From the Guidelines
Failure to thrive is typically quantified as a weight loss of more than 5% over 3 months, which is a significant indicator of undernutrition and potential further nutritional deterioration. This quantification is based on the most recent and relevant evidence from the ESPEN guidelines for nutrition screening 2002 1.
Key Points to Consider
- The condition of failure to thrive is not solely defined by weight loss but also by other factors such as stability of the condition and previous measurements in medical records.
- Weight loss of more than 5% over 3 months is considered significant and may reveal undernutrition that was not previously discovered, such as in cases of obesity.
- Other studies, such as those related to famine-affected populations 1 and diabetes care 1, provide additional perspectives but are not directly relevant to the quantification of failure to thrive in the general population.
Clinical Implications
- Clinicians should be aware of the potential for undernutrition and further nutritional deterioration in patients with significant weight loss.
- Regular weight monitoring is essential for at-risk populations, including the elderly, chronically ill patients, and young children.
- Early identification of failure to thrive is crucial to prevent developmental delays in children and increased morbidity and mortality in adults.
From the Research
Definition of Failure to Thrive (FTT)
- Failure to Thrive (FTT) is defined as a lack of expected normal physical growth or failure to gain weight 2, 3.
- It can be caused by inadequate caloric intake, inadequate nutrient absorption, or increased metabolism 2.
- FTT can also be due to underlying medical conditions, neglect, or family food insecurity 2, 3.
Weight Loss Quantification
- A weight loss of more than 10% of actual body weight in 6 months or more than 5% in 1 month is considered significant 4.
- In children, a weight-for-age z-score below -2 is considered acute malnutrition, while a height-for-age z-score below -2 is considered chronic malnutrition 5.
- FTT is often quantified by repeated valid measurements of weight, height, and head circumference over time 2, 3.
Common Causes of FTT
- Inadequate nutrition is the most common cause of FTT, accounting for 61.4% of cases 5.
- Psychiatric and behavioral disorders, endocrinologic disorders, recurrent infections, gastrointestinal diseases, and cardiac disorders are other possible causes of FTT 5.
- Malnutrition secondary to psychosocial and caregiver factors is a common cause of FTT in children 3.
Importance of Early Identification and Management
- Early identification and management of FTT are critical to prevent long-term consequences such as impaired cognitive skills, immune function, and growth 2, 3.
- Primary care physicians can effectively treat most children with FTT, and subspecialist consultation or hospitalization is rarely indicated 2.