Failure to Thrive

No Results

No Results

processing….

Although the discussion of pediatric growth failure can be traced back over a century in the medical literature, the term failure to thrive (FTT) has only been used in the past several decades. The previously used dichotomy of nonorganic (environmentally related) and organic growth failure is the result of either inadequate calorie absorption, excessive calorie expenditure or inadequate intake of calories. [1] See the image below.

The objective parameter is usually the deceleration of growth height and weight. If FTT is severe, the parameter is poor brain growth as evidenced by head circumference. The diagnosis is based on growth parameters that (1) fall over 2 or more percentiles, (2) are persistently below the third or fifth percentiles, or (3) are less than the 80th percentile of median weight for height measurement. Growth failure is now generally accepted to be overly simplistic and obsolete.

A good working definition of growth failure related to aberrant caregiving is the failure to maintain an established pattern of growth and development that responds to the provision of adequate nutritional and emotional needs of the patient. Most cases of FTT are not related to neglectful caregiving, although it may be a sign of maltreatment and should be considered during an evaluation for growth failure. [2] A joint clinical report by the American Academy of Pediatrics Committee on Child Abuse and Neglect and the American Academy of Pediatrics Committee on Nutrition outlines 3 indicators of neglect: “Intentional withholding of food from the child; strong beliefs in health and/or nutrition regimens that jeopardize a child’s well-being; and family that is resistant to recommended interventions despite a multidisciplinary team approach.” [3]

United States

Incidence of true growth failure of children in the United States is not accurately known. However, nearly 20% of children younger than 4 years live in poverty, and the inability to obtain adequate food is directly related to such conditions.

International

International problems of poverty and hunger occur in many nations. The death rate from malnutrition and infection for these countries can be high. [4]

The morbidity of malnutrition as a separate clinical entity is discussed in Malnutrition. Malnutrition that accompanies FTT can lead to significant developmental delays in children. The first 2 years of a child’s life are a sensitive period of rapid brain growth when neurodevelopmental outcomes can be influenced. Motor, fine motor, speech, language, and cognitive delays have been documented. The resultant poor cognitive ability can lead to emotional and behavioral problems as well. Children die each year in the United States from malnutrition; some severe cases are directly related to intentional child neglect.

No racial predilection is noted because growth failure related to aberrant caregiving can affect people of all races.

No sex predilection is important to note.

Growth failure for this discussion is described in children from infancy through the toddler period.

Cole SZ, Lanham JS. Failure to thrive: an update. Am Fam Physician. 2011 Apr 1. 83(7):829-34. [Medline].

Black MM, Dubowitz H, Casey PH, et al. Failure to thrive as distinct from child neglect. Pediatrics. 2006 Apr. 117(4):1456-8; author reply 1458-9. [Medline].

Block RW, Krebs NF, American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatrics Committee on Nutrition. Failure to thrive as a manifestation of child neglect. Pediatrics. 2005 Nov. 116(5):1234-7. [Medline].

Brewster DR. Inpatient management of severe malnutrition: time for a change in protocol and practice. Ann Trop Paediatr. 2011. 31(2):97-107. [Medline].

Wojcicki JM, Holbrook K, Lustig RH, Epel E, Caughey AB, Muñoz RF, et al. Chronic maternal depression is associated with reduced weight gain in latino infants from birth to 2 years of age. PLoS One. 2011 Feb 23. 6(2):e16737. [Medline]. [Full Text].

Bambang S, Spencer NJ, Logan S, Gill L. Cause-specific perinatal death rates, birth weight and deprivation in the West Midlands, 1991-93. Child Care Health Dev. 2000 Jan. 26(1):73-82. [Medline].

Frank D, et al. Failure To Thrive. Reece R, Christian C, eds. Child Abuse Medical Diagnosis and Management. 3rd ed. Chicago, Ill: American Academy of Pediatrics; 2009. 465-512.

Gahagan S. Failure to thrive: a consequence of undernutrition. Pediatr Rev. 2006 Jan. 27(1):e1-11. [Medline].

Lowen D. Failure to Thrive. Jenny C, ed. Child Abuse and Neglect Diagnosis, Treatment and Evidence. 1st ed. St. Louis, Mo: Elsevier Saunders; 2011. 547-62.

Andrew P Sirotnak, MD Professor and Vice Chair of Faculty Affairs, Department of Pediatrics, University of Colorado School of Medicine; Department Head, Child Abuse and Neglect, Director, Child Protection Team, The Children’s Hospital

Andrew P Sirotnak, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Antonia Chiesa, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine

Antonia Chiesa, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Phi Beta Kappa

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Failure to Thrive

Research & References of Failure to Thrive|A&C Accounting And Tax Services
Source