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Failure to thrive
Failure to thrive (FTT), also known as weight faltering or faltering growth, indicates insufficient weight gain or absence of appropriate physical growth in children. FTT is usually defined in terms of weight, and can be evaluated either by a low weight for the child's age, or by a low rate of increase in the weight.
The term "failure to thrive" has been used in different ways, as no single objective standard or universally accepted definition exists for when to diagnose FTT. One definition describes FTT as a fall in one or more weight centile spaces on a World Health Organization (WHO) growth chart depending on birth weight or when weight is below the 2nd percentile of weight for age irrespective of birth weight. Another definition of FTT is a weight for age that is consistently below the fifth percentile or weight for age that falls by at least two major percentile lines on a growth chart. While weight loss after birth is normal and most babies return to their birth weight by three weeks of age, clinical assessment for FTT is recommended for babies who lose more than 10% of their birth weight or do not return to their birth weight after three weeks. Failure to thrive is not a specific disease, but a sign of inadequate weight gain.
In veterinary medicine, FTT is also referred to as ill-thrift.
Failure to thrive is most commonly diagnosed before two years of age, when growth rates are highest, though it can present among children and adolescents of any age. Caretakers may express concern about poor weight gain or smaller size compared to peers of a similar age. Physicians often identify FTT during routine office visits, when a child's growth parameters such as height and weight are not increasing appropriately on growth curves. Other signs and symptoms may vary widely depending on the etiology of FTT. Differentiating stunting from wasting is important, as they can indicate different causes of FTT. "Wasting" refers to a deceleration in stature more than two standard deviations from median weight-for-height, whereas "stunting" is a drop of more than two standard deviations from the median height-for-age.
The characteristic pattern seen with children with inadequate nutritional intake is an initial deceleration in weight gain, followed several weeks to months later by a deceleration in stature, and finally a deceleration in head circumference. Inadequate caloric intake could be caused by lack of access to food, or caretakers may notice picky eating habits, low appetite, or food refusal. FTT caused by malnutrition could also yield physical findings that indicate potential vitamin and mineral deficiencies, such as scaling skin, spoon-shaped nails, cheilosis, or neuropathy. Lack of food intake by a child could also be due to psychosocial factors related to the child or family. Screening patients and their caretakers for psychiatric conditions such as depression or anxiety is vital, as well as for signs and symptoms of child abuse, neglect, or emotional deprivation.
Children who have FTT caused by a genetic or medical problem may have differences in growth patterns compared to children with FTT due to inadequate food intake. A decrease in length with a proportional drop in weight can be related to long-standing nutritional factors or genetic or endocrine causes. Head circumference, as well, can be an indicator for the etiology of FTT. If head circumference is affected initially in addition to weight or length, other factors are more likely causes than inadequate intake. Some of these include intrauterine infection, teratogens, and some congenital syndromes.
Children who have a medical condition causing FTT may have additional signs and symptoms specific to their condition. Fetal alcohol syndrome (FAS) has been associated with FTT, and can present with characteristic findings including microcephaly, short palpebral fissures, a smooth philtrum and a thin vermillion border. Disorders that cause difficulties absorbing or digesting nutrients, such as Crohn's disease, cystic fibrosis, or celiac disease, can present with abdominal symptoms. Symptoms can include abdominal pain, abdominal distention, hyperactive bowel sounds, bloody stools, or diarrhea.
Traditionally, causes of FTT have been divided into endogenous and exogenous causes, which can also be largely grouped into three categories - inadequate caloric intake, malabsorption/caloric retention defect, and increased metabolic demands.
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Failure to thrive
Failure to thrive (FTT), also known as weight faltering or faltering growth, indicates insufficient weight gain or absence of appropriate physical growth in children. FTT is usually defined in terms of weight, and can be evaluated either by a low weight for the child's age, or by a low rate of increase in the weight.
The term "failure to thrive" has been used in different ways, as no single objective standard or universally accepted definition exists for when to diagnose FTT. One definition describes FTT as a fall in one or more weight centile spaces on a World Health Organization (WHO) growth chart depending on birth weight or when weight is below the 2nd percentile of weight for age irrespective of birth weight. Another definition of FTT is a weight for age that is consistently below the fifth percentile or weight for age that falls by at least two major percentile lines on a growth chart. While weight loss after birth is normal and most babies return to their birth weight by three weeks of age, clinical assessment for FTT is recommended for babies who lose more than 10% of their birth weight or do not return to their birth weight after three weeks. Failure to thrive is not a specific disease, but a sign of inadequate weight gain.
In veterinary medicine, FTT is also referred to as ill-thrift.
Failure to thrive is most commonly diagnosed before two years of age, when growth rates are highest, though it can present among children and adolescents of any age. Caretakers may express concern about poor weight gain or smaller size compared to peers of a similar age. Physicians often identify FTT during routine office visits, when a child's growth parameters such as height and weight are not increasing appropriately on growth curves. Other signs and symptoms may vary widely depending on the etiology of FTT. Differentiating stunting from wasting is important, as they can indicate different causes of FTT. "Wasting" refers to a deceleration in stature more than two standard deviations from median weight-for-height, whereas "stunting" is a drop of more than two standard deviations from the median height-for-age.
The characteristic pattern seen with children with inadequate nutritional intake is an initial deceleration in weight gain, followed several weeks to months later by a deceleration in stature, and finally a deceleration in head circumference. Inadequate caloric intake could be caused by lack of access to food, or caretakers may notice picky eating habits, low appetite, or food refusal. FTT caused by malnutrition could also yield physical findings that indicate potential vitamin and mineral deficiencies, such as scaling skin, spoon-shaped nails, cheilosis, or neuropathy. Lack of food intake by a child could also be due to psychosocial factors related to the child or family. Screening patients and their caretakers for psychiatric conditions such as depression or anxiety is vital, as well as for signs and symptoms of child abuse, neglect, or emotional deprivation.
Children who have FTT caused by a genetic or medical problem may have differences in growth patterns compared to children with FTT due to inadequate food intake. A decrease in length with a proportional drop in weight can be related to long-standing nutritional factors or genetic or endocrine causes. Head circumference, as well, can be an indicator for the etiology of FTT. If head circumference is affected initially in addition to weight or length, other factors are more likely causes than inadequate intake. Some of these include intrauterine infection, teratogens, and some congenital syndromes.
Children who have a medical condition causing FTT may have additional signs and symptoms specific to their condition. Fetal alcohol syndrome (FAS) has been associated with FTT, and can present with characteristic findings including microcephaly, short palpebral fissures, a smooth philtrum and a thin vermillion border. Disorders that cause difficulties absorbing or digesting nutrients, such as Crohn's disease, cystic fibrosis, or celiac disease, can present with abdominal symptoms. Symptoms can include abdominal pain, abdominal distention, hyperactive bowel sounds, bloody stools, or diarrhea.
Traditionally, causes of FTT have been divided into endogenous and exogenous causes, which can also be largely grouped into three categories - inadequate caloric intake, malabsorption/caloric retention defect, and increased metabolic demands.