Failure to thrive

Failure to thrive
Classification and external resources
Specialty pediatrics
ICD-10 R62.8
ICD-9-CM 783.41, 783.7
DiseasesDB 18756
MedlinePlus 000991
eMedicine ped/738
MeSH D005183

Failure to thrive (FTT),[1] more recently known as faltering weight or weight faltering,[2] is a term used in pediatric, adult as well as veterinary medicine (where it is also referred to as ill thrift), to indicate insufficient weight gain or inappropriate weight loss. When not more precisely defined, the term refers to pediatric patients. In children, it is usually defined in terms of weight, and can be evaluated either by a low weight for the child's age, or by a low rate of increase in the weight.[3]

Children

As used by pediatricians, it covers poor physical growth of any cause and does not itself imply abnormal intellectual, social, or emotional development, although it can subsequently be a cause of such pathologies. The term has been used in different ways,[4] and different objective standards have been defined.[5][6] Many definitions use the 5th percentile as a cutoff.[7]

Traditionally, causes of FTT have been divided into endogenous and exogenous causes. Initial investigation should consider physical causes, calorie intake and psychosocial assessment.

Endogenous (or "organic")
Causes are due to physical or mental issues with the child itself. It can include various inborn errors of metabolism. Problems with the gastrointestinal system such as gas and acid reflux are painful conditions which may make the child unwilling to take in sufficient nutrition. Cystic fibrosis, diarrhea, liver disease, and celiac disease make it more difficult for the body to absorb nutrition. Other causes include physical deformities such as cleft palate and tongue tie. Milk allergies can cause endogenous FTT. Also the metabolism may be raised by parasites, asthma, urinary tract infections, and other fever-inducing infections, or heart disease so that it becomes difficult to get in sufficient calories to meet the higher caloric demands.
Exogenous (or "nonorganic")
Caused by caregiver's actions. Examples include physical inability to produce enough breastmilk, using only babies' cues to regulate breastfeeding so as to not offer a sufficient number of feeds (sleepy baby syndrome),[8] inability to procure formula when needed, purposely limiting total caloric intake (often for what the caregiver views as a more aesthetically pleasing child), and not offering sufficient age-appropriate solid foods for babies and toddlers over the age of six months . A recent study on toddlers with exogenous FTT has found preliminary evidence suggesting that difficulty experienced during feeding times with this condition may in fact be impacted by preexisting sensory processing problems. Such difficulties with sensory processing are more commonly observed in toddlers who have a history of growth deficiency and feeding problems; however, further research is required in order to determine a causal relationship between sensory processing problems and nonorganic FTT.[9] In developing countries, conflict settings and protracted emergencies, exogenous faltering may be caused by chronic food insecurity, lack of nutritional awareness, and other factors beyond the caregiver's control.[10]
Mixed
However, to think of the terms as dichotomous can be misleading, since both endogenous and exogenous factors may co-exist. For instance a child who is not getting sufficient nutrition may act content so that caregivers do not offer feedings of sufficient frequency or volume, and a child with severe acid reflux who appears to be in pain while eating may make a caregiver hesitant to offer sufficient feedings.

Recently the term faltering growth has become a popular replacement for failure to thrive, which in the minds of some represents a more euphemistic term.

Adults

The term "failure to thrive" is also applied to geriatrics or more generally in adult medicine as a descriptive, non-specific term that encompasses "not doing well". Manifestations of this condition include weight loss, decreased appetite, poor nutrition, and inactivity. Four syndromes are prevalent and predictive of adverse outcomes in patients with failure to thrive: impaired physical function, malnutrition, depression, and cognitive impairment.[11][12]

See also

References

  1. ↑ "failure to thrive" at Dorland's Medical Dictionary
  2. ↑ Shields, B.; Wacogne, I.; Wright, C. M. (25 September 2012). "Weight faltering and failure to thrive in infancy and early childhood". BMJ 345 (sep25 1): e5931–e5931. doi:10.1136/bmj.e5931.
  3. ↑ "Failure to Thrive: Miscellaneous Disorders in Infants and Children: Merck Manual Professional". Retrieved 2010-03-23.
  4. ↑ Hughes I (February 2007). "Confusing terminology attempts to define the undefinable". Arch. Dis. Child. 92 (2): 97–8. doi:10.1136/adc.2006.108423. PMC 2083328. PMID 17264278.
  5. ↑ Raynor P, Rudolf MC (May 2000). "Anthropometric indices of failure to thrive". Arch. Dis. Child. 82 (5): 364–5. doi:10.1136/adc.82.5.364. PMC 1718329. PMID 10799424.
  6. ↑ Olsen EM, Petersen J, Skovgaard AM, Weile B, Jørgensen T, Wright CM (February 2007). "Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population". Arch. Dis. Child. 92 (2): 109–14. doi:10.1136/adc.2005.080333. PMC 2083342. PMID 16531456.
  7. ↑ Olsen EM (2006). "Failure to thrive: still a problem of definition". Clin Pediatr (Phila) 45 (1): 1–6. doi:10.1177/000992280604500101. PMID 16429209.
  8. ↑ B. F. Habbick and J. W. Gerrard (1984). "Failure to thrive in the contented breast-fed baby". Can Med Assoc J. 131 (7): 765–768. PMC 1483563. PMID 6541091.
  9. ↑ Yi S. H., Joung Y. S., Chloe Y. H., Kim E. H., Kwon J. Y. (2015). "Sensory Processing Difficulties in Toddlers with Nonorganic Failure to Thrive and Feeding Problems". Journal of Pediatric Gastroenterology and Nutrition 60 (6): 819–824. doi:10.1097/mpg.0000000000000707.
  10. ↑ Prendergast, Andrew J; Humphrey, Jean H (2014-04-01). "The stunting syndrome in developing countries". Paediatrics and International Child Health 34 (4): 250–265. doi:10.1179/2046905514Y.0000000158. ISSN 2046-9047. PMC 4232245. PMID 25310000.
  11. ↑ Sarkisian C. A., Lachs M. S. (June 1996). ""Failure to thrive" in older adults". Ann. Intern. Med. 124 (12): 1072–8. doi:10.7326/0003-4819-124-12-199606150-00008. PMID 8633822.
  12. ↑ Robertson R. G., Montagnini M. (July 2004). "Geriatric failure to thrive". Am Fam Physician 70 (2): 343–350. PMID 15291092.
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