Failure To Thrive: A General Pediatrician’s Perspective

Abstract

1. Joseph A. Zenel Jr, MD* 1. 2. *Assistant Professor, Division of General Pediatrics, Doernbecher Children’s Hospital, Oregon Health Sciences University, Portland, OR. 1. Failure to thrive is a sign of unexplained weight loss or poor weight gain in an infant or child. 2. If results of the history and physical examination do not indicate the etiology of failure to thrive, it is unlikely that laboratory testing will reveal the diagnosis. 3. The division of failure to thrive into the categories of organic and nonorganic is too simplistic and overlooks the complex interaction among psychosocial, environmental, neurologic, and anatomic factors. 4. Undernutrition is the immediate underlying cause of failure to thrive; the child must be fed. Most primary care pediatricians will encounter the infant or toddler who, without apparent medical reason, fails to gain weight and possibly height. Efforts to evaluate and treat such patients are time-consuming, expensive, and frustrating if the clinician does not appreciate the idiosyncrasies of failure to thrive (FTT). These include the history of the definition of FTT, its traditional categorization into organic and nonorganic causes, the diagnostic approach, and current thought on its treatment and outcome. Older review articles state that FTT accounts for 1% to 5% of pediatric hospital admissions. National and state surveys suggest that as many as 10% of children seen for primary care show signs of growth failure. In inner-city emergency departments, 15% to 30% of young children receiving acute care show growth deficits. Even though current population-based data are not available, FTT appears to be a common diagnostic challenge. In 1968, Glaser defined FTT as a syndrome characterized by failure of physical growth, malnutrition, and retardation of motor and social development. Frank and Zeisel, in 1988, stated that FTT referred to infants and children whose growth deviated from the norms for their age and gender. As Mathisen noted in 1989, the pattern of growth retardation usually is characterized by low weight and/or length for age or, as …