Failure to Thrive: Overview of Diagnosis and Management

Abstract

Failure to thrive (FTT) is a common and potentially serious growth problem identified in the first three years of life, affecting 5% to 10% of children seen in the primary care setting (Schwartz, 2000). It accounts for 5% to 10% of referrals to (Daniel et al., 2008) and 1% of hospital admissions in tertiary care centers (Berwick et al., 1982). Although FTT is relatively common, there seems to be no consensus regarding its definition (Raynor & Rudolf, 2000). The term is most often used to describe persistently inadequate linear growth and/or weight gain within the first three years of life (Schwartz, 2000). FTT is a sign or finding rather than a diagnosis since it simply represents an abnormal growth pattern in young children. The underlying condition causing FTT might be difficult to determine, requiring a thorough history and physical examination with special attention to dietary and psychosocial factors. It requires close monitoring by the primary physician. Poor growth or poor weight gain in children may be due to a variety of medical or psychosocial problems. Therefore, monitoring growth is an invaluable tool for primary care physicians and should be done vigilantly at every well-child visit. Growth charts are useful in comparing a child to appropriate standards for age, sex and ethnic background. If any abnormality in the growth pattern is detected, necessary measures should be undertaken to ensure appropriate evaluation for and treatment of any underlying condition. Long-term FTT without significant underlying organic etiology has been shown to negatively impact neurodevelopmental outcome (Hufton et al., 1977). Studies have shown that five to eight years after a FTT diagnosis these children show disorders of personality trait, have decreased educational attainment and demonstrate lower IQ’s despite having average anthropometric parameters at the time of evaluation (Hufton, et al., 1977). Therefore, early diagnosis and intervention are believed to be key factors in improving outcome in children with FTT (Casey et al., 1994). In the absence of effective treatment, children with FTT may develop irreversible cognitive and behavioral disorders that seem to correlate with the severity and duration of the FTT. However, other studies have reached the opposite conclusion. In a review and analysis of thirteen studies, there seemed to be no significant difference in the IQ of patients with failure to thrive compared to the general population (Wright et al., 1998). This discrepancy in outcome is probably due to the lack of large, randomized, controlled studies in children with FTT.