Failure to Thrive

What is failure to thrive (Faltering Growth / FTT)?

Failure to thrive is a condition rather than a disease and has been recognised for many years. In the first year of a child's life most children gain weight and grow far quicker than they will later on. Many babies and children will follow a pattern, with variable growth rates which are still considered within the normal range.

FTT is where children do not utilize, retain or consume the neccessary calories required to sustain normal growth and development patterns.

Diagnosing and treating a child with failure to thrive relies on being able to pin point the exact cause and identify the underlying problem. Doctors and members of their teams should work with families to get a child back on to a normal growth pattern.

Symptoms of failure to thrive:

Weight, height and head circumference do not develop within normal ranges, as measured on doctors growth charts. Usually if weight is on or below the 3rd percentile, weight is 20 percent below ideal weight for height, or the child has fallen off from a previously established growth curve, they may be classed as failure to thrive.

Development can be delayed, physical skills can be slow to develop, for example Sitting, walking, rolling over.

Below normal mental and social interaction for example, talking, self feeding and toilet training.

Normal growth and development can vary widely, what is important is the rate of change measured by medical professionals, during check ups.

How do they diagnose failure to thrive?

Most babies will at some point lose or not gain weight. This is perfectly normal.

If FFT is diagnosed then the child will be assessed to differentiate if the child is suffering from: 'Organic failure to thrive' or 'Non-organic failure to thrive' or a combination of both. These terms have been used in the past but may be now considered out dated by some.

Organic failure to thrive usually results from insufficient intake of feeds for example; breast feeding failure, bottle feeding problems, inability to feed properly, or chronic illness.

In some cases it may also be due to nutrient loss or malabsorption which can include: persistent vomiting, diarrhoea, food intolerance's and many others.

Non-organic failure to thrive can be a result of poor background, emotional distress, inadequate nutrition. In some cases it can occur where a child is already sick, and the distress of the parents may inadvertently disrupt the parent child relationship.

Diagnosis may involve the following

Examination of growth charts commonly used to monitor a childs physical development such as weight, length and head circumference. These charts are often filled out during routine visits of health visitors or your GP.

A medical history may be requested, and further details about your childs feeding regime may be required. Other tests which may be performed include

• Blood counts
• Various blood chemical tests
• Electrolyte tests
• Urine tests

Such test can provide an insight into underling problems. Other specific tests may be required in certain cases.

Parents may be asked to compile a journal detailing the childs consumption over a period of time. Such information allows the doctor and dietician to calculate the precise intake of callories, and to assess if their is a shortfall in what would be required to sustain regular growth patterns.

Occasionally during such an observation period it may be requested that the child resides in Hospital. In this way further tests may also be carried out during the stay delivering a faster diagnosis.

How is it treated?

In many cases a whole team will be brought in to help and work at home with the family. The more common professionals you are likely to see within this team are

• GP (general practitioner)
• Pediatrician
• Gastroenterologist
• Dietitian
• Speech therapist
• Occupational therapist

Dependant on the cause and diagnosis others may also be invited to participate.

Where the problem is considered to be a result of the parents or carers actions then social workers, psychologists, or other mental health people may be brought in to assist, advise and offer support within the home environment.

In extreme cases it may be necessary for the child to be enteral (tube) fed, to help with nutrition. Community nurses will provide help and support to parents within the home environment until they feel confident.

Occasionally it may be neccessary for a child to be hospitalised, for continued monitoring and observation.