Failure to thrive

The diagnosis of failure to thrive (FTT) requires a careful assessment of growth parameters (weight, length/height, and head circumference) over time.

The condition requires a comprehensive evaluation as both medical and psychosocial problems may contribute.

Extensive medical tests are, however, generally not indicated, unless suggested by the history or exam.

Interdisciplinary collaboration is ideal in evaluation and treatment.

Hospitalization should be reserved for severe or recalcitrant cases.

The presence of an organic etiology does not rule out the possibility of psychosocial contributing factors.

Can occur at all socioeconomic levels. Although occurrence may be highest among children from low income families, recent evidence from the UK reported no association between socioeconomic status and growth at age 12 months.

FTT is a descriptive term and refers to less than expected growth over time during the first 3 years of life when tracked on appropriate growth charts for children of the same age and sex.[1]Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11. 2002 May;(246):1-190. http://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf http://www.ncbi.nlm.nih.gov/pubmed/12043359?tool=bestpractice.com However, the definition varies between different healthcare providers, and the criteria used to diagnose the condition must be specified. FTT can be a pejorative term. Undernutrition is a descriptive term for poor growth and is preferred because it is more specific than FTT; it does not compound the possible failure parents may feel due to their infant's poor growth.[2]Kessler DB. Failure to thrive and pediatric undernutrition: historical and theoretical context. In: Kessler DB, Dawson P, eds. Failure to thrive and pediatric undernutrition. Baltimore, MD: Paul H. Brookes Publishing; 1999:3-18.