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What is Failure to Thrive?

What is Failure to Thrive in Children?


Failure to thrive (FTT) is defined as a lack of normal expected growth or weight gain in a child, which is diagnosed when the child’s measurements for both height and weight measurements fall below the third or fifth percentile for children of the similar sex or a downward change is observed in growth across two major growth percentiles, according to the Children’s Hospital of Philadelphia (CHOP).


The good news is, FTT is not a disease or illness, but rather an indication that there’s a problem with growth. If your concerned about your child’s growth, it’s important to know that there’s no single measurement that determines with certainty whether or not a child has FTT. Instead, it appears as a cluster of symptoms that lead to the growing challenges and FTT diagnosis.


What are the symptoms of Failure to Thrive?


If your child is shorter or growing slower than his or her classmates, he or she may not automatically be suffering from FTT. Your child could be experiencing constitutional growth delay, which is the medical term for a “late bloomer.” This is why it’s critical to get your child to every wellness exam, according to the recommended schedule from the American Association of Pediatrics.


To determine whether your child is suffering from FTT, the doctor evaluates several different measurements, which you’ll see on the AAP well visit chart. These include:


  • Weight for length
  • Head circumference
  • Body Mass Index

The key is taking and checking these measurements overtime, which indicate an abnormal growth pattern, suggests the American Family Physician. Not to mention, FTT is considered a common diagnosis, with 10 percent of children in primary care diagnosed, and 5 percent of those who are hospitalized.


At home, you may notice some of the physical symptoms. According to Johns Hopkins Medicine, those include:


  • Physical skills, including as rolling over, sitting, standing and walking
  • Mental and social skills

What are the causes of Failure to Thrive?


There are many causes of failure to Thrive, the most common of which is inadequate caloric intake. There are many reasons your child could have inadequate caloric, including picky eating, something many children struggle with. If you’re worried about your child’s picky eating habits and their grown, first and foremost see your pediatrician, who can determine whether it’s linked to FTT based on rate of growth over time. You can also check out our guide, 10 Ways to Make Sure Your Picky Eater Gets Important Nutrients.


The American Family Physician suggests the potential causes for FTT include:


  • Gastroesophageal reflux
  • Inadequate breast milk supply or ineffective latching
  • Incorrect formula preparation
  • Mechanical feeding difficulties (e.g., cleft lip or palate)
  • Neglect or abuse
  • Poor feeding habits
  • Poor oral neuromotor coordination
  • Toxin-induced gastrointestinal upset (e.g., elevated lead levels leading to anorexia, constipation, or abdominal pain)
  • Inadequate nutrient absorption
  • Anemia, iron deficiency
  • Biliary atresia
  • Celiac disease
  • Chronic gastrointestinal conditions (e.g., irritable bowel syndrome), infections
  • Cystic fibrosis
  • Inborn errors of metabolism
  • Milk protein allergy
  • Pancreatic cholestatic conditions
  • Increased metabolism
  • Chronic infection (e.g., human immunodeficiency virus infection, AIDS, tuberculosis)
  • Chronic lung disease of prematurity
  • Congenital heart disease
  • Hyperthyroidism
  • Inflammatory conditions (e.g., asthma, inflammatory bowel disease)
  • Malignancy
  • Renal failure

What are the risk factors for Failure to Thrive?


Medical conditions of family or environmental issues can lead to FTT, if not handled early on in their life. American Family Physician also lays out the potential risk factors as follows:

  • Congenital anomalies (e.g., cerebral palsy, autism, trisomy 21)
  • Developmental delay
  • Gastroesophageal reflux
  • Low birth weight (< 2,500 g [5 lb, 8 oz])*
  • Poor oral health, dental caries
  • Prematurity (< 37 weeks' gestation)
  • Tongue-tie (controversial)
  • Psychosocial (family) issues
  • Disordered feeding techniques
  • Family stressors
  • Parental or family history of intimate partner abuse or violence (perpetrator or victim)
  • Poor parenting skills
  • Postpartum depression
  • Poverty†
  • Social isolation of a caretaker
  • Substance abuse
  • Unusual health and nutritional beliefs (e.g., restricted diets)

How is failure to thrive diagnosed?


If your child’s doctor suspects FTT, they will need to do a complete and through medical assessment of the child’s growth, health, and home environment. Ultimately, however, a diagnosis of FTT requires monitoring the child over time and is usually not determined with a single measurement or just one evaluation.


A diagnosis of FTT will usually include:


Measurements of Growth


If you’ve been doing all of your well visits, your child’s pediatrician will have a full sampling of growth, including height, weight and head circumference. This growth rate is compared to the standard growth curve for children of the same sex and age, which is referred to in the CDC Growth Charts.


Because environmental causes can lead to an FTT diagnosis, it’s important that the doctor ensure there are no lifestyle issues at home for your child. It’s also important that the pediatrician address any potential causes that could have been overlooked from your child’s health in the past.


Physical Examination and Tests


In addition to growth, the doctor may conduct a physical exam to rule out any potential causes. There aren’t any specific diagnostic tests for determining FTT, according to American Family Physician, but if the doctor wants to test for risk factors that could be causing the FTT, those may include:


  • Complete blood count
  • Urinalysis
  • Electrolyte measurement
  • Thyroid tests
  • Celiac disease tests
  • Cystic fibrosis
  • Food allergies
  • Human immunodeficiency virus infection (HIV)
  • Tuberculosis

All of these tests are done on a case-by-case basis, depending on the symptoms and issues being presented in your child.


Developmental Screenings


Children generally meet certain developmental milestones at specific ages. A failure to meet these milestones, such as walking, crawling, or rolling over, could indicate a problem with growth. The assessment will likely include an evaluation of the child’s development and if it is appropriate for their age.


How is failure-to-thrive treated


Treatment for FTT will be determined by the severity of the symptoms and the initial causes and risk factors. The goal is to ensure the underlying issue is treated and the child is getting adequate calories and nutrition, according to Rady Children’s Hospital; this means, some of the medical professionals you may work with for treatment include:


  • Primary care doctor or pediatrician
  • Registered dietitian: Needed to evaluate dietary needs.
  • Speech therapists: Needed to address challenges or problems related to sucking or swallowing.
  • Occupational therapist: needed to help the family create successful feeding behaviors
  • Social worker: needed if the cause of FTT is related to family challenges.
  • Psychologists and other mental health professionals: Needed to address potential behavioral issues.
  • Various specialists (such as a cardiologist, neurologist, or gastroenterologist): Needed to treat the underlying health conditions that were uncovered during testing.

There are no medications or specific treatments for FTT; rather, the goal is both education of the caregivers and helping to correct any underlying issues that caused the FTT in the first place.


Very rarely may a child be hospitalized for failure to thrive. This is considered if the child requires extensive feeding observation or intense supplementation. Hospitalization is also considered if there is significant evidence of abuse, neglect, injury, or severe malnutrition.


What does failure to thrive mean for your child long-term?


In many cases, FTT is resolvable if the underlying causes can be addressed. Many children are able to catch up in growth and develop normally, according to Rady Children’s Hospital, but it will take time:


“How long treatment lasts can vary. Weight gain takes time, so it might be several months before a child is back in the normal range. When the condition is due to a chronic illness or disorder, kids may have to be monitored regularly at their doctor’s office. In those cases, treatment may take even longer, perhaps for a lifetime.”


Prevention is Key


The best way to do prevent FTT is to be in regular contact with your child’s pediatrician. Attend all scheduled appointments and address any concerns about growth immediately. FTT is addressed by looking at growth patterns over a long period of time, so every check up is a chance to uncover important information in case there’s an issue in the future.

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