Failure to Thrive

Aka: Failure to Thrive, Failure to Thrive in Children, Pediatric Failure to Thrive, Weight Faltering, Growth Faltering, FTT

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II. Definitions

  1. Growth Faltering (previously known as Failure to Thrive)
    1. Inadequate weight gain (or Weight Faltering) over time
    2. Malnutrition due to inadequate Caloric Intake or absorption, or excessive caloric expenditure

III. Epidemiology

  1. Incidence
    1. Hospitalized children <2 years: 1-5%
    2. Families with Medical, psychosocial problems: 10%

IV. Risk Factors

  1. Low socioeconomic status
  2. Children of Refugees
  3. Children with Developmental Delay
    1. Autism associated feeding difficulties are common (RR 4)
  4. Low birth weight
  5. Intrauterine Growth Retardation (IUGR)
  6. Gastrointestinal Disorders
  7. Congenital Disorders
  8. Chronic Infections (e.g. HIV Infection, Tuberculosis)

V. Causes

  1. Failure to Thrive Causes

VI. Signs

  1. Weight is affected first by Malnutrition
  2. Length and Head Circumference affected in severe cases
  3. Cognition and failure to meet Developmental Milestones may occur in very severe cases

VII. Diagnosis: Growth Faltering (Failure to Thrive)

  1. See Growth Faltering Diagnosis (Failure to Thrive Diagnosis)
  2. Growth Faltering Screening relies on accurately recorded weight and height on growth chart over time
    1. Weight below 5th percentile for gender and Corrected age OR
    2. Weight for Length <5th percentile OR
    3. BMI for age <5th percentile OR
    4. Decreased Growth Velocity with Weight for Length falling by more than 2 major percentile lines
  3. Growth Faltering Diagnosis is based on anthropometric Z-Scores
    1. Z Scores are calculated from Weight for Length or BMI for age and range from -3 to +3
    2. Negative Z Scores represent lower than expected weight
    3. More negative values represent more severe Malnutrition (-1=mild, -2=moderate, -3=severe)
    4. Drop in Z-Score over time is also used to determine severity (drop of 1 = mild, drop of 2 = moderate, drop of 3 = severe)
  4. Resources
    1. Z-Score for ages 0 to 2 years (WHO)
      1. https://peditools.org/growthwho/
    2. Z-Score for ages 2 to 20 years (CDC)
      1. https://peditools.org/growthpedi/

VIII. Evaluation

  1. See Failure to Thrive Evaluation
  2. See Growth Assessment

IX. Management

  1. See Failure to Thrive Management

X. Prognosis

  1. Nonorganic Failure to Thrive risks poor outcomes
    1. Risk of cognitive delay and school difficulty
      1. Lower Wechsler Intelligence Scale for Children
      2. Poorer language development and reading skills
    2. Social immaturity
      1. More frequent behavior problems
  2. References
    1. Oates (1985) Pediatrics 75:36 [PubMed]

XI. References

  1. Cole (2011) Am Fam Physician 83(7): 829-34 [PubMed]
  2. Gahagen (2006) Pediatr Rev 27(1): e1-11 [PubMed]
  3. Goodwin (2023) Am Fam Physician 107(6): 597-603 [PubMed]
  4. Homan (2016) Am Fam Physician 94(4): 295-9 [PubMed]
  5. Shah (2002) J Clin Gastroenterol 35(5):371-4 [PubMed]

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Related Studies

Ontology: Failure to Thrive (C0015544)

Definition (MSH) A condition of substandard growth or diminished capacity to maintain normal function.
Definition (CCC) Inability to grow and develop normally
Definition (NCI) A clinical finding indicating less than normal growth in infancy.
Definition (PSY) Growth disorder of infants and children due to nutritional and/or emotional deprivation and resulting in loss of weight and delayed physical, emotional, and social development.
Concepts Disease or Syndrome (T047)
MSH D005183
ICD9 783.41
ICD10 R62.51
SnomedCT 206927009, 54840006, 433476000, 158280000
LNC LP36298-5, MTHU019355
English Thrive, Failure to, FAILURE TO THRIVE, [D]Failure to thrive, [D]Failure to thrive (context-dependent category), failure to thrive (diagnosis), failure to thrive (history), failure to thrive, Failure to thrive in infant, Failure to thrive in infant (disorder), Failure To Thrive, Failure-to-thrive, Failure to thrive-child, Failure to thrive (child), Failure to Thrive [Disease/Finding], rndx failure to thrive (diagnosis), rndx failure to thrive, failure to thrive syndrome, failure-to-thrive, growth failure, Infant Failure to Thrive, [D]Failure to thrive (situation), Failure to thrive syndrome, Failure to Thrive in Infant, Failure to thrive, FTT - Failure to thrive, Failure to thrive (disorder), defective; thrive, thrive; failure, Failure to Thrive
Italian Ritardo nella crescita, Deficit di accrescimento ponderale
French Absence de croissance, TROUBLES DE LA SENSIBILITE THERMI, Syndrome de glissement, Retard de croissance staturo-pondérale
German Gedeihstoerung, SCHLECHTES GEDEIHEN, schlechtes Gedeihen, Gedeihstörung
Portuguese Falta de desenvolvimento geral, ATRASO DE CRESCIMENTO, Insuficiência de desenvolvimento geral, Insuficiência de Crescimento
Japanese 成長障害, ｾｲﾁｮｳｼｮｳｶﾞｲ
Swedish Tillväxthämning
Spanish [D]falta de progreso (categoría dependiente del contexto), retraso del desarrollo (trastorno), falta de progreso en el lactante, falta de progreso, retraso del crecimiento, falta de progreso (trastorno), falta de progreso en el lactante (trastorno), retraso del desarrollo, [D]falta de progreso, [D]falta de progreso (situación), Retardo en el Desarrollo Físico, Fracaso para prosperar, Insuficiencia de Crecimiento
Czech růst - neschopnost vývoje, Neprospívání, neprospívání
Finnish Lapsen huono menestyminen
Russian FIZICHESKOGO RAZVITIIA DETEI OTKLONENIIA, DETEI FIZICHESKOGO RAZVITIIA OTKLONENIIA, DETI, FIZICHESKOGO RAZVITIIA OTKLONENIIA, OSTANOVKA V VESE DETEI, PLOKHOE PRIBAVLENIE V VESE DETEI, ПЛОХОЕ ПРИБАВЛЕНИЕ В ВЕСЕ ДЕТЕЙ, ОСТАНОВКА В ВЕСЕ ДЕТЕЙ, ДЕТЕЙ ФИЗИЧЕСКОГО РАЗВИТИЯ ОТКЛОНЕНИЯ, ДЕТИ, ФИЗИЧЕСКОГО РАЗВИТИЯ ОТКЛОНЕНИЯ, ФИЗИЧЕСКОГО РАЗВИТИЯ ДЕТЕЙ ОТКЛОНЕНИЯ
Polish Niedomoga rozwoju fizycznego, Niedomoga wzrastania, Rozwój niedostateczny
Hungarian Növekedési elégtelenség
Norwegian Manglende vekst og trivsel, Mistrivsel, Manglende tilvekst
Dutch gebrek; gedijen, gedijen; gebrek, niet goed groeien, Vertraagde groei
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pediatric failure to thrive (C2315100)

Definition (NCI) A clinical finding indicating less than normal growth in an infant or child, or a state of global decline in an adult.
Definition (NCI) Less than normal weight gain in an infant or child, which may include poor linear and head growth.
Concepts Finding (T033)
SnomedCT 432788009
English Paediatric failure to thrive, Pediatric failure to thrive, Pediatric failure to thrive (disorder), Failure to Thrive, Pediatric Failure to Thrive
Spanish falta de progreso pediátrico (trastorno), falta de progreso pediátrico
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pediatrics

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