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The definition of failure to thrive is a decelerated or arrested physical growth (height and weight measurements fall below the fifth percentile, or a downward change in growth across two major growth percentiles) and is associated with poor developmental and emotional functioning (Children’s National Health System 2019).
There are two types of failure to thrive, which are organic and non-organic. Organic failure is caused by a medical condition or issue and non-organic, which can be psychosocial is a child who is younger than two year old that has no known medical condition that causes poor growth.
Pathophysiology
The pathophysiology of failure to thrive depends on the underlying etiology. However, at its core is a lack of necessary calories for adequate growth. This could stem from inadequate calorie intake, losing too many calories, or increased caloric demand. There are multiple formulas available for calculating caloric needs based on age and gender that can be helpful for catch-up growth once the underlying etiology is identified (Smith & Badireddy 2019).
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Epidemiology
Failure to thrive is most common in infants and younger children. Gender or race are not a predisposition. Failure to thrive has been associated with lower socioeconomic status, lower parental education level, and with other increased psychosocial stressors in the home environment (Smith & Badireddy 2019).
Physical Exam Findings
In a history and physical it is important to identify any congenital abnormalities such as known congenital heart disease, esophageal abnormalities, intestinal abnormalities, endocrine disorders, and genetic disorders (Smith & Badireddy 2019). Family history should fully be taken and feeding history of the patient as well. Carefully assessing for any hints to an organic etiology such as an oral motor dysfunction, heart murmur, tachypnea, abnormal abdominal or genitourinary (GU) exam, or prominent skin lesions is essential. Often, the exam will be notable only for the poor weight gain and a thin appearing infant without providing any specific clues to the underlying cause (Smith & Badireddy 2019).
In order to manage this condition it is important to note the underlying etiology that addresses the inability to gain weight or calorie deficit. For patients with feeding refusal or inability to consume enough calories, nasogastric tubes as a short term option and gastrostomy tubes for a long term option are sometimes needed.
Parenteral nutrition is a last resort. For patients with increased caloric demands, working with nutritionists to prescribe a high-calorie diet that is appropriate for the patient is essential. Establishing specific meal times and routines can help with toddlers who have difficulty feeding as well as minimizing fruit juices and empty calories is also helpful (Smith & Badireddy 2019). Psycho social issues like alcohol abuse, family environment, parental education, and post-par-tum depression needs to also be evaluated. Restoring weight gain in these patients is essential.
References
- Children’s National Health System (2019). Pediatric poor growth failure to thrive. Retrieved from https://childrensnational.org/choose-childrens/conditions-and-treatments/stomach-digestion-gi/poor-growth-failure-to-thrive
- Smith A. E & Badireddy M. (2019). Failure To Thrive. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459287/
