Failure to Thrive (FTT)

RMacLean
January 2007

what is failure to thrive (FTT)?

A baby is considered to be failure to thrive (also called FTT) when they fail to gain weight and grow at a healthy, steady and predictable manner. In some cases, the child may even lose weight.  Generally, the term failure to thrive is reserved for children under the age of two years who fall below the 3rd percentile.

What Causes Failure To Thrive?

There are two main types of failure to thrive--organic and non-organic-- with each have very different causes.

Potential Causes of Organic Failure To Thrive:

• premature birth, especially if the fetus had intrauterine growth retardation
• maternal smoking, alcohol or drug use during pregnancy
• poor ability to suck or swallow, for example, presence of cleft lip and cleft palate or other mechanical problems
• unexplained poor appetites that are unrelated to mechanical problems or structural abnormalities, for example, breathing difficulties (which can make eating difficult) that can result from congestive heart failure
• Inadequate caloric intake resulting from metabolic abnormalities, excessive vomiting caused by obstruction of the gastrointestinal tract, kidney dysfunction or gastroesophageal reflux causing vomiting or refusal of food
• poor absorption of food, inability of the body to use absorbed nutrients, or increased loss of nutrients
• diabetes
• liver disease
• kidney disorder

Causes of Non-Organic Failure To Thrive:

• poor feeding skills on the part of the parent
• dysfunctional family interactions
• difficult parent-child interactions
• lack of social support
• lack of parenting preparation
• family dysfunction, such as abuse or divorce
• child neglect
• emotional deprivation

Studies show that only between 5 percent and 26 percent of FTT cases are due to a purely organic cause. Children in abusive or neglectful families are at higher risk of FTT.

What Are The Symptoms of Failure to Thrive?

• delayed social and mental skills
• delayed development of secondary sexual traits in adolescents
• height, weight, and head circumference in an infant or young child not progressing as expected on growth charts
• edema (swelling)
• wasting
• enlarged liver
• rashes or changes in the skin
• changes in hair texture
• emotional and behavioral problems

How is Failure To Thrive Diagnosed?

First a thorough medical history will be taken and a physical examination will follow.  Your health care provider will gather information such as:

• the pregnancy and newborn period
• feeding patterns and development
• the amount of calories being fed
• the ability of the child to absorb calories being fed
• the home environment
• the complete blood count, also called a CBC
• kidney function tests taken with a check of the urine

If a doctor does not have a diagnosis after the history, physical, and laboratory evaluation, he or she may order further studies. They will also likely do one or several feeding evaluations, where they will observe the feeding process.  A psychological and social service evaluation of the family may also be requested.

What are the long-term effects?

Children may show signs of:

• diminished growth
• delayed language development
• low reading skills
• social immaturity
• frequent behavioral difficulties

How Is Failure to Thrive Treated?

The course of treatment used for a child with failure to thrive depends entirely on underlying cause--that is, whether it is organic failure to thrive or non-organic.  If the cause is organic, treatment for the disorder causing the failure will begin and will often reverse the condition.  It's not unusual for an infant to be hospitalized and fed under controlled conditions either by the medical care providers, or by the parent and observed by the medical care providers, to determine if the cause is organic or non-organic.

In some cases of FTT, tube feeding may be required. If the infant thrives and gains weight, the cause may not be organic. The hospital setting also allows professionals to observe how the parent interacts with the child. If the cause is thought to be environmental or non-organic, a social worker may become involved to help guide and support the parents.