In the first few years of life most kids gain weight and
grow much more quickly than they will later on. Sometimes, however,
kids don't meet expected standards of growth. Most still follow
growth patterns that are variations of normal, but others are
considered to have "failure to thrive."
This is a general diagnosis, with many possible causes. Common
to all cases, though, is the failure to gain weight as expected,
often accompanied by poor height growth.
Diagnosing and treating a child who fails to thrive focuses on
identifying any underlying problem. From there, doctors and the
family work together to get the child back into a healthy growth
pattern.
About Failure to Thrive
Although it's been recognized for more than a century,
failure to thrive lacks a precise definition, in part because it
describes a condition rather than a specific disease. Kids who fail
to thrive don't receive or are unable to take in, retain, or
utilize the calories needed to gain weight and grow as
expected.
Most diagnoses of failure to thrive are made in infants and
toddlers in the first few years of life - a crucial period of
physical and mental development. After birth, a child's brain
grows as much in the first year as it will grow during the rest of
life.
Poor nutrition
during this period can have permanent negative effects on mental
development.
Most babies double their birth weight by 4 months and
triple it by age 1, but kids with failure to thrive often don't
meet those milestones. Sometimes, a child who starts out
"plump" and who shows signs of growing well can begin to
fall off in weight gain. After a while, linear (height) growth may
slow as well.
If the condition progresses, undernourished kids may:
- become disinterested in their surroundings
- avoid eye contact
- become irritable
- not reach developmental milestones like sitting up, walking,
and talking at the usual age
Causes
Failure to thrive can result from a variety of underlying
causes, such as:
- Social factors.
In some cases, doctors may not identify a medical problem, but
may find that the parents are actually
causing
the failure to thrive. For example, some parents inappropriately
restrict the amount of calories they give their infants. They may
fear the child will get fat or enforce a limited diet similar to
one they follow. Or, they might not feed the child enough either
because of a lack of interest or because of too many distractions
in the household, leading to neglect of the child. Living in
poverty also can lead to an inability to provide kids with proper
nutrition.
- Conditions involving the gastrointestinal
system.
These include
gastroesophageal reflux disease (GERD)
, chronic
diarrhea
,
cystic fibrosis
, chronic liver disease, and celiac disease. With GERD, the
esophagus may become so irritated that a child refuses to eat
because it hurts. Persistent diarrhea can interfere with the
body's ability to hold on to the nutrients and calories from
food.
Cystic fibrosis, chronic liver disease, and celiac disease are
malabsorptive disorders that limit the body's ability to
absorb nutrients. An infant may eat a lot, but the body
doesn't absorb and retain enough of that food. Celiac disease
is a sensitivity to a dietary protein found in wheat and certain
other grains. The immune system's abnormal response to this
protein causes damage to the lining of the intestine, interfering
with its ability to absorb nutrients.
- A chronic illness or medical disorder.
A child who has trouble eating - because of prematurity or a
cleft lip
or palate, for example - may not take in enough calories to
support normal growth. Other conditions that can lead to failure
to thrive include cardiac, endocrinologic, and respiratory
disorders, which can increase a child's caloric needs so that
it becomes difficult to meet them.
- An intolerance of milk protein.
This can cause difficulty with absorbing nutrients until it's
diagnosed. It can also put an entire class of food out of reach,
restricting the child's diet and occasionally leading to
failure to thrive.
- Infections.
Parasites, urinary tract infections, tuberculosis, etc., can
put great energy demands on the body and force it to use
nutrients rapidly (and can diminish appetite), sometimes
bringing about short- or long-term failure to thrive.
- Metabolic disorders.
These can limit the body's capacity to make the most of
calories consumed. They might make it difficult for the body to
break down, process, or derive energy from food, or cause a
buildup of toxins during the breakdown process that can make a
child feed poorly or vomit.
In some cases, doctors are unable to pinpoint a specific
cause.
In the past, doctors tended to categorize cases of failure to
thrive as either organic (caused by an underlying medical disorder)
or inorganic (caused by caregivers' or parents' actions),
but are less likely to make a distinction today because
medical and behavioral causes often appear together.
For instance, if a baby has severe reflux and is reluctant to
eat, feeding times can be stressful. The baby may become upset
and frustrated, and the caregiver might be unable to feed the
child adequate amounts of food.
Diagnosis
Many babies go through brief periods when their weight gain
plateaus or they even lose a little weight. However, if a baby
doesn't gain weight for 3 consecutive months during the first
year of life, doctors usually become concerned.
Doctors diagnose failure to thrive by using standard
growth charts
to plot weight, length, and head circumference, which are measured
at each well-baby exam. Children who fall below a certain weight
range for their age or who are failing to gain weight at the
expected rate will be evaluated further to determine if there's
a problem.
Along with obtaining a thorough medical and feeding history and
performing a detailed physical exam, the doctor may order a
complete blood count
,
urine test
, and various blood chemical and electrolyte tests to search for
underlying medical problems. If a particular disease or disorder is
suspected, the doctor might perform additional tests specific to
that condition.
To determine whether a child is receiving enough food, the
doctor (sometimes with the help of a dietitian) will do a calorie
count after asking the parents what the child eats every day. And
talking to the parents can help a doctor identify any problems at
home, such as neglect, poverty, household stress, or feeding
difficulties.
Treatment
Children with failure to thrive need the help of their parents
and a doctor. Sometimes, an entire medical team will work on the
case.
In addition to the primary doctor, the team might include a
nutritionist to evaluate the child's dietary needs, and an
occupational
or
speech therapist
to help the caregiver and child develop successful feeding
behaviors and address any sucking or swallowing problems.
Occupational and speech therapists are often helpful because of
their expertise in the muscular control that's involved in
eating.
Because treatment of failure to thrive involves treating any
disease or disorder causing the problem, specialists such as a
cardiologist, neurologist, or gastroenterologist may also be part
of the care team.
Particularly in cases of failure to thrive that are thought to
be caused by caregivers' or parents' actions, a social
worker and a psychologist or other mental health professional may
help address problems in the home environment and provide any
needed support.
In cases of poor nutrition, treatment often can be carried out
at home with frequent follow-up visits to the doctor's office
or clinic. The doctor will recommend high-calorie foods and place
an infant on a high-calorie formula.
More severe cases may call for tube feedings in which a tube is
put in that runs from the nose into the stomach. Liquid nutrition
is provided at a steady rate through the tube. Once the tube is in
place, the child is usually fed at night to avoid interference with
daily activities or limiting the child's desire to eat during
the day. (About half of a child's caloric needs can be
delivered at night through a continuous drip.) Once more adequately
nourished, the child will feel better and will probably start
to eat more on his or her own. At that point, the tube can be
removed.
A child with extreme failure to thrive may need to be
hospitalized to be fed and monitored continuously. During this
time, any possible underlying causes of the condition can be
evaluated and treated appropriately. This also lets the doctors see
the caregiver's feeding technique and the interaction between
caregiver and child during feedings and at other times.
How long treatment lasts varies from case to case. Weight gain
takes time, so several months may pass before a child is back in
the normal range. Kids who require hospitalization may stay for 10
to 14 days or more to establish satisfactory weight gain, but it
can be many months until the symptoms of severe malnutrition are
gone.
Failure to thrive caused by a chronic illness or disorder may
have to be monitored periodically and treated for even longer,
perhaps for a lifetime.
Does My Child Have Failure to Thrive?
If you're worried that your child is failing to thrive,
remember that many things can cause slower weight gain. For
instance,
breastfed
babies and bottle-fed babies often gain weight at different rates
in the early newborn period.
Genetics also play a big role in weight gain, so if you and your
spouse are slim, your baby may not put on pounds quickly. However,
infants should still gain weight steadily and it can be difficult
to monitor this from home. So it's important to see your
child's doctor regularly.
As a guideline, babies usually eat eight to 12 times in a
24-hour period (a couple of ounces [60 milliliters] every few
hours) in the first weeks after birth. By the time they're 2 to
3 months old, the number of feedings has dropped to six to eight,
but the amount they eat each time has increased. At 4 months, about
30 ounces (890 milliliters) a day provides sufficient nutrition for
most infants.
Your doctor will have many opportunities to identify a problem
at regular well-baby checkups. You can also periodically check your
baby's weight at home, if you want the reassurance.
When to Call the Doctor
If you notice a drop in weight gain or your baby doesn't
seem to have a normal appetite, call your doctor. Any major change
in eating pattern also warrants a call. Toddlers and older kids may
have days and sometimes weeks when they show little interest in
eating, but that shouldn't happen in infants.
If you have trouble feeding your baby, your doctor can help.
When a child doesn't readily eat, parents can become frustrated
and feel they're doing something wrong. That can magnify the
problem and increase the stress for you and your baby. Instead, get
help for both of you by consulting the doctor.
Reviewed by:
Steven Dowshen, MD
Date reviewed: September 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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