Is Failure to Thrive an Actual Diagnosis? A Comprehensive Overview

According to the American Academy of Family Physicians, Failure to Thrive (FTT) is a sign of undernutrition, not a specific disease itself. While it describes a pattern of insufficient growth, determining the root cause requires a comprehensive diagnostic approach to identify the underlying medical, nutritional, or psychosocial issue. This means that while FTT is a medical concern, healthcare providers do not simply conclude that a patient has 'failure to thrive' without further investigation.

Quick Summary

Failure to thrive (FTT) is a clinical sign of inadequate growth and undernutrition, rather than a stand-alone diagnosis. It is a descriptor for a problem caused by various underlying medical or non-medical factors. The evaluation requires a detailed history, physical exam, and monitoring to find the specific etiology, which could range from an organic disease to psychosocial issues.

Key Points

• Definition: Failure to Thrive (FTT) is a clinical sign, not a diagnosis, indicating poor growth and undernutrition.

• Causes are Varied: The etiology is often multifactorial, including medical conditions (organic) and psychosocial or environmental issues (non-organic).

• Evaluation is Key: A detailed history and physical exam are crucial for determining the root cause, with targeted testing used only when specific conditions are suspected.

• Affects All Ages: While most discussed in children, a similar syndrome exists in older adults called Adult Failure to Thrive (AFTT).

• Treatment is Targeted: Management focuses on correcting the underlying cause and ensuring adequate nutritional intake, often involving a multidisciplinary team.

Understanding the Concept of Failure to Thrive

Failure to Thrive (FTT) is a term used to describe a pattern of inadequate growth in children and, less commonly, in adults. For children, this is typically characterized by a sustained pattern of weight loss or a significant deceleration in the rate of weight gain. Instead of being a singular diagnosis like 'strep throat,' FTT is a clinical finding that points to a more complex underlying problem. It is a red flag that indicates a need for deeper medical investigation into why a person is not receiving or processing adequate nutrition to support proper growth and development.

Historically, FTT was categorized as either 'organic' or 'non-organic'. Organic FTT was attributed to an underlying medical condition, while non-organic FTT was linked to psychosocial or environmental factors. However, this distinction is now considered outdated, as the causes of malnutrition are often complex and intertwined, frequently involving both medical and psychosocial elements. For instance, a child with a chronic illness (organic cause) may also experience feeding difficulties due to parental stress (non-organic factor).

Pediatric FTT Criteria and Assessment

For pediatric patients, FTT is often defined by specific anthropometric measurements, though there is no universally accepted definition. Common criteria include:

• Weight for age that falls below the 5th percentile on a standardized growth chart.
• A weight deceleration that crosses two or more major percentile lines on a growth chart.
• A weight-for-length measurement that falls below the 5th percentile.

The diagnostic process relies on a thorough evaluation by a healthcare provider. This involves a detailed history and physical examination to identify potential causes. In many cases, the cause can be identified without extensive laboratory testing, especially when psychosocial or nutritional factors are evident.

• History: A detailed feeding history is crucial, covering aspects like frequency, duration, formula preparation, and any feeding difficulties. Family medical and social history can provide clues about genetic conditions, food insecurity, or parental mental health.
• Physical Exam: Accurate and consistent measurements of weight, height (or length), and head circumference are the first steps. The exam also looks for signs of specific medical conditions, such as heart murmurs, abdominal issues, or physical signs of abuse or neglect.
• Diagnostic Testing: Routine lab work is often unnecessary and rarely yields a diagnosis. Testing is typically targeted based on findings from the history and physical exam. For example, testing for celiac disease might be done if there are symptoms of malabsorption.

Comparison of Potential Causes for FTT

Identifying the etiology of FTT is crucial for effective treatment. The causes are numerous and can often overlap, necessitating a multidisciplinary approach. Below is a comparison of potential contributing factors.

Category of Cause	Examples for Infants and Toddlers	Examples for Older Children and Adults
Inadequate Caloric Intake	Breastfeeding problems, improper formula preparation, food availability issues, caregiver depression, cleft lip or palate.	Mood disorders, eating disorders (ARFID), food insecurity, caregiver-child relationship issues.
Poor Caloric Absorption	Food allergies (e.g., cow's milk allergy), pyloric stenosis, malabsorptive syndromes (cystic fibrosis, celiac disease), severe reflux.	Inflammatory bowel disease, celiac disease, malabsorption, genetic or metabolic disorders.
Excessive Caloric Expenditure	Congenital heart disease, chronic infections, chronic lung disease (e.g., cystic fibrosis), hyperthyroidism.	Cystic fibrosis, thyroid disease, chronic pulmonary disease, malignancy, heart disease.

Adult Failure to Thrive (AFTT)

While FTT is most commonly discussed in pediatrics, a similar pattern of decline exists in older adults. Adult Failure to Thrive (AFTT) is a serious syndrome characterized by unexplained weight loss, diminished appetite, poor nutrition, and reduced physical activity. Like pediatric FTT, AFTT is a clinical syndrome rather than a specific diagnosis. It suggests an underlying problem, which can be due to a combination of physical and mental health issues, such as:

• Chronic disease
• Depression or dementia
• Social isolation
• Malnutrition and nutrient deficiencies

The diagnostic approach for AFTT also focuses on identifying the specific contributing factors. Clinicians must consider potential underlying medical conditions and psychosocial stressors.

Management and Treatment

Since FTT is not a diagnosis but a sign, treatment is not standardized but rather tailored to the identified underlying cause. The primary goal is to ensure adequate nutritional intake to promote catch-up growth and development. A multidisciplinary team, which may include a pediatrician, gastroenterologist, nutritionist, social worker, or feeding specialist, is often involved.

• Nutritional Intervention: The cornerstone of treatment often involves increasing caloric density in the diet. For infants, this may mean adjusting formula preparation, and for toddlers, it could involve limiting nutrient-poor liquids. For adults, nutritional counseling and supplementation are key.
• Treating Underlying Conditions: If a medical condition is identified, such as celiac disease or a heart defect, treating that condition is the priority.
• Psychosocial Support: For cases involving family stress or caregiver issues, support services like home visits or mental health counseling can be vital.
• Monitoring: Close follow-up with the healthcare team is essential to monitor progress and ensure that growth trends are improving.

Conclusion

In summary, the answer to the question, 'Is failure to thrive an actual diagnosis?' is no. Instead, it is a clinical observation or syndrome—a description of a state of insufficient growth that can have myriad causes. For both children and adults, it is a critical warning sign that prompts a comprehensive medical evaluation to uncover the true underlying issue. This multifactorial nature is why healthcare professionals approach it with a broad perspective, investigating biological, psychosocial, and environmental factors. By correctly identifying the root cause, a targeted and effective treatment plan can be implemented to address the nutritional deficiencies and restore a healthy growth trajectory.

Is failure to thrive an actual diagnosis?: FAQs

• Does failure to thrive show up on a growth chart? Yes, failure to thrive (FTT) is typically identified by plotting a child's weight and height on a standardized growth chart. A weight that falls below the 5th percentile or a significant drop across two major percentile lines is a common indicator.
• Can a child recover from failure to thrive? With early identification and appropriate intervention, most children can achieve catch-up growth and developmental milestones. The long-term outcome depends heavily on the cause and how quickly it is addressed.
• Is FTT just a sign of neglect? No, while neglect is a possible contributing factor, it is not the sole cause. FTT can also result from a wide range of medical conditions, genetic syndromes, or difficulties with feeding and nutrition.
• How long does it take to treat FTT? The duration of treatment varies widely depending on the underlying cause and the severity of the undernutrition. It requires ongoing monitoring and can take months to resolve.
• What are the long-term effects of FTT? Untreated or severe FTT can lead to long-term consequences such as short stature, behavioral problems, developmental delays, and learning difficulties. Early intervention is crucial to minimizing these risks.
• What is the ICD-10 code for failure to thrive? For medical billing and coding purposes, failure to thrive does have an ICD-10 code, such as R62.51 for a child or R62.7 for an adult. However, these are often used in conjunction with a more specific code for the underlying condition.
• What is 'organic' vs. 'non-organic' FTT? Organic FTT is caused by an underlying medical condition, while non-organic FTT is caused by psychosocial or environmental factors. This classification is now considered outdated, as most cases are multifactorial and involve a mix of both.

Citations

• American Academy of Family Physicians (AAFP) - Failure to Thrive: An Update: https://www.aafp.org/pubs/afp/issues/2011/0401/p829.html
• American Academy of Family Physicians (AAFP) - Failure to Thrive: A Practical Guide: https://www.aafp.org/pubs/afp/issues/2016/0815/p295.pdf
• NCBI Bookshelf - Failure to Thrive: https://www.ncbi.nlm.nih.gov/books/NBK459287/
• Unbound Medicine - Failure to Thrive | 5-Minute Clinical Consult: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688552/all/Failure_to_Thrive
• Phoenix Children's Hospital - Failure to Thrive (FTT) in Children: https://phoenixchildrens.org/specialties-conditions/failure-thrive-ftt-children
• Children's Hospital of Philadelphia - Failure to Thrive: https://www.chop.edu/conditions-diseases/failure-thrive
• GenHealth.ai - R62.7 - Adult failure to thrive: https://genhealth.ai/code/icd10cm/R62.7-adult-failure-to-thrive
• Freedom Care - Failure to Thrive in the Elderly: https://freedomcare.com/failure-to-thrive-elderly/
• CDC ICD-10-CM - R62.51: https://icd10cmtool.cdc.gov/?fy=FY2022&query=failure%20to%20thrive
• Unbound Medicine - R62.7 - Adult failure to thrive | ICD-10-CM: https://www.unboundmedicine.com/icd/view/ICD-10-CM/947182/all/R62_7___Adult_failure_to_thrive?q=-+adults+childhood+development+expected+lack+normal+physiological+r62
• ICDcodes.ai - Adult Failure to Thrive - ICD-10 Documentation Guidelines: https://icdcodes.ai/diagnosis/adult-failure-to-thrive/documentation
• Cedars-Sinai - Failure to Thrive (FTT) in Children: https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/f/failure-to-thrive-ftt-in-children.html
• American Academy of Family Physicians (AAFP) - Failure to Thrive: A Practical Guide: https://www.aafp.org/pubs/afp/issues/2016/0815/p295.html
• American Academy of Family Physicians (AAFP) - Failure to Thrive: An Update: https://www.aafp.org/pubs/afp/issues/2011/0401/p829.html
• NCBI Bookshelf - Failure to Thrive: https://www.ncbi.nlm.nih.gov/books/NBK459287/
• Cedars-Sinai - Failure to Thrive (FTT) in Children: https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/f/failure-to-thrive-ftt-in-children.html
• Children’s Health - Failure to thrive (FTT) in children: https://www.childrens.com/specialties-services/conditions/failure-to-thrive
• AAPC - ICD-10 Code for Adult failure to thrive- R62.7: https://www.aapc.com/codes/icd-10-codes/R62.7
• American Academy of Family Physicians (AAFP) - Failure to Thrive: https://www.aafp.org/pubs/afp/issues/2003/0901/p879.html/1000
• PMC - Failure to think about failure to thrive: https://pmc.ncbi.nlm.nih.gov/articles/PMC2083320/
• American Academy of Family Physicians (AAFP) - Failure to Thrive: An Update: https://www.aafp.org/pubs/afp/issues/2011/0401/p829.html

Frequently Asked Questions

Is failure to thrive a diagnosis or a symptom?

Failure to thrive (FTT) is a symptom, or a clinical sign, that indicates inadequate growth and undernutrition. It is not a diagnosis itself but rather a description of a child's or adult's physical state, signaling an underlying issue that needs to be identified.

What is the difference between organic and non-organic FTT?

Organic FTT was traditionally defined as being caused by an underlying medical condition, while non-organic FTT was attributed to environmental or psychosocial factors. However, this distinction is now considered outdated, as the causes are often intertwined.

How is FTT typically identified?

FTT is usually identified by a healthcare provider during routine checkups by plotting a patient's weight, height, and head circumference on a standardized growth chart. A consistent pattern of inadequate weight gain over time is a key indicator.

What kind of medical conditions can cause FTT?

Medical conditions causing FTT can include issues with caloric intake (such as pyloric stenosis), poor caloric absorption (like celiac disease or cystic fibrosis), or excessive caloric expenditure (from chronic diseases like heart failure or hyperthyroidism).

Are there environmental factors that can cause FTT?

Yes, environmental factors can cause FTT. These include food insecurity, parental mental health issues like depression, inadequate knowledge of nutritional needs, or problems with the feeding routine and caregiver-child interaction.

Does FTT also occur in adults?

Yes, a similar condition called Adult Failure to Thrive (AFTT) exists and affects older adults. It is characterized by unexplained weight loss, poor appetite, and functional decline, pointing to underlying medical or psychosocial problems.

How is FTT treated?

Treatment for FTT is highly individualized and focuses on addressing the specific underlying cause. It usually involves a combination of nutritional intervention, treating any identified medical conditions, and providing psychosocial support.