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Welcome, medical contents search April 29, 2013
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Failure to Thrive

more about Failure to Thrive

  • In this condition, height, weight, and head size are not following the normal upward trend of infancy and childhood, and are either remaining constant or not accelerating at nearly the normal rate of growth, or are declining (which is called "falling off the growth curve").
  • Let us take 100 normal children 5 years old, and line them up in order of their weight, with the thinnest, lightest child in the front.  The lightest child is called the "1st percentile," the 3rd lightest child is called the "3rd percentile," and the heaviest child is the "100th percentile."  Now, when we have another 5 year old child, who is a sick child in the hospital, and measure his weight, we can say, "he fits in the 3rd percentile for a 5 year old's weight, but last month he was in the 50th percentile for a 5 year old's weight, so, now we will investigate."
  • If the height, weight, or head circumference (which were previously far above the 3rd percentile) are now below the 3rd percentile, this is unusual and is "failure to thrive" by one definition.  However, out of 100 normal children, 3 of them will be at or below the 3rd percentile and still be normal.  The 3rd percentile is just an arbitrary cutoff point for deciding to investigate.
  • Failure to thrive usually refers to the situations described above, in which the cause is unknown.  If the cause were known, it would just be lack of normal growth due to the known circumstance.
  • A significant group of failure to thrive cases is due to psychosocial causes, and no physical disease is responsible.

  • The first symptom is weight loss, or failure to gain weight.  The next symptom is failure to gain height.  The last symptom is failure of the head size to grow.  There may be other symptoms, such as loss-of-appetite, apathy, listlessness, intellectual functioning below normal, Diarrhea, and constipation.

  • Psychosocial causes: lack of available food, "maternal deprivation" (lack of bonding to this particular child); psychological illness within the family unit
  • In the United States, psychosocial causes are  very common, and if the child is hospitalized for failure to thrive, a hospital social worker will often be part of the medical team.
  • Physical causes: kidney disease, gastrointestinal disease, Congenital Heart Disease, and Tuberculosis are fairly common causes, but any severe medical condition can be the cause.
  • A genetic background in which many family members in several generations have short stature is not considered "failure to thrive."

  • Diagnosis is extremely difficult.  It involves two issues:
    1. The physician must decide that the height, weight, and/or head circumference are abnormal (when a few normal children of that age will have that weight and still be normal, for example).
    2. The physician must discover if a social issue is involved (such as child Abuse), or find underlying kidney disease, intestinal disease, heart disease, or Tuberculosis, for example.
  • Common tests include a complete blood count (CBC), creatinine test for kidney disease, stool examination to look for bleeding and to look for parasites, and chest X-ray to examine the heart and lungs.
  • A growth chart is created to plot onto a special graph all the heights, weights, and head size measurements that were ever taken for this child.  This shows his measurements in comparison to normal children in every age group.  It shows the age at which this child first started to "fall off the growth curve."
  • The shape of the curve can be important.  For example, Growth Hormone Deficiency does not make a child fall off the growth curve until approximately 10 months of age.

  • In psychosocial cases of failure to thrive, where the underlying problem is a lack of food, a hospitalization starting initially with IV fluids or a clear liquid diet and advancing the diet as tolerated, usually shows that resumption of a normal growth curve is possible on hospital food alone, with no other medical treatment.  Psychosocial help for the family is needed.
  • In cases of physical disease, treatment of the underlying disease is the corrective measure.  Often, these patients must start initially with IV fluids or a clear liquid diet as well (because the bowel cannot yet tolerate a regular diet).

  • Loss of intellect
  • Severe physical disability
  • Need for hyperalimentation (high calorie continuous feeding, given through intravenous tubing)

  • Look at the measurements for your child's height, weight, and head size that are being recorded.  Weight is the most likely measurement to be abnormal.  If your child is not gaining weight at the expected rate, discuss this with your physician to see if testing should be done (blood tests, stool tests, chest X-ray).
  • There are standard graphs available at most doctors' offices, for the doctor to chart your child's height, weight, and head size in comparison to hundreds of normal children.  Your child's measurements are often plotted on these graphs if you suspect failure to thrive.
  • Note that there are reasons why your child might not match the growth curve in a doctor's office.  For example, the growth curves use measurements on normal U.S. children in the Midwest.  This might not apply to your child, if your child is foreign-born, or a premature infant, for example.

  • Kwashiorkor: Malnutrition caused by lack of protein in the diet, but eating nearly the normal amount of Calories.  These children often have a large liver; edema of the face and the 4 limbs; thin, weak muscles; failure to gain weight.
  • Marasmus: Malnutrition caused by lack of Calories causing starvation.  These children often have a distended abdomen but not a large liver; wrinkled, loose skin that seems to "hang off them"; loss of all body fat from under the skin; body temperature below normal; slow pulse; thin, weak muscles; failure to gain weight.

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