much lower than that of other children of similar age and sex.
Causes
Failure to thrive may be caused by medical problems or factors in the child's environment, such as abuse or neglect.
There are many medical causes of failure to thrive. These include:
- Problems with genes, such as Down syndrome
Down syndrome
Down syndrome is a genetic condition in which a person has 47 chromosomes instead of the usual 46.
Read Article Now Book Mark Article - Organ problems
- Hormone problems
- Damage to the brain or central nervous system, which may cause feeding difficulties in an infant
- Heart or lung problems, which can affect how nutrients move through the body
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Anemia or other blood disorders
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
Read Article Now Book Mark Article - Gastrointestinal problems that make it hard to absorb nutrients or cause a lack of digestive enzymes
- Long-term (chronic) infections
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Metabolism problems
Metabolism
Metabolism refers to all the physical and chemical processes in the body that convert or use energy, such as:BreathingCirculating bloodControlling bo...
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Factors in the child's environment include:
- Loss of emotional bond between parent and child
- Poverty
- Problems with child-caregiver relationship
- Parents do not understand the appropriate diet needs for their child
- Exposure to infections, parasites, or toxins
- Poor eating habits, such as eating in front of the television and not having formal meal times
Many times, the cause cannot be determined.
Symptoms
Children who fail to thrive do not grow and develop normally as compared to children of the same age. They seem to be much smaller or shorter. Teenagers may not have the usual changes that occur at puberty.
Grow and develop normally
A child's growth and development can be divided into four periods:InfancyPreschool yearsMiddle childhood yearsAdolescence Soon after birth, an infant...
Read Article Now Book Mark ArticleSymptoms of failure to thrive include:
- Height, weight, and head circumference do not match standard growth charts
Head circumference
Head circumference is a measurement of a child's head around its largest area. It measures the distance from above the eyebrows and ears and around ...
Read Article Now Book Mark Article - Weight is lower than third percentile of standard growth charts or 20% below the ideal weight for their height
- Growth may have slowed or stopped
The following may be delayed or slow to develop in children who fail to thrive:
- Physical skills, such as rolling over, sitting, standing and walking
- Mental and social skills
- Secondary sexual characteristics (delayed in adolescents)
Babies who fail to gain weight or develop often lack interest in feeding or have a problem receiving the proper amount of nutrition. This is called poor feeding.
Other symptoms that may be seen in a child that fails to thrive include:
- Constipation
- Excessive crying
- Excessive sleepiness (lethargy)
- Irritability
Exams and Tests
Your health care provider will perform a physical exam and check the child's height, weight, and body shape. Parents will be asked about the child's medical and family history.
A special test called the Denver Developmental Screening Test may be used to show any delays in development. A growth chart outlining all types of growth since birth is created.
The following tests may be done:
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Complete blood count (CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Electrolyte balance
Electrolyte balance
Electrolytes are minerals in your blood and other body fluids that carry an electric charge. Electrolytes affect how your body functions in many ways...
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Hemoglobin electrophoresis to check for conditions such as sickle cell disease
Hemoglobin electrophoresis
Hemoglobin is a protein that carries oxygen in the blood. It is present inside the red blood cells. Hemoglobin electrophoresis measures the levels ...
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Hormone tests, including thyroid function tests
Hormone tests
Blood or urine tests can determine the levels of various hormones in the body. This includes reproductive hormones, thyroid hormones, adrenal hormon...
Read Article Now Book Mark Article - X-rays to determine bone age
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Urinalysis
Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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Treatment
Treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional problems can be helped by showing the parents how to provide a well-balanced diet.
Do not give your child dietary supplements such as Boost or Ensure without talking to your provider first.
Other treatment depends on how severe the condition is. The following may be recommended:
- Increase the number of calories and amount of fluid the infant receives
- Correct any vitamin or mineral deficiencies
- Identify and treat any other medical conditions
The child may need to stay in the hospital for a little while.
Treatment may also involve improving the family relationships and living conditions.
Outlook (Prognosis)
Normal growth and development may be affected if a child fails to thrive for a long time.
Normal growth and development may continue if the child has failed to thrive for a short time, and the cause is determined and treated.
Possible Complications
Permanent mental, emotional, or physical delays can occur.
When to Contact a Medical Professional
Contact your provider for an appointment if your child does not seem to be developing normally.
Prevention
Regular checkups can help detect failure to thrive in children.
References
Marcdante KJ, Kliegman RM, Schuh AM. Failure to thrive. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 21.
Srinath A, Rudolph JA. Nutrition and gastroenterology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 11.
Review Date: 8/5/2023
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.