Pediatrics: Failure to Thrive

Failure to Thrive (FTT)

• FTT occurs in children whose nutritional intake is insufficient for supporting normal growth and weight gain, typically present before two years of age.
• Parents may express concern about picky eating habits, poor weight gain, or smaller size compared to peers of similar age.

Signs and Symptoms

• Physicians often identify FTT during routine office visits, when a child's growth parameters are not tracking appropriately on growth curves.
• Physical exam findings that can indicate a potential cause of FTT include:
  • Scaling skin, spoon-shaped nails, and neuropathy, which may indicate potential vitamin and mineral deficiencies.
  • "Wasting" – deceleration in stature >2 standard deviations from median weight-for-height.
  • "Stunting" – drop of >2 standard deviations from the median height-for-age.

Causes of FTT

Endogenous (or "organic") FTT

• Caused by physical or mental issues with the child itself.
• Includes various inborn errors of metabolism.
• Problems with the gastrointestinal system, such as excessive gas and acid reflux, can make the child unwilling to take in sufficient nutrition.
• Other causes include:
  • Cystic fibrosis, diarrhea, liver disease, anemia, or iron deficiency, which make it difficult for the body to absorb nutrition.
  • Physical deformities, such as cleft palate and tongue tie.
  • Milk allergies can cause endogenous FTT.
  • Fetal alcohol syndrome (FAS) has also been associated with FTT.

Exogenous (or "non-organic") FTT

• Caused by caregiver's actions.
• Includes physical inability to produce enough breastmilk, using only babies' cues to regulate breastfeeding, leading to insufficient feeds.
• In developing countries, conflict settings, and protracted emergencies, exogenous faltering may be caused by chronic food insecurity, lack of nutritional awareness, and other factors beyond the caregiver's control.

Diagnosis and Treatment

• Patient history, including diet history, is a key element for identifying potential causes of FTT.
• Complete physical examination may reveal signs of possible child neglect or abuse.
• Treatment considerations include addressing underlying causes, such as acid reflux, and promoting proper feeding practices.