From the Guidelines
Failure to thrive (FTT) in pediatric patients is typically defined as a condition where a child's weight or weight gain falls significantly below expected parameters for their age and gender, often identified when a child's weight falls below the 3rd or 5th percentile on standard growth charts, drops more than two major percentile lines over time, or when weight-for-height is less than the 5th percentile. This condition can be categorized as organic (resulting from underlying medical conditions like gastrointestinal disorders, endocrine issues, or genetic syndromes) or non-organic (stemming from psychosocial factors, feeding difficulties, or inadequate caloric intake) 1. According to the most recent guidelines, regular measurements of height and weight are crucial in evaluating growth patterns and identifying potential issues, such as failure to thrive 1.
Key Characteristics of FTT
- Inadequate physical growth or inability to maintain growth
- Weight or weight gain falls significantly below expected parameters for age and gender
- Typically diagnosed when a child's weight falls below the 3rd or 5th percentile on standard growth charts
- Can be categorized as organic or non-organic
Importance of Early Identification
Early identification of FTT is crucial as prolonged FTT can lead to developmental delays, cognitive impairment, and immune dysfunction 1. Assessment typically involves detailed growth measurements, nutritional evaluation, developmental screening, and investigation of potential underlying causes. Management focuses on addressing the underlying cause, optimizing nutrition through increased caloric density of feeds, establishing appropriate feeding schedules, and sometimes supplementation. Regular follow-up with weight checks is essential to monitor progress and adjust interventions as needed.
Recent Recommendations
The most recent study from 2023 recommends regular measurements of height and weight, considering parental height, when evaluating short stature, and growth hormone therapy is a consideration if testing indicates deficiency 1. However, the definition and diagnosis of FTT remain largely based on growth parameters, such as weight and height percentiles, and the condition's impact on morbidity, mortality, and quality of life.
From the Research
Definition of Failure to Thrive (FTT)
Failure to thrive (FTT) is defined as an abnormal growth pattern determined by inadequate nutrition, representing 5% to 10% of patients seen in an outpatient setting 2. It is a common problem in children, characterized by a weight less than the 5th percentile on the growth chart or a decreasing rate of weight gain 3. FTT can be described as a state of undernutrition due to inadequate caloric intake, inadequate caloric absorption, or excessive caloric expenditure 4.
Key Characteristics of FTT
- Weight less than the 5th percentile on the growth chart or a decreasing rate of weight gain 3
- Inadequate caloric intake, inadequate caloric absorption, or excessive caloric expenditure 4
- Associated with social and health detrimental outcomes 5
- Most cases involve inadequate caloric intake caused by behavioral or psychosocial issues 6, 4
Diagnosis and Treatment of FTT
- Diagnosis is based on clinical history evaluation and physical examination, with routine laboratory testing rarely identifying a cause 6, 4
- Treatment includes behavioral or nutritional interventions, as well as treatment of possible underlying diseases 5
- A multidisciplinary approach to treatment, including home nursing visits and nutritional counseling, has been shown to improve weight gain, parent-child relationships, and cognitive development 4