Failure to Thrive




Keywords

failure to thrive, nutrition, growth, re-feeding syndrome

 


Failure to thrive ( FTT ) is a descriptive term given to infants and young children with malnourishment resulting in inadequate growth. To date, there are no universally accepted anthropometric criteria for FTT as different anthropometric indicators and cut points have been used. Commonly used criteria include weight below the 3rd or 5th percentile for age; weight decreasing, crossing two major percentile lines on the growth chart over time; or weight less than 80% of the median weight for the height of the child. Caveats to these definitions exist. According to growth chart standards, 3% of the population naturally falls below the 3rd percentile. These children, who typically have short stature or constitutional delay of growth, usually are proportional (normal weight for height). Additionally, in the first few years of life, large fluctuations in percentile position can occur in normal children. Changes in weight should be assessed in relation to height (length) and head circumference.


Despite these limitations in defining FTT, anthropometric data and growth charts provide important information. Of note, allowances must be made for prematurity; weight corrections are needed until 24 months of age, height corrections until 40 months of age, and head circumference corrections until 18 months of age. Also of note, there are specific growth charts for genetic conditions such as Down syndrome and Turner syndrome that should be used when assessing growth for children with these conditions. Although some growth variants can be difficult to distinguish from FTT, growth velocity and height-for-weight determinations can be useful in distinguishing the cause. In children with FTT, malnutrition initially results in wasting (deficiency in weight gain). Stunting (deficiency in linear growth) generally occurs after months of malnutrition, and head circumference is spared except with chronic, severe malnutrition. FTT that is symmetric (proportional weight, height/length, and head circumference) suggests long-standing malnutrition, chromosomal abnormalities, congenital infection, or teratogenic exposures. Short stature with preserved weight suggests an endocrine etiology.




Etiology


There are multiple possible causes of growth failure ( Table 21.1 ). In the past, etiologies of FTT were sometimes categorized as organic (underlying medical condition diagnosed) and nonorganic (no underlying medical cause). This dichotomous classification can be problematic because, in many cases, the cause of FTT is multifactorial with interaction between multiple biological and psychosocial factors. FTT can be caused by inadequate nutritional intake (e.g., neurological condition impeding feeding, improper mixing of formula, food insecurity), malabsorption (e.g., celiac disease, milk protein allergy), and/or increased metabolic demands (e.g., cardiac disease, chronic infection). Clinical studies suggest that major organic diseases are detected in a minority of patients with FTT. As outlined in Table 21.2 , the common causes of FTT vary by age.



TABLE 21.1

Causes of Failure to Thrive































































































ENVIRONMENTAL (COMMON)
Emotional deprivation
Rumination
Child maltreatment
Maternal depression
Poverty
Poor feeding techniques
Improper formula preparation
Improper mealtime environment
Unusual parental nutritional beliefs
GASTROINTESTINAL
Cystic fibrosis and other causes of pancreatic insufficiency
Celiac disease
Other malabsorption syndromes
Gastrointestinal reflux
CONGENITAL/ANATOMIC
Chromosomal abnormalities, genetic syndromes
Congenital heart disease
Gastrointestinal abnormalities (e.g., pyloric stenosis, malrotation)
Vascular rings
Upper airway obstruction
Dental caries
Congenital immunodeficiency syndromes
INFECTIONS
Human immunodeficiency virus
Tuberculosis
Hepatitis
Urinary tract infection, chronic sinusitis, parasitic infection
METABOLIC
Thyroid disease
Adrenal or pituitary disease
Aminoaciduria, organic aciduria
Galactosemia
NEUROLOGICAL
Cerebral palsy
Hypothalamic and other central nervous system tumors
Hypotonia syndromes
Neuromuscular diseases
Degenerative and storage diseases
RENAL
Chronic renal failure
Renal tubular acidosis
Urinary tract infection
HEMATOLOGIC
Sickle cell disease
Iron deficiency anemia

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Jun 24, 2019 | Posted by in PEDIATRICS | Comments Off on Failure to Thrive
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