Failure to thrive

• Genetic conditions (such as defects in the digestive system, metabolic conditions, cystic fibrosis, coeliac disease or diabetes) that make it hard for the body to process food and absorb nutrients;
• Problems with food intake, such as cleft lip and palate, diarrhea or vomiting, that make it hard for the child to eat enough food or retain what was eaten;
• Allergies to food milk proteins or other components of food;
• Premature birth, low birth weight, pregnancy complications, or;
• Conditions that cause the child's body to expend much more energy than usual, for example, some heart and respiratory problems, hormone disorders, nervous system disorders and infections.

Environmental causes

In many cases, FTT is caused by the child not being fed adequately. Causes can include:

• Poverty, homelessness;
• Parents or carers do not understand their child's nutritional needs;
• Lack of structure in family feeding habits, such as no set mealtimes;
• Parental inattention, parental inexperience, parental neglect;
• Misdirected parental distress with the child's feeding. For example, anxiety over feeding, worries that the baby is 'too fat', unnecessary dietary restriction, perceived food allergies;
• For infants and babies, problems with breastfeeding, or;
• Maternal depression.

Behavioral causes

FTT can also be the result of a child who is not eating well despite being offered enough food. Causes can include:

• Food refusal;
• Eating disorders, or;
• Mood disorders.

Food refusal may be one of the causes of failure to thrive. 

Multiple causes

FTT can often be the result of the combination of several of the causes listed above. For instance, the parents of a child who vomits regularly with every feeding might not be inclined to feed it as much, or as often as they normally would. Parental emotional distress can be both a cause of a child's failure to thrive as well as a result of it.

Signs and symptoms

FTT does not have a single definition. FTT is suspected if:

• The child's weight, length and/or head circumference are at the extreme low end of the standard growth figures for their age, or;
• The child is growing very slowly or not at all.

Other signs that a child may be failing to thrive include:

• Being chronically sleepy, easily fatigued;
• Irritability;
• Constipation, or;
• Changes in the child's developmental milestones.

In many cases, it will be hard for a parent to notice that their child is failing to thrive, since this can be a gradual process.

Methods for diagnosis

A doctor will diagnose FTT based on two main methods:

• A physical examination that includes measurements of height, weight and head circumference, and;
• A detailed history and an account of the child's and the family's eating patterns.

Further testing may be required if the doctor suspects that an underlying medical condition is causing the child's FTT.

It should be remembered that there are children whose growth and development are at the low end of the standard charts, who are nevertheless healthy and do not have FTT.

Types of treatment

Treatment of FTT depends on its root cause. For medical disorders, diet must come together with the appropriate medical care.

For environmental causes, it is often best to educate and work with the parents to make it easier for them to provide a good diet for their child. Parents may benefit from consultations with healthcare professionals including dietitians, maternal and child health nurses, social workers and psychologists.

In cases of extreme malnutrition, a child may be admitted to a hospital to receive emergency care and tube feeding.

Nutritional therapy

Nutritional therapy, also known as nutritional rehabilitation, is often used to help children with FTT to 'catch up' - to gain weight more rapidly in a safe and healthy way. An individual plan will be developed by a healthcare professional that includes foods high in calories and nutritional value. This 'boost' of nutrition is usually at about 110% to 120% of normal food intake.

Prognosis

Infancy and early childhood are key periods in a person's growth and development. Poor nutrition at this stage can have far-reaching long-term effects. FTT is associated with poor health, poor growth and learning and cognitive difficulties later in life.

That said, a short period of FTT that is treated effectively should have little to no effect on future development.

Prevention

The best way to prevent FTT is to be aware of the child's nutritional status and to ask for help if you are not confident in your knowledge of caring for your child. Nutrition is a complicated subject and parenting is a difficult skill. Parents can often benefit from assistance and guidance.