Failure-to-Thrive

Endocrine disease Thyroid problemsPituitary diseaseDiabetesGrowth hormone deficiency Infectious disease HIVBacteria or parasites of the gastrointestinal tractTuberculosisChromosomal birth defectsFetal alcohol syndromeLead poisoningCancerPovertyChild abuse or negligenceParental ignorance Risk Factors A risk factor is something that increases your chance of getting a disease or condition. Untreated medical conditionsPoverty, including lack of available foodPoor parenting skillsDepression in the parent Severe family stress Symptoms Symptoms include: Slowed growth in a young child, including height and weightSlowed development, including late rolling, sitting, crawling, standing, walking, and talkingSmall musclesWeakness, low energyHair lossLoose folds of skinOther symptoms related to an underlying medical condition DiagnosisFailure-to-thrive is diagnosed based on tracking a child's growth. The doctor will plot a child's weight, height, and head circumference on standard growth charts. If the child falls below a certain weight range or drops two percentiles on the growth chart, the doctor will evaluate the child further. If a medical condition may be the cause, the doctor will order further tests. Tests may include:

Blood testsUrine testsBlood lead levelHIV testThyroid testsSweat-chloride test Gastrointestinal x-raysX-rays of the gastrointestinal tract, skeletal survey, bone age Sometimes, a child must be hospitalized for a period of time to find the cause of failure-to-thrive. During this time the doctor will: Monitor the relationship between parent and child, paying particular attention to their behavior around feedingSet up a feeding schedule with an adequate amount of caloriesMake sure that an appropriate feeding technique is usedIf the child can gain weight under these circumstances, this supports the diagnosis of nonorganic failure-to-thrive. TreatmentTreatment may include: Treating a Medical ConditionTreating the underlying medical condition may correct failure-to-thrive. Providing Extra CaloriesChildren who are malnourished may need liquid supplements to help boost their weight and nutrition. Parent TrainingWhen a child is hospitalized for diagnosis, the hospital staff can also provide treatment. Nurses can teach parents appropriate feeding techniques and how to best interact with their child. If the child isn't hospitalized, parents can still have training sessions with a nutritionist or a nurse. CounselingParents and children who are having difficulty with their relationship may benefit from counseling.

Prevention To help prevent failure to thrive: Take children to the doctor regularly to have their growth checked. This helps detect and treat failure-to-thrive before it becomes severe.Develop a good relationship with your child's doctor.Ask the doctor about proper parenting and nutrition for early in a baby's life. Encourage at-risk parents to attend parent-training sessions. At-risk includes: Known depression in the parentLack of understanding about basic childcare issuesPoverty RESOURCES: American Academy of Family Physicianshttp://www.aafp.org American Academy of Pediatricshttp://www.aap.org CANADIAN RESOURCES: About Kids Healthhttp://www.aboutkidshealth.ca Alberta Health and Wellnesshttp://www.health.gov.ab.ca/ References: Failure to thrive: parental neglect or well-meaning ignorance. Am Fam Physician . 2001;63(9). Available at http://www.aafp.org/afp/20010501/curbside.html. Kleigman RM, Jensen HB, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007. Merck Manual of Diagnosis and Therapy . 17th ed. Merck and Company, Inc; 1999. Last reviewed November 2007 by Kari L. Kassir, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.