Failure to Thrive

Failure to thrive is failure to gain in height and weight at the expected rate, the expected rate usually being that indicated by charts for height and weight related to age and sex in reference populations. Since it is often easier to measure weight than height in small children and since weight can be lost as well as not gained, whereas height gain can only be absent or slowed, assessment of failure to thrive is frequently made on weight progress alone. Although a child may be low weight for height and age, this does not necessarily imply failure to thrive since some 'normal' children are always small, perhaps because of genetic endowment. They grow with normal velocity but at the lower extreme of normal population distribution. Thus, following weight gain over time is essential for diagnosis of failure to thrive (Figure 1).

Failure to thrive can result from a wide range of underlying medical problems as outlined in Table 2.

Figure 1 Failure to thrive: figurative growth chart for increase in either weight or height of four children with abnormal growth showing normal population growth as median and ± standard deviations (SD) , failure to thrive in above average child with growth falling below the median and then showing complete catch up growth;-----, failure to thrive in a child growing below the median with failure to thrive, falling below -2SD and then showing complete catch up;

-, child with failure to thrive and failure to complete catch up so growth continues at about average rate but child remains below previous SD position; — ■ — ■ — -, child gaining throughout at normal velocity but starting below -2SD and remaining below -2SD in size, i.e., 'small normal'.

Figure 1 Failure to thrive: figurative growth chart for increase in either weight or height of four children with abnormal growth showing normal population growth as median and ± standard deviations (SD) , failure to thrive in above average child with growth falling below the median and then showing complete catch up growth;-----, failure to thrive in a child growing below the median with failure to thrive, falling below -2SD and then showing complete catch up;

-, child with failure to thrive and failure to complete catch up so growth continues at about average rate but child remains below previous SD position; — ■ — ■ — -, child gaining throughout at normal velocity but starting below -2SD and remaining below -2SD in size, i.e., 'small normal'.

Table 2 Some causes of failure to thrive according to pathophysiology

Basic cause of FTT

Clinical situation

Medical condition

Too little energy taken in

Inadequate food energy offered

Poverty; ignorance of child's needs; lack of understanding of progression of weaning process

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