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Failure to ThriveFailure to thrive (FTT) is usually first considered when a child is found to weigh less than the third percentile of norms for age and gender. Although FTT occurs in all socioeconomic strata, it is more frequent in families living in poverty. FTT describes a sign -- it is not a diagnosis. The failure to thrive, growth delay underlying etiology must be determined. Ten percent of children seen in the primary care setting show signs of growth failure. Children with FTT attain lower verbal intelligence, poorer language develop ment, less developed reading skills, lower social maturity, and a higher incidence of Diagnostic Criteria for Failure to Thrive A child younger than 2 years of age whose weight is below the 3rd or 5th percentile for age on more than one occasion. A child younger than 2 years of age whose weight is less than 80% of the ideal weight for age. A child younger than 2 years of age whose weight crosses two major percentiles downward on a standardized growth grid. Exceptions to the previously noted criteria include the following: Children of genetically short stature. Small-for-gestational age infants. Preterm infants. "Overweight" infants whose rate of height gain increases while the rate of weight gain decreases. Infants who are normally lean. Many patients with FTT have either an organic or nonorganic cause; however, a sizable number of patients have both psychosocial and organic causes for their condition. FTT should be approached as a syndrome of malnutrition brought on by a combination of organic, behavioral, and environmental factors. Clinical Evaluation of Poor Weight Gain or Weight Loss Feeding history should assess details of breast or formula feeding, timing and introduction of solids, feeding advice already followed, who feeds the infant, position and placement of the infant for feeding, and stooling or vomiting patterns. Treatment should include |