Failure to Thrive Causes

1. See Also
   1. Delayed Growth
   2. Failure to Thrive
   3. Failure to Thrive Diagnosis
   4. Failure to Thrive Red Flags
   5. Failure to Thrive Evaluation
   6. Failure to Thrive Management
2. Precautions
   1. First define if growth is truly abnormal (See Failure to Thrive Diagnosis)
   2. Failure to Thrive Red Flags suggest organic cause
3. Causes: Normal Physiologic
   1. Half of infants under age 2 shift weight, height by 25%
   2. Familial Short Stature (Short Parents)
      1. Most common reason for Short Stature in children
4. Causes: Nonorganic (80% of cases, no Failure to Thrive Red Flags)
   1. Accidental error in formula preparation or Breast Feeding
      1. Improper feeding technique
      2. Misconception about nutrition needs
      3. Breast fed infants without sufficient caloric intake
      4. Formula too dilute
   2. Economic deprivation or limited access to food
   3. Emotional deprivation
   4. Child neglect
   5. Child Abuse
   6. Caregiver Major Depression
5. Causes: Organic - Insufficient caloric intake
   1. Infant or toddler
      1. Cleft Palate
      2. Choanal Atresia
      3. Pediatric Gastroesophageal Reflux
   2. Child or adolescent
      1. Pediatric Gastroesophageal Reflux
      2. Eating Disorder
      3. Major Depression in Children
6. Causes: Organic - Defect in food assimilation or absorption
   1. Infant or Toddler
      1. Food Allergy (e.g. Cow's milk protein allergy)
      2. Inborn error of metabolism
      3. Giardiasis
      4. Protein losing Enteropathy or other malabsorption
      5. Gastrointestinal malformation
         1. Pyloric stenosis
         2. Biliary atresia
   2. Child or adolescent
      1. Food Allergy
      2. Celiac Disease or other malabsorption
      3. Inflammatory Bowel Disease or other Chronic Diarrhea
      4. Inborn error of metabolism
7. Causes: Organic - Increased energy requirements, expenditure
   1. Malignancy
   2. Congenital Heart Disease
   3. Chronic pulmonary disease (e.g. Severe Persistent Asthma)
   4. Renal disease
   5. Hyperthyroidism
   6. Primary Immunodeficiency
      1. Generalized Lymphadenopathy
      2. Hepatosplenomegaly
      3. Oral Candidiasis
      4. Otitis Media
      5. Pneumonia
      6. Recurrent or Chronic Diarrhea
8. Causes: Organic - Prenatal
   1. Intrauterine infection
   2. Maternal malnutrition
   3. Maternal smoking
   4. Fetal Alcohol Syndrome
   5. Fetal Hydantoin Syndrome
   6. Chromosomal disorders
   7. Dysmorphic syndromes
9. References
   1. Levy (2009) J Pediatr Gastroenterol Nutr 48(3): 355-62
   2. Shah (2002) J Clin Gastroenterol 35(5): 371-4