Definition 

Failure-to-thrive is a term used to describe a child who is not growing as expected. But, it is not the same as normal growth in a child who is small for his or her age. The exact definition is not completely agreed upon.

In general, failure-to-thrive means that a child:

  • Is at or below the 3rd to 5th percentile for height and weight, or
  • Has failed to grow as expected, as shown by dropping two growth percentiles (For example, the child goes from the 75th percentile to below the 25th percentile.)

Types include:

  • Organic failure-to-thrive—caused by some other medical condition
  • Nonorganic failure-to-thrive—occurs in children with no known medical condition
  • Mixed failure-to-thrive—occurs when the child has features of both organic and nonorganic failure-to-thrive

Causes 

Causes include:

Risk Factors 

A risk factor is something that increases your chance of getting a disease or condition.

  • Untreated medical conditions
  • Poverty, including lack of available food
  • Poor parenting skills
  • Depression in the parent
  • Severe family stress

Symptoms 

Symptoms include:

  • Slowed growth in a young child, including height and weight
  • Slowed development, including late rolling, sitting, crawling, standing, walking, and talking
  • Small muscles
  • Weakness, low energy
  • Hair loss
  • Loose folds of skin
  • Other symptoms related to an underlying medical condition

Diagnosis 

Failure-to-thrive is diagnosed based on tracking a child's growth. The doctor will plot a child's weight, height, and head circumference on standard growth charts. If the child falls below a certain weight range or drops two percentiles on the growth chart, the doctor will evaluate the child further.

If a medical condition may be the cause, the doctor will order further tests. Tests may include:

  • Blood tests
  • Urine tests
  • Blood lead level
  • HIV test
  • Thyroid tests
  • Sweat-chloride test
  • Gastrointestinal x-rays
  • X-rays of the gastrointestinal tract, skeletal survey, bone age

Sometimes, a child must be hospitalized for a period of time to find the cause of failure-to-thrive. During this time the doctor will:

  • Monitor the relationship between parent and child, paying particular attention to their behavior around feeding
  • Set up a feeding schedule with an adequate amount of calories
  • Make sure that an appropriate feeding technique is used

If the child can gain weight under these circumstances, this supports the diagnosis of nonorganic failure-to-thrive.

Treatment 

Treatment may include:

Treating a Medical Condition 

Treating the underlying medical condition may correct failure-to-thrive.

Providing Extra Calories 

Children who are malnourished may need liquid supplements to help boost their weight and nutrition.

Parent Training 

When a child is hospitalized for diagnosis, the hospital staff can also provide treatment. Nurses can teach parents appropriate feeding techniques and how to best interact with their child. If the child isn't hospitalized, parents can still have training sessions with a nutritionist or a nurse.

Counseling 

Parents and children who are having difficulty with their relationship may benefit from counseling.

Prevention 

To help prevent failure to thrive:

  • Take children to the doctor regularly to have their growth checked. This helps detect and treat failure-to-thrive before it becomes severe.
  • Develop a good relationship with your child's doctor.
  • Ask the doctor about proper parenting and nutrition for early in a baby's life.
  • Encourage at-risk parents to attend parent-training sessions. At-risk includes:
    • Known depression in the parent
    • Lack of understanding about basic childcare issues
    • Poverty