Failure to Thrive

DEFINITION

Defined as a diagnosis to describe infants and children who lose weight

or fail to gain weight in accordance with standardized growth charts
All infants and children should be accurately measured for weight,
length (recumbent, younger than 2 years), or height (standing, 2 years
and older), and head circumference
These measurements should be plotted on standardized growth curves
There is no consensus on criteria for FTT, but investigation is appropriate
in any child:
a) Whose weight or height-for-age is below 5th percentile
b) Whose growth slows to cross two major percentiles
c) Whose weight-for-height is less than the 5th percentile

COMMON DIAGNOSIS
Etiologies for FTT can classified into 4 categories. There are often multiple
contributing factors:
a) Inadequate calorie intake, as in feeding errors or mechanical feeding
difficulties
b) Inadequate absorption, as because of GI disease
c) Defective utilization, as in metabolic or congenital disorders
d) Excess metabolic demand, as seen in metabolic, cardiopulmonary, or
renal disease
FTT must be distinguished from the following normal variants, in which
growth failure is usually symmetric
Familial Short Stature
Growth deceleration represents a physiologic adjustment for the childs
growth potential. Approximately 25% of normal babies have a downward
shift in the first 2 years. Calculation of the midparental height can be
helpful in establishing a childs growth potential

Familial short stature can be diagnosed when:

a) There is a proportional decrease in weight and length

b) Bone age is consistent with chronological age
c) The child maintains a normal annual growth rate without further
deceleration
Constitutional Growth Delay
Growth decelerates In the first 3 years of life, followed by stabilization on
a new growth curve until adolescence, when a growth spurt occurs.
It is suspected in the following conditions:
a) Weight and height are proportionally decreased
b) Bone age is less than chronological age. There may be a 2- to 3-year
delay in skeletal maturation
c) There is a family history of a parent or sibling with a similar growth
pattern
d) A work-up does not reveal inadequate intake, or any other cause of
growth delay
Intrauterine Growth Retardation
Failure of intrauterine growth because of prenatal factors and not
genetic predisposition
a) These infants are easily identified by their birth weight below the
fifth percentile, or less than 2500 g.
b) Many of these infants catch up to their peers within the first 6
months, but growth may be slow for the first several years.
c) Careful monitoring over time should show an improvement in
growth. Low-birthweight infants should double their birth weight by
age 4 months and triple it by 1 year.
d) Very low-birth-weight infants (weighing less than 1500 g), owing to
prematurity, should be followed up on a specific very low-birthweight graph, with postnatal age adjusted for gestational age.

DIFFERENTIAL DIAGNOSIS