Failure to Thrive: Current Clinical Concepts

Abstract

1. Arthur C. Jaffe, MD* 1. *Associate Professor, Division of General Pediatrics, Oregon Health & Science University, Doernbecher Children's Hospital, Portland, OR. After completing this article, readers should be able to: 1. Characterize the limitations of the classic dichotomy of “nonorganic” versus “organic” failure to thrive (FTT). 2. Recognize that FTT is not a diagnosis but rather a physical sign of inadequate nutrition to support growth. 3. Know potential sequelae of FTT. 4. Understand how the diagnostic process must account for the multifactorial nature of FTT. 5. Describe a systems-based, multidisciplinary approach to treatment of FTT. 6. Discuss potential adverse effects of nutritional repletion of children who fail to thrive. Failure to thrive (FTT) or growth failure has long been a major focus of attention and critical thought for pediatricians. Over many years, consensus has evolved about its cause, outcome, diagnosis, and management. By the last half of the 20th century, mainstream thinking held that FTT developed by one of two alternative mechanisms. On rare occasions, an underlying medical condition could lead to a failure of growth, which would present as “organic” FTT. In such cases, correct management of this underlying disorder would allow the patient to resume his or her normal growth. However, in most FTT cases, as many as 90% in some series, it was believed that no underlying medical diagnosis could be made. Affected children were said to have “nonorganic” FTT (NOFTT). This term and its synonym, “psychosocial” FTT, were often used as euphemisms to imply that the child was intrinsically normal and healthy and that the observed growth failure was due to environmental issues, most commonly family factors such as neglect, indifference, or other failures of parenting. This construct led to children receiving extensive medical evaluations to rule out diagnosable conditions and to prolonged hospitalizations that …