What is Failure to Thrive (FTT)?
Failure to thrive (FTT), also referred to as "growth faltering" or "weight faltering," is a general medical term used to describe a child whose weight or rate of weight gain is significantly below that of other children of similar age and sex. While it is not a diagnosis in itself, it is a clinical observation that points toward an underlying issue, most often inadequate nutrition. This inadequacy can stem from numerous factors, not just a lack of food, and requires a thorough medical evaluation to identify the root cause.
Clinical Criteria for Diagnosing Failure to Thrive
Pediatricians rely on standard growth charts to identify potential FTT. Instead of a single weight number, a child's growth trajectory over time is evaluated using a combination of anthropometric measurements. Key criteria include a weight for age less than the fifth percentile, a weight-for-length/height ratio less than 80% of the median, or a decrease in weight percentile of more than two major percentile lines on the growth chart. It is important to note that a child who has always consistently tracked along a lower percentile line may be growing normally. The change or decline in the growth curve is often more concerning than a low percentile alone.
Factors Contributing to FTT
The causes of FTT are complex and can be categorized into three main areas: inadequate caloric intake, poor nutrient absorption, and increased metabolic demand. These are often intertwined, and a thorough medical evaluation is needed to pinpoint the root cause.
Inadequate Intake
Insufficient food supply, problems with feeding technique, or developmental or behavioral issues can lead to inadequate calorie intake, which is the most common reason for growth faltering.
Poor Absorption
Conditions such as Cystic Fibrosis, Celiac Disease, or severe food allergies can prevent children from absorbing nutrients properly, even if they consume enough calories.
Increased Caloric Demand
Chronic health conditions like Congenital Heart Disease, chronic infections, or Hyperthyroidism can increase a child's metabolic needs, requiring more calories to maintain growth.
Multidisciplinary Approach for Evaluation and Management
A comprehensive evaluation is essential to determine the cause of FTT and create an effective treatment plan. A team including pediatricians, dietitians, and social workers is often involved. The table below outlines key assessment areas and potential outcomes:
| Assessment Area | Example Evaluation Method | Associated Concerns | Outcomes Addressed |
|---|---|---|---|
| Nutritional | Detailed dietary history, calorie count | Inadequate intake, formula issues, poor food choices | Corrected calorie/nutrient deficits, improved growth trajectory |
| Medical | Physical exam, lab tests (CBC, electrolytes), specialist consultations | Gastrointestinal disorders, chronic illness, genetic syndromes | Treatment of underlying medical cause, restored nutrient absorption |
| Developmental | Milestones assessment, feeding therapy evaluation | Swallowing difficulties, feeding aversion, motor delays | Improved feeding skills, progress toward developmental milestones |
| Psychosocial | Social history, family dynamics, feeding observations | Food insecurity, parental stress, feeding relationship issues | Supportive environment, decreased mealtime stress, access to resources |
Conclusion
Determining what weight is considered failure to thrive involves more than a single number; it's a comprehensive evaluation of a child's growth pattern using standardized charts. FTT is a sign of an underlying problem, encompassing medical, nutritional, and social factors. Addressing these contributing factors through a multidisciplinary approach is vital for supporting healthy growth and preventing long-term complications such as developmental delays.
Keypoints
- FTT is Not a Single Weight: Failure to thrive is not defined by a specific weight number but by a child's growth pattern relative to standard growth charts.
- Growth Deceleration is Key: A weight that crosses downward over two or more major percentile lines is a significant indicator of potential FTT.
- Multiple Factors Contribute: The causes of FTT are complex and can be related to inadequate calorie intake, poor nutrient absorption, or increased metabolic demand.
- A Multidisciplinary Team is Best: Effective management of FTT often requires a team of professionals, including pediatricians, dietitians, and specialists.
- Prompt Intervention is Crucial: Early identification and treatment are essential to prevent potential long-term complications like developmental delays.
