Nonorganic Failure To Thrive Research Articles

Characteristics and Outcomes of Failure to Thrive in Pediatric Patients Referred to the King Abdulaziz Medical City Pediatric Clinic.

Failure to thrive (FTT) in pediatric populations is a diagnostic challenge with implications for growth and development. Despite its prevalence, detailed epidemiological data, especially concerning organic versus non-organic etiologies, are sparse.This study examines the prevalence, characteristics, and outcomes of organic and non-organic FTT in a pediatric outpatient setting at King Abdulaziz Medical City, Jeddah. This retrospective chart review included pediatric patients aged three months to 14 years diagnosed with FTT at KAMC from 2016 to 2023. FTT was defined by weights below the 3rd percentile or a decline across two major growth percentiles. Patients were stratified into organic and non-organic FTT groups based on predefined criteria. Prevalence rates, clinical characteristics, and outcomes were compared to draw distinctions between the two categories. Out of 349 evaluated patients, organic FTT was present in 160 patients (45.8%), with gastrointestinal conditions and endocrine disorders being the most common etiologies. Non-organic FTT, accounting for 189 (54.2%) of cases, was primarily associated with inadequate nutritional intake and behavioral factors. Notably, the non-organic FTT group exhibited a significantly higher rate of condition resolution (45.0%) compared to their organic counterparts (32.5%). Furthermore, significant laboratory parameter differences were noted, indicating a higher white blood cell count in organic cases, among other findings. Non-organic FTT was more prevalent and demonstrated higher resolution rates, suggesting better outcomes with timely intervention and appropriate care strategies. The study advocates for increased educational efforts for caregivers and healthcare providers and calls for further research to explore effective management protocols for FTT.

Biopsychosocial characteristics of children admitted with failure to thrive.

The aim of this study was to characterise and compare the biopsychosocial characteristics of children admitted with failure to thrive (FTT), subdivided into those with underlying medical complexities (categorised as organic FTT - OFTT) and those with none (categorised as non-organic FTT - NOFTT), with a focus on the medical, nutritional, feeding skills and psychosocial domains. A retrospective review of medical records was conducted in children admitted with FTT from January 2010 to December 2020. Descriptive statistics were used for data analysis. A total of 353 children were included, with the mean age of presentation 0.82 ± 2.05 years (OFTT 1.16 ± 2.50 years, NOFTT 0.49 ± 1.41 years, P = 0.002). Approximately, half of the children were classified as having OFTT. These children had lower birth weights, were more likely to have a history of intrauterine growth restriction and had longer hospital stays. The NOFTT group had significantly more abnormal feeding strategies identified in their caregivers, whereas the OFTT group had more delayed feeding skills and oral aversion. There was no significant difference in psychosocial domains, with both groups having a comparably high risk of abuse and neglect. The classification of FTT as non-organic or organic based purely on psychosocial parameters did not reflect the complex nature of FTT within our local population. These groups had different medical variables, and caregiver feeding strategies. A multidisciplinary team approach is recommended for the assessment and intervention for children with FTT to address these domains and the complex interactions between them.

Failure to Thrive (FTT)- Causes and Treatments

Since past 6 million years, humans and their ancestors have been walking on this biosphere. As the humans developed so does the environment, and along with them myriad diseases, disorders as well different medical conditions also flourished. Covid-19 is one of the recent and well know example of the pandemic viral diseases. Every year thousands of humans succumbed to death who were suffering from different diseases or disorders. But comparatively, the death rate of the affected persons from diseases or disorders is more than those who are suffering from some medical conditions. One of that is Failure to Thrive which is mostly referred as FTT. In general practice, FTT is commonly used for any child who fails to gain weight or height according to standard medical growth charts. FTT occurs when a child is either not receiving adequate calories or is unable to properly utilize the calories that are given, resulting in failure to grow or gain weight over a period. About 3% - 5% of children admitted to hospitals suffers from this condition. The FTT is of two types, one is “organic” and other one is “non-organic”. Organic FTT refers to growth failure caused by an acute or chronic medical illness that interferes with regular food intake, absorption, or digestion of food, or by a higher calorie need to keep up with or aid growth. Whereas most babies with FTT do not have a specific underlying disease or medical condition to account for their growth failure. This is referred to as Non-organic FTT. Up to 80% of all children with FTT have non-organic type FTT. Non-organic FTT most commonly occurs when there is inadequate food intake or there is a lack of environmental stimuli. Lack of food intake owing to the issues with feeding procedures, or an insufficient supply of breast milk are all examples of non-organic FTT. The best indication of nutritional status is weight. Obtaining your child's height is also vital; however, a single height measurement is less useful for the diagnosis of FTT than numerous height measures taken over time. Linear growth may be impacted in malnourished children, although this typically reflects a protracted period of low nutrition. Majority of children with non-organic FTT exhibit growth failure in their first year of life and seek medical attention around the age of six months. The time of presentation in children with organic FTT is more varied and depends on the child's underlying medical condition. Treatment The treatment of failure to thrive is determined by the child's age, the related symptoms, and the underlying cause of the poor growth. The general objective of therapy is to offer appropriate calories and any additional assistance required to encourage child's growth. If the kid is experiencing organic failure to thrive, extra therapy may be required to treat the underlying medical issue. Intestinal problems, for instance, might result in inadequate dietary absorption and failure to flourish. In that case, a particular diet may be required. Failure to thrive can occur in twins or triplets simply because multiple births are more difficult to care for and are more demanding to the feed. Premature births are more likely to have FTT because many of the physiological and biochemical processes are still immature at the birth. Lung or heart illness, particularly in very young babies, can make feedings difficult, resulting in low calorie intake and failure to grow.

Micronutrients Are Not Deficient in Children with Nonorganic Failure to Thrive.

PurposeInadequate calorie intake is one of the most important causes of nonorganic failure to thrive (NOFTT) and is thought to lead to multiple micronutrient deficiencies. However, there have been few studies on NOFTT and micronutrients. The aim of this study was to evaluate the micronutrient status of children with NOFTT.MethodsWe conducted a retrospective cohort study in 161 children (106 with NOFTT and 55 health controls) at a single institution. Data on weight for age, height for age, body mass index, and biochemical parameters, indicating the children's nutritional and micronutrient status were reviewed via electronic medical records, and the two groups were compared.ResultsExcept inorganic phosphate levels, no statistically significant differences were seen in the laboratory findings indicating the children's nutritional and micronutrient status; notably, the inorganic phosphate levels were within the normal range in both groups. We then compared the severe NOFTT (weight for age below the first percentile) and control groups; however, no statistically significant differences were seen for any of the measured parameters.ConclusionMost children with NOFTT in this study had normal micronutrient levels and other laboratory findings. Therefore, element deficiencies should not be considered a natural consequence of NOFTT or in healthy children. Close monitoring and additional evaluations are needed.

Effects of oral zinc supplementation on zinc status and catch-up growth during the first 2 years of life in children with non-organic failure to thrive born preterm and at term

BackgroundWe aimed to analyze the effect of oral zinc supplementation on serum insulin-like growth factor-1 (IGF-1) levels and catch-up growth in infants with non-organic failure to thrive (NOFTT) who were born preterm as compared to those born at term. MethodsTotally, 105 NOFTT infants aged 2 years or less were enrolled and divided into two groups according to gestational age at birth. Oral zinc sulfate was administered for 6 months to 49/66 children born at term, and 21/39 children born preterm. Serum zinc, IGF-1, weight, and height were measured at baseline and at 6 months. ResultsThere were no differences in baseline serum zinc levels between the two groups. In preterm NOFTT infants, zinc supplementation significantly increased serum zinc levels compared to those in the non-supplementation group (Δ zinc 0–6 month 10.3 ± 26.4 μg/dL vs. −8.8 ± 23.7 μg/dL, p = 0.018), but it did not significantly change serum IGF-1 levels or weight- and height for age Z-scores. In NOFTT infants born at term who received zinc supplementation, serum zinc levels, IGF-1, weight for age Z-score, and height for age Z-score increased at 6 months (p = 0.001, p = 0.014, p = 0.049, and p = 0.029, respectively), but this increase was not significantly greater than in the non-supplementation group. Only the increase in serum zinc levels was significant after 6 months (Δ zinc 0–6 month 16.8 ± 32.0 μg/dL vs. −10.0 ± 22.6 μg/dL, p = 0.002). ConclusionZinc supplementation in NOFTT infants improves serum zinc status, regardless of gestational age at birth. Zinc supplementation in NOFTT infants born at term may improve serum IGF-1 levels and growth, but it does not in NOFTT infants born preterm. Overall nutritional support rather than supplementation of a single nutrient may be more effective for catch-up growth in NOFTT infants born preterm.

Preliminary findings on the association between attachment patterns and levels of growth hormone in a sample of children with non-organic failure to thrive

Deficiency of growth hormone (GH) in absence of pituitary injuries is one of the causes of short stature and of the non organic failure to thrive (NOFTT) condition. Advances in developmental psychology have highlighted the role of emotions and caregiving behaviors in the organization of child’s personality and psychobiology, with the mother-son attachment bond being considered a fundamental developmental experience. The objective of the present preliminary study was to assess whether there are significant correlations between attachment patterns and GH levels in a sample of subjects with NOFTT. Overall, 27 children (mean age 9.49±2.63 years) with NOFTT were enrolled. Perceived attachment security was assessed through the Security Scale (SS) and its subscales focused on maternal and paternal security. Pearson partial correlation was used to test associations between GH levels and SS measures adjusting for confounding factors (i.e. age, gender and body mass index). Across all subjects, GH was significantly positively correlated with general security (r=0.425; p=0.038) and maternal security (r=0.451; p=0.027) and not significantly correlated with paternal security (r=0.237; p=0.264). These findings preliminarily suggest that the association between GH levels and perceived attachment security may play a role in the pathophysiology of NOFTT and add to the accumulating evidence that attachment patterns may be related with specific psychoendocrine underpinnings.

Exploring the correlation between perceived attachment security and levels of GH hormone in a sample of children with non-organic failure to thrive: Preliminary findings

IntroductionShort stature caused by growth hormone (GH) deficiency is one of the causes of the “Failure to Thrive” (FTT) condition. In absence of clear organic causes, several different psychosocial conditions may play a role in explaining the FTT phenotype. Advances in developmental psychology have highlighted the role of emotions and caregiving behaviors in the organization of child's personality and psychobiology, with the mother–son attachment bond being considered a fundamental developmental experience. The objective of the present preliminary study was to assess whether there are significant correlations between attachment styles and GH levels in a sample of subjects with non-organic FTT.MethodsWe enrolled 27 children (mean age: 9.49 ± 2.63) with non-organic FTT. Perceived attachment security was assessed through the Security Scale (SS) and its subscales focused on maternal and paternal security. Pearson partial correlation was used to test associations between GH levels and SS measures adjusting for confounding factors (i.e. age, gender and BMI).ResultsAcross all subjects, GH was significantly positively correlated with general security (r = 0.425; P = 0.038) and maternal security (SSM) (r = –0.451; P = 0.027) and not significantly correlated with paternal security (SSP) (r = 0.237; P = 0.264).DiscussionThese findings preliminarily suggest that perceived attachment security may play a role in the etiopathogenesis of non-organic GH deficiencies and add to the accumulating evidence that attachment styles are associated with specific psychoendocrine underpinnings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Hospitalization for Failure to Thrive: A Prospective Descriptive Report.

Failure to thrive (FTT) is a common symptom leading to hospitalization of children. Most literature describing this population is from 30 years ago. Since that time the hospitalized population has become more medically complex. We aimed to describe children hospitalized for FTT in a tertiary care pediatric hospital. We prospectively collected demographic, anthropometric, evaluation, and outcome data for 92 consecutive children admitted with FTT. The majority of children grew with behavioral interventions alone (primary nonorganic FTT) and had negative evaluation (n = 63). Children with primary organic FTT had longer hospital stays (7 vs 4 days; P < .001) and lower daily weight gain (35 vs 58 g/d; P < .001). Laboratory, radiological, and endoscopic evaluation rarely led to a diagnostic etiology of FTT in hospitalized children. We conclude that children hospitalized with FTT should be observed for weight gain prior to pursuing diagnostic investigation.

Serum and Hair Mineral Levels in Children with Failure to Thrive According to the Type of Feeding Difficulties.

This study evaluated serum and hair mineral and trace element levels as well as levels of other nutritional factors affecting growth and appetite in young children with non-organic failure to thrive (NOFTT) based on the presence or types of feeding difficulty (FD). Between August 2012 and July 2015, 136 children less than 6years of age with NOFTT were included. FD was diagnosed based on Wolfson criteria and divided into subtypes according to Chatoor's classification. Clinical data were reviewed, and serum and hair mineral levels were measured. Of all assessed serum and hair minerals, only hair sulfur contents differed significantly between subjects with and without infantile anorexia (39,392± 2211 vs. 40,332 ± 2551μg/g, P =0.034). There were no differences in serum and hair mineral levels between children with and without sensory food aversion. Hair copper contents were significantly lower in children with FD of reciprocity (12.3±6.0 vs. 22.4±25.1μg/g, P =0.049). While hair zinc contents were also lower, the difference was not statistically significant (49.2±26.8 vs. 70.6±41.0μg/g, P =0.055). Only hair manganese contents were significantly lower in children with posttraumatic FD (0.12±0.04 vs. 0.26±0.73μg/g, P =0.037). In conclusion, there were no differences in most serum and hair mineral levels in children with NOFTT, except for relatively lower hair levels of sulfur, copper and possibly zinc, and manganese in infantile anorexia, reciprocity, and posttraumatic types of FD, respectively.

Clinical Characteristics of Failure to Thrive in Infant and Toddler: Organic vs. Nonorganic

PurposeTo investigate the clinical characteristics and outcomes among infants and toddlers with failure to thrive (FTT).MethodsThis retrospective study was done with 123 patients who had visited Pusan National University Children's Hospital during their first two years of life and had received an FTT diagnosis. We compared the clinical characteristics of the patients based on the causes of their FTT and their ages at the time of first hospital visit. We investigated triggering factors, feeding practices, and outcomes in 25 patients with nonorganic FTT (NOFTT).ResultsEighty cases (65.0%) were NOFTT. The gestational ages, birth weights, and weights at the first visits were significantly lower in patients with organic FTT (OFTT) (p<0.05). Infants who had first visited the clinic at age <6 months had the least z-score. The percentage of patients with severe weight decline was higher in OFTT than in NOFTT (60.0% vs. 17.3%). The z-scores at the follow-up visits were improved after treatment in both of the groups. Preceding infection was the most common triggering factor of NOFTT and persecutory feeding as abnormal behavior of caregiver was observed in 22 cases (88.0%). After treatment with feeding method modification, all patients with NOFTT showed normal growth.ConclusionWeight decline is more severe in OFTT patients and in younger patients at the first visit. Infants with FTT can attain normal weight gain growth by treating organic diseases and supplying proper nutrition in OFTT, and by correcting abnormal dietary behavior of caregiver in NOFTT.

Clinical approaches to failure to thrive of infants and toddlers: a new paradigm

Failure to thrive (FTT) is a term used to describe growth failure in infants and toddlers. The three categories of FTT are based on anthropometric measurements of weight, length, and head circumference for age. Type 1 FTT is the failure to gain weight due mainly to inadequate nutrition. Type 2 FTT is a clinical condition associated with short stature induced by endocrine or genetic factors. Type 3 FTT results from chromosome anomalies or central nervous system abnormalities. Pediatric endocrinologists may be involved in treating patients with short stature of type 2 FTT. Pediatric gastroenterologists may be interested in patients with malnutrition of type 1 FTT, and pediatric psychologists may play a major roll in treating those with non-organic FTT or feeding disorders. This review introduces a new paradigm of clinical approaches to FTT in infants and toddlers to emphasize the importance of multidisciplinary clinical approaches to FTT.

Failure to Thrive: Current Clinical Concepts

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 …

Psychosocial dwarfism: Psychopathological aspects and putative neuroendocrine markers

There exists an extensive terminology for defining the situation of children who, in varying circumstances, suffer from affective deprivation (AD), within an unsatisfactory family situation or in institutions. Nevertheless, the neuroendocrine mechanisms (if they exist) determining it have yet to be identified. Our objective was to determine if specific neuroendocrine markers, all of them previously implicated in affective disorders, could be modified, and in which sense, in affective deprivation syndrome of the child. For this purpose, we studied three separate groups of children: (1) control group (CG); (2) children suffering from AD; and (3) children with non-organic failure to thrive (NOFT). In every case, we studied the serum levels of melatonin, serotonin, β-endorphins and adrenocorticotropic hormone (ACTH); and kynurenine pathway tryptophan metabolites (both during the day and at night). Significantly, there was a conspicuous reduction in the levels of each of the neuroendocrine markers (melatonin, serotonin, β-endorphins and ACTH) in the group suffering from affective deficiency, a diminution which was even more noticeable in the group of patients presenting delayed growth. Furthermore, as also occurs in other affective disorders, there were corresponding modifications in the metabolisation of tryptophan. We report the existence of neuroendocrine mechanisms that are associated with the above-mentioned clinical manifestations in these patients, mechanisms that may underlie the close connection existing between AD syndrome and the cause of NOFT. These data suggest that the AD syndrome and NOFT comprise a single process, but one with a different evolutionary continuum of psychosocial dwarfism.

Bovine Colostrum in the Management of Nonorganic Failure to Thrive: A Randomized Clinical Trial

The objective of the study was to evaluate the clinical efficacy of oral bovine colostrum in the management of nonorganic failure to thrive (FTT). In a randomized clinical trial, 120 children (1-10 years of age) of either sex with mild or moderate nonorganic FTT were divided into 2 groups. Both groups were matched with regard to age, sex, weight, and height. One group (control) received routine treatments for FTT and the other group (case), besides routine treatments, received supplementary bovine colostrum at the dose of 40 mg . kg . day for a 3-month period. Following the initial visit, subsequent visits were completed following 1, 2, and 3 months of supplementation. For quantitative measurements, Waterlow I (height for age) and Gomez (weight for age) indices were used. The mean value of Gomez index in the case group (81.72) was significantly higher than the control group (77.12) at the end of the third month of supplementation (P = 0.003). Such a difference was not reported based on Waterlow I index between the case and control groups (92.91 vs 91.71; P = 0.094). According to Gomez index 12 patients (20%) who received colostrum became healthy at the end of the third month, which was significantly higher than the control group (2 cases, 3.3%); P = 0.006. Bovine colostrum supplementation for a 3-month period is a useful method without any side effects, in addition to known medical and psychological treatments, to increase the weight of children with nonorganic FTT.

‘Failure to thrive’ revisited

AbstractThe term ‘non‐organic failure to thrive’ (FTT) has long been used in relation to young children with faltering growth for which no organic cause is found. In this paper, problems arising from dichotomised organic/non‐organic responses to FTT are explored and reasons for the assumption that non‐organic FTT was always due to emotional abuse or neglect are presented. The case is made that, except in a minority of cases, children fail to grow because they consume insufficient calories. Research studies on reasons for poor intake, from factors related to the child and their parents to the wider family and environment, are summarised. Following a brief reference to literature on outcomes, I argue that centile charts should be routinely completed for all young children. If faltering growth is identified, a multi‐factorial assessment should be undertaken. Such an assessment reduces the risk of interventions being based on outdated assumptions about non‐organic FTT and maximises the potential for successful resolution of poor growth. After briefly summarising the literature on interventions, I conclude with suggestions for improving practice in this field, including working in partnership with families and with health and social care professionals already known to them. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Inhibition of Milk Ingestion and Growth After Administration of a Neutral Cannabinoid CB1 Receptor Antagonist on the First Postnatal Day in the Mouse

We have shown previously that neonatal exposure to the cannabinoid CB1 receptor antagonist/inverse agonist rimonabant (SR141716) interfered with suckling and development. However, it was not clear whether the developmental deficiencies were induced by neutral CB1 receptor blockade, thereby inhibiting endogenous cannabinoid "tone," or by inverse agonist reduction of constitutive CB1 receptors. CB1 receptor blockade supports our hypothesis that low CB1 receptor concentrations and/or reduced endocannabinoid levels underlie infant nonorganic failure to thrive (NOFTT). Inverse agonism implies that lower constitutive CB1 receptor activity may be responsible for impaired food intake in newborns. In the present study, we injected the neutral CB1 receptor antagonist 5-(4-chlorophenyl)-3-[(E)-2-cyclohexylethenyl]-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole (VCHSR1) to 1-d-old mouse pups and recorded weight gain, gastric milk contents (milkbands), axillary temperature, and survival between age 1 and 10 d. The results showed a dose-related interference with all measures. These data show that (1) growth failure induced by rimonabant is generalized to another CB1 antagonist and (2) cannabinoid CB1 receptor activation by endocannabinoids is essential for normal milk ingestion and development in mice. This supports our hypothesis that endocannabinoid deficiency and perhaps CB1 receptor dysfunction represents the uncharacterized biologic vulnerability, which underlies NOFTT.

Leptin and cytokines levels in children with failure to thrive.

The majority of cases of failure to thrive (FTT) are non-organic. Many of these patients present with significant decreased caloric intake. It appears as if the appetite regulation center in the hypothalamus is not attuned to the calorie requirements of the infant. Our hypothesis was that some cases of non-organic FTT might be caused by abnormalities in hunger/satiety control secondary to neuroendocrine or cytokine imbalance. The aim of this study was to investigate which hormonal/cytokine profiles could be assigned to a defined category of FTT, namely organic, psychosocial and idiopathic subgroups. 34 patients were enrolled and 32 completed the study (12 controls, 12 idiopathic FTT, 5 organic FTT, and 3 psychosocial FTT). Each child was assessed by a pediatric gastroenterologist, dietician, and social worker and underwent appropriate laboratory investigation during which leptin, IL1, IL6 and TNF-alpha levels were determined. The Mann-Whitney U test was used to compare the groups. IL6 was the only cytokine that showed significant differences between FTT patients (4.06 +/- 6.3 pg/ml) and normal controls (0.0 pg/ml (p = 0.028). Leptin values were significantly higher in the normal control group (1632 +/- 483 pg/ml) as compared to FTT patients (685 +/- 687 pg/ml) (p = 0.001). Our results indicate that leptin does not play a role in the pathogenesis of anorexia in children with FTT. It is however, possible that IL6 may be an important factor in the etiology of anorexia in patients with FTT.

Non-Organic Failure to Thrive

Source: Ramsay M, Gisel EG, McCusker J, et al. Infant sucking ability, non-organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study. Dev Med Child Neurol. 2002;44:405–414.These investigators explored whether inefficient sucking, later feeding difficulties, and/or maternal depression contributed to non-organic failure to thrive (NFTT). Healthy term infants and their mothers were recruited from St. Mary’s Hospital in Montreal, Canada, within 24 hours of birth and were tested at 1 week of age to determine if inefficient sucking was associated with slow weight gain. Those with inefficient sucking comprised the index group (n=265), and an equal number of randomly selected infants with efficient sucking (sustained frequency, amplitude, and duration) comprised the matched control group (n=255). Both groups were retested in the home at 2, 6, 10, and 14 months of age with various combinations of the Edinburgh Postnatal Depression Scale completed by the mother, a feeding questionnaire administered by trained evaluators, an observation of infant feeding behavior, anthropometric measurements of the infant, and measurement of the infant’s suck. NFTT was defined as exhibiting 2 of the following: 1) weight loss across 2 major percentiles (n=32), 2) weight for length below 90th percentile of ideal weight (adjusted for parental height) (n=15), and 3) weight for age below 5th percentile (n=3), all in the absence of recognized organic disease. Eighteen infants were thus classified as NFTT. Inefficient sucking at 1 week did not predict later feeding difficulties, and postnatal growth was not influenced by early or concurrent maternal depression or maternal feeding practice.The data in this study did not allow an analysis of the possibility that these NFTT infants were simply adjusting their growth curve to a genetically preprogrammed lower one. The researchers were unable to demonstrate an association between early sucking efficiency and later feeding difficulties. This does not rule out a predominantly oral motor etiology for much of what is classed as NFTT; it simply demonstrates that a measure of sucking efficiency at 1 week is not sensitive to the later expression of feeding difficulties. Indeed, while 94% of infants with efficient sucking remained efficient at 2 months, only 50% of infants with inefficient sucking remained inefficient at 2 months. Perhaps this study’s failure to demonstrate any association between maternal depression and NFTT will help retire that tired presumption. The 2 etiologies for these growth patterns that would seem to be underestimated are: 1) subtle oral-motor difficulties1 and/or 2) the infants are simply following a familial growth curve. However the cookie crumbles, the infant’s failure to grow appropriately is often attributed to the mother. Perhaps this presumption should also be retired.

Infant sucking ability, non-organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study.

This prospective study examined the relation of neonatal sucking to later feeding, postnatal growth, maternal postpartum depression, and feeding practices. Healthy infants of at least 37 weeks gestational age were recruited. At 1 week of age, a strain-gage device was attached to the infant's cheeks during sucking to identify sucking efficiency. Two-hundred and two infants (100 males, 102 females; mean age 39.6 weeks, SD 1.1 weeks) with efficient sucking and 207 (101 males, 106 females; mean gestational age 39.4 weeks, SD 1.2 weeks) with inefficient sucking were identified. Growth was measured at 2, 6, 10, and 14 months. Mothers completed a feeding questionnaire and the Edinburgh Postnatal Depression Scale at the same testing points. While 18 infants (5%) showed a downward shift in growth, their clinical picture did not present as non-organic failure to thrive (NFTT). Inefficient neonatal sucking did not predict postnatal growth, later feeding difficulties, nor maternal feeding practices, but concurrent inefficient feeding did. Maternal depression did not affect feeding practices, infant feeding abilities, nor growth, suggesting that the importance of maternal postpartum depression in association with feeding may be less than previously assumed. The term NFTT, therefore, merits reexamination and a more focused definition.

Infant sucking ability, non‐organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study

This prospective study examined the relation of neonatal sucking to later feeding, postnatal growth, maternal postpartum depression, and feeding practices. Healthy infants of at least 37 weeks gestational age were recruited. At 1 week of age, a strain‐gage device was attached to the infant's cheeks during sucking to identify sucking efficiency. Two‐hundred and two infants (100 males, 102 females; mean age 39.6 weeks, SD 1.1 weeks) with efficient sucking and 207 (101 males, 106 females; mean gestational age 39.4 weeks, SD 1.2 weeks) with inefficient sucking were identified. Growth was measured at 2, 6, 10, and 14 months. Mothers completed a feeding questionnaire and the Edinburgh Postnatal Depression Scale at the same testing points. While 18 infants (5%) showed a downward shift in growth, their clinical picture did not present as non‐organic failure to thrive (NFTT). Inefficient neonatal sucking did not predict postnatal growth, later feeding difficulties, nor maternal feeding practices, but concurrent inefficient feeding did. Maternal depression did not affect feeding practices, infant feeding abilities, nor growth, suggesting that the importance of maternal postpartum depression in association with feeding may be less than previously assumed. The term NFTT, therefore, merits reexamination and a more focused definition.