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Failure to Thrive

Failure 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 failure to thrive, inadequate growth, growth delay. Although failure to thrive occurs in all socioeconomic strata, it is more frequent in families living in poverty. FTT describes a sign -- it is not a diagnosis. The underlying etiology must be 

Ten percent of children seen in the primary care setting show signs of growth failure. Children with FTT attain lower verbal intelligence, poorer language development, less developed reading skills, lower social maturity, and a higher incidence of

Pathophysiology

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

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

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

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

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

Causes of Inadequate Caloric Intake

Lack of Appetite

! Anemia (eg, iron deficiency)

! Psychosocial problems (eg, apathy)

! Central nervous system (CNS) pathology (eg, hydrocephalus, tumor)

! Chronic infection (eg, urinary tract infection, acquired immunodeficiency syndrome)

! Gastrointestinal disorder (eg, pain from reflux esophagitis)

Difficulty with Ingestion

! Psychosocial problems (eg, apathy, rumination)

! Cerebral palsy/CNS disorder (eg, hypertonia, hypotonia)

! Craniofacial anomalies (eg, choanal atresia, cleft lip and palate micrognathia, glossoptosis)

! Dyspnea (congenital heart disease, pulmonary disease)

! Feeding disorder

! Generalized muscle weakness/pathology (eg, myopathies)

! Tracheoesophageal fistula

! Genetic syndrome (eg, Smith-Lemli-Opitz-syndrome)

! Congenital syndrome (eg, fetal alcohol syndrome)

Unavailability of Food

! Inappropriate feeding technique

! Inadequate volume of food

! Inappropriate food for age

! Withholding of food (abuse, neglect, psychosocial)

Vomiting

! CNS pathology (increased intracranial pressure)

! Intestinal tract obstruction (eg, pyloric stenosis, malrotation)

! Gastroesophageal reflux

! Drugs (eg, syrup of ipecac)

Causes of Increased Calorie Requirements

Increased Metabolism/Increased Use of Calories

Chronic/recurrent infection (eg, urinary tract infection, tuberculosis)

Chronic respiratory insufficiency (eg, bronchopulmonary dysplasia)

Congenital heart disease/acquired heart disease

Malignancy

Chronic anemia

Toxins (lead)

Drugs (eg, excess levothyroxine)

Endocrine disorders (eg, hyperthyroidism, hyperaldosteronism)

Defective Use of Calories

Metabolic disorders (eg, aminoacidopathies, inborn errors of carbohydrate metabolism)

Renal tubular acidosis

Chronic hypoxemia (eg, cyanotic heart disease)

Treatment of Failure to Thrive

The normal, healthy infant requires an average of 100 kcal/kg of body weight per day. Nutritional requirements in 

Treatment of Infants

The number of calories per ounce of formula can be increased by adding less water (13 oz infant formula concentrate mixed with 10 oz water provides 24 kcal/oz high-calorie formula) or by adding more carbohydrate in the form of glucose polymers or fat in the form of

Once nutritional recovery begins, the infant often demands and eats enough food to