Failure to thrive: Description, Causes and Risk Factors:
Growth failure or `failure to thrive' is a term used for describing inadequate growth in early childhood. It is applied to children whose current weight or rate of weight gain is significantly below (less than the fifth percentile) other children of similar age and sex.
Causes may include:
Social factors. In some cases, doctors may not identify a medical problem, but may find that the parents are actually causing the failure to thrive. For example, some parents inappropriately restrict the amount of calories they give their infants. They may fear the child will get fat or enforce a limited diet similar to one they follow. Or, they might not feed the child enough either because of a lack of interest or because of too many distractions in the household, leading to neglect of the child. Living in poverty also can lead to an inability to provide kids with proper nutrition.
- Metabolic disorders. These can limit the body's capacity to make the most of calories consumed. They might make it difficult for the body to break down, process, or derive energy from food, or cause a buildup of toxins during the breakdown process that can make a child feed poorly or vomit.
- Cystic fibrosis, chronic liver disease, and celiac disease are malabsorptive disorders that limit the body's ability to absorb nutrients. An infant may eat a lot, but the body doesn't absorb and retain enough of that food. Celiac disease is a sensitivity to a dietary protein found in wheat and certain other grains. The immune system's abnormal response to this protein causes damage to the lining of the intestine, interfering with its ability to absorb nutrients.
- Conditions involving the gastrointestinal system. These include gastroesophageal reflux disease (GERD), chronic diarrhea, cystic fibrosis, chronic liver disease, and celiac disease. With GERD, the esophagus may become so irritated that a child refuses to eat because it hurts. Persistent diarrhea can interfere with the body's ability to hold on to the nutrients and calories from food.
- A chronic illness or medical disorder. A child who has trouble eating — because of prematurity or a cleft lip or palate, for example — may not take in enough calories to support normal growth. Other conditions that can lead to failure to thrive include cardiac, endocrinologic, and respiratory disorders, which can increase a child's caloric needs so that it becomes difficult to meet them.
- An intolerance of milk protein. This can cause difficulty with absorbing nutrients until it's diagnosed. It can also put an entire class of food out of reach, restricting the child's diet and occasionally leading to failure to thrive.
- Infections. Parasites, urinary tract infections, tuberculosis, etc., can put great energy demands on the body and force it to use nutrients rapidly (and can diminish appetite), sometimes bringing about short- or long-term failure to thrive.
In some cases, doctors are unable to pinpoint a specific cause. In the past, doctors tended to categorize cases of failure to thrive as either organic (caused by an underlying medical disorder) or inorganic (caused by caregivers' or parents' actions), but are less likely to make a distinction today because medical and behavioral causes often appear together. For instance, if a baby has severe reflux and is reluctant to eat, feeding times can be stressful. The baby may become upset and frustrated, and the caregiver might be unable to feed the child adequate amounts of food.
The best way to prevent failure to thrive is by early detection at routine well-baby examinations and periodic follow up with older children. If your child is consistently underweight or does not gain weight for unclear reasons, or you are worried about your child's development, or think there is a problem, please contact your child's health care provider.
Many children may not gain weight or even lose a littleweight for a brief period of time. However, if your childdoes not gain weight for three consecutive months during the first year of life, it's a matter of concern
.The most common symptoms of failure to thrive areirritability, excessive sleepiness
, lack of interest in theirsurroundings, lack of age-appropriate social response,thin and wasted appearance, pale skin, swollen stomach,avoiding eye contact, delayed motor development andabsence of vocal sounds. Since these symptoms maylook like other conditions, you need to consult yourchild's health care provider to check and see if yourchild meets the developmental milestones.
Many babies go through brief periods when their weight gain plateaus or they even lose a little weight. However, if a baby does not gain weight for 3 consecutive months during the first year of life, doctors usually become concerned.
Doctors diagnose failure to thrive by using standard growth charts to plot weight, length, and head circumference, which are measured at each well-baby exam. Children who fall below a certain weight range for their age or who are failing to gain weight at the expected rate will be evaluated further to determine if there's a problem.
Along with obtaining a thorough medical and feeding history and performing a detailed physical exam, the doctor may order a complete blood count, urine test, and various blood chemical and electrolyte tests to search for underlying medical problems. If a particular disease or disorder is suspected, the doctor might perform additional tests specific to that condition.
To determine whether a child is receiving enough food, the doctor (sometimes with the help of a dietitian) will do a calorie count after asking the parents what the child eats every day. And talking to the parents can help a doctor identify any problems at home, such as neglect, poverty, household stress, or feeding difficulties.
Children with failure to thrive need the help of their parents and a doctor. Sometimes, an entire medical team will work on the case.
In addition to the primary doctor, the team might include a nutritionist to evaluate the child's dietary needs, and an occupational or speech therapist to help the caregiver and child develop successful feeding behaviors and address any sucking or swallowing problems. Occupational and speech therapists are often helpful because of their expertise in the muscular control that's involved in eating.
Because treatment of failure to thrive involves treating any disease or disorder causing the problem, specialists such as a cardiologist, neurologist, or gastroenterologist may also be part of the care team.
Particularly in cases of failure to thrive that are thought to be caused by caregivers' or parents' actions, a social worker and a psychologist or other mental health professional may help address problems in the home environment and provide any needed support.
In cases of poor nutrition, treatment often can be carried out at home with frequent follow-up visits to the doctor's office or clinic. The doctor will recommend high-calorie foods and place an infant on a high-calorie formula.
More severe cases may call for tube feedings in which a tube is put in that runs from the nose into the stomach. Liquid nutrition is provided at a steady rate through the tube. Once the tube is in place, the child is usually fed at night to avoid interference with daily activities or limiting the child's desire to eat during the day. (About half of a child's caloric needs can be delivered at night through a continuous drip.) Once more adequately nourished, the child will feel better and will probably start to eat more on his or her own. At that point, the tube can be removed.
A child with extreme failure to thrive may need to be hospitalized to be fed and monitored continuously. During this time, any possible underlying causes of the condition can be evaluated and treated appropriately. This also lets the doctors see the caregiver's feeding technique and the interaction between caregiver and child during feedings and at other times.
How long treatment lasts varies from case to case. Weight gain takes time, so several months may pass before a child is back in the normal range. Kids who require hospitalization may stay for 10 to 14 days or more to establish satisfactory weight gain, but it can be many months until the symptoms of severe malnutrition are gone.
Failure to thrive caused by a chronic illness or disorder may have to be monitored periodically and treated for even longer, perhaps for a lifetime.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.