The Pediatric Origin and Controversy
The term "failure to thrive" first appeared in a medical textbook in 1933, used to describe infants and children who were not meeting expected growth milestones. In the mid-20th century, the dominant theory, influenced by psychoanalysis, suggested that the condition stemmed from a lack of maternal affection, a theory that placed the blame squarely on parents. This led to the now-discredited "mother-blaming" era, which stigmatized families rather than seeking underlying medical or nutritional causes.
Moving Beyond Blame
By the 1980s, the medical community began to challenge the psychoanalytic theory, shifting focus toward nutritional and physiological factors. Pediatricians like Dr. Frank, who founded a clinic for children with FTT, recognized the harm of the stigmatizing name. She later changed her clinic's name to the "Grow Clinic" after a donor pointed out the negative connotations. This push for more compassionate and accurate terminology in pediatrics led to alternatives like "growth faltering".
The Term’s Expansion to Geriatrics
In the 1970s, geriatric medicine adopted the term "failure to thrive" to describe a syndrome of progressive decline in older adults. Before this, geriatricians often used informal and pejorative shorthand like "the dwindles". The term was meant to be a more formal description for the complex, multifactorial decline observed in some elderly patients, which can include unexplained weight loss, decreased appetite, physical inactivity, and cognitive impairment.
Why the Term is Problematic in Senior Care
While intended to formalize a syndrome, the term FTT proved to be problematic in geriatrics for several reasons:
- Vague and Nonspecific: Like its pediatric counterpart, FTT in adults is a nonspecific label rather than a diagnosis, often obscuring an underlying, treatable medical problem.
- Minimizes Acute Issues: Using a catch-all term like FTT can lead physicians to underestimate the severity of an older adult's condition, assuming it's part of an inevitable decline. A 2020 study found that older adults admitted to the hospital with a diagnosis of FTT waited significantly longer for care and had longer hospital stays, despite most ultimately receiving specific acute medical diagnoses.
- Implies Inevitable Decline: Critics argue that the term reinforces a fatalistic view of aging, suggesting that decline is a foregone conclusion rather than a treatable condition. As one geriatrician noted, "Maybe it's OK not to thrive when you're in your 90s, but your life is still worth living".
- Contributes to Ageism: By using such a dismissive label, the medical community can inadvertently reinforce ageist stereotypes that portray older adults as frail and past the point of effective intervention.
Comparison of Terminology
| Aspect | Failure to Thrive (FTT) | Frailty | Frailty | Frailty |
|---|---|---|---|---|
| Origin | Pediatrics (1930s), later adopted by geriatrics | Geriatrics (more recent development) | Geriatrics (more recent development) | Geriatrics (more recent development) |
| Definition | A vague, nonspecific syndrome of decline | A measurable clinical condition of decreased physiological reserve and increased vulnerability to stressors | A measurable clinical condition of decreased physiological reserve and increased vulnerability to stressors | A measurable clinical condition of decreased physiological reserve and increased vulnerability to stressors |
| Primary Issue | Risks diagnostic closure and masks underlying acute conditions | Acknowledges increased risk and helps with resource allocation and prognosis | Acknowledges increased risk and helps with resource allocation and prognosis | Acknowledges increased risk and helps with resource allocation and prognosis |
| Impact on Care | Can lead to delays in investigation and treatment | Promotes careful assessment, risk stratification, and patient-centered decision-making | Promotes careful assessment, risk stratification, and patient-centered decision-making | Promotes careful assessment, risk stratification, and patient-centered decision-making |
The Modern Push for Precise Language
In response to these issues, medical professionals are advocating for phasing out the term "failure to thrive" in favor of more precise language.
Why Specificity Matters
Using specific, descriptive language in a patient's chart improves communication and leads to better outcomes. Instead of writing "failure to thrive," a clinician can document specific symptoms and findings, such as:
- Generalized weakness and anorexia: This describes what the patient is experiencing without making an overarching judgment.
- Unexplained weight loss: Highlights a specific clinical sign that requires further investigation.
- Recent functional decline: Indicates a change in the patient's ability to perform daily activities.
- Hypoactive delirium: Precisely identifies a common, serious condition in older adults that can present with vague symptoms.
The Rise of "Frailty"
In geriatrics, the concept of frailty has emerged as a preferred alternative to FTT. Unlike FTT, frailty is a well-defined, measurable geriatric syndrome that captures a patient's increased vulnerability to stressors. Clinicians can use specific screening tools to assess frailty, which helps in risk stratification, guiding medical decision-making, and coordinating resources for more targeted care. This approach fosters a mindset of curiosity and action rather than dismissiveness.
Re-thinking the Approach to Decline
The story of why it's called failure to thrive is a cautionary tale about the power of medical terminology. It demonstrates how a single phrase, born from historical context, can shape clinical practice and patient outcomes for decades. The medical community's growing awareness of the term's shortcomings and the push toward more accurate language like "frailty" marks a significant step forward in providing more compassionate and effective care for both seniors and children.
To dive deeper into the history and implications of this term, read this insightful article on the topic: The New York Times article on FTT controversy.
Conclusion: Beyond the Label
The move away from the term "failure to thrive" is not just a semantic shift; it reflects a deeper evolution in medical practice. By embracing more precise language and structured assessments like frailty scores, healthcare providers can avoid diagnostic shortcuts, investigate underlying conditions more thoroughly, and provide more compassionate, patient-centered care. For families and caregivers, understanding the limitations of this outdated term empowers them to advocate for a more detailed and proactive medical evaluation for their loved ones.
Ultimately, it is a reminder that the language used in medicine profoundly affects how patients are perceived and treated. By choosing words that inform rather than dismiss, clinicians can better serve the needs of a vulnerable population.
