Failure to Thrive in Children

Failure to thrive (FTT) in children can be defined as a failure to gain weight. There may be many reasons for it like socio-economic factors, picky eating, child neglect or abuse, health issues like various diseases or chronic medical conditions and most importantly malnutrition. Treatment includes hospitalization (in severe cases), nutritional treatment (increasing protein, carbohydrates, essential nutrient intake) and lots of love and care.

What Does Failure To Thrive (FTT) Mean?

Failure to thrive (FTT) means baby is not putting on weight as normal. It is a condition when a baby’s growth (height or weight) rate is much slower than the rest of the babies of his age. It is associated with poor developmental and emotional functioning. In this condition, the baby is either not receiving or has an inability to take in or retain adequate nutrients in order to gain weight or grow. If the condition is not taken care of, the child may not be able to do even basic things like sitting, walking or talking like other children of his age.

It can be chiefly be classified into two types namely,

1. Non Organic Failure To Thrive (NOFTT)

It is primarily due to rejection and neglect by the mother or the caregiver of the infant. The condition can prevail in all the social classes but is more common in situations of poverty, poor marital relationships of the parents and chaotic family lifestyle.

2. Organic Failure To Thrive (OFTT)

This condition is caused due to some underlying disease or sickness in the child which interferes with the nutrient intake of the infant/child like a Cleft lip/Palate, Cerebral Palsy or some genetic disorder that the child may have inherited from his parent.

Should You Be Concerned If Your Child Isn’t Gaining Weight?

A baby losing weight after being sick is normal. He will eventually gain the weight back. If your baby has not lost weight but is slow in gaining weight, it is normal as well. However, if your child has consistently been in a higher growth percentile but of late dropped to a rather low percentile, it should be an alarm for you.

Failure To Thrive Causes

Failure to thrive can be further classified into two types:

1. Non-Organic Failure To Thrive (occurs in a child who is usually younger than 2 years and has no known medical condition that causes poor growth)
2. Organic Failure To Thrive(when there is an underlying medical cause).

Non-Organic Failure To Thrive Causes

• No or weak emotional bond between parent and child
• Poverty
• Inability of parents to understand the diet requirements of their baby
• Picky eating by the child
• Maternal deprivation

Organic Failure To Thrive Causes

• Genetic disorders like Down Syndrome
• Hormonal problems
• Defects in major organs
• Neurological problems or brain damage
• Heart or lung problems
• Blood disorders like Anaemia
• Digestive problems
• Chronic infections
• Low metabolic rate
• Low birth weight due to problems during pregnancy

What are the Signs & Symptoms?

• Improper weight gain
• Always tired
• Lack of age-appropriate social response
• Late in motor development
• Learning and behavioural problems later when the child grows
• Lethargy
• Too cranky
• Irritability

Diagnosis

Failure to thrive can be accessed through various processes.

• Diet history of the baby/child is taken since that is the most important and potential cause of FTT.
• The doctor will conduct a complete physical examination of the child. This will include the child’s height, weight, any birth defects, abnormal breathing signs and signs of any vitamin or essential nutrient deficiencies.
• Child’s medical history and family history will also be asked.
• The doctor may also check for any kind of physical abuse on the child or child neglect.
• The Denver Developmental Screening Test (especially meant for such cases) will be done on the child to determine delays in development.

Other Than These Tests The Following Tests Are Done:

• Complete Blood Count (CBC)
• Electrolyte balance
• Haemoglobin Electrophoresis to determine blood disorders like Sickle Cell Disease
• Hormonal Tests including Thyroid function tests
• X Rays to determine bone age
• Urine tests

Risk Factors

Here are some factors which increase the risk of FTT:

• Poverty: The most important reason behind Failure to thrive (FTT) is poverty. At times, the child may be deprived of vitamins and essential nutrients in his diet due to poverty. This may lead to various diseases which may result in low weight of the baby/child.

• Psychological and social reasons: Apart from that, some children suffer from FTT due to psychological and social reasons with too.

• Inadequate care: Emotional or maternal deprivation equals to nutritional deprivation. This happens when the mother or the caregiver fails to or neglects the child’s nutritional needs due to her preoccupation with other things. These may include:
  • Having to take care of others
  • No knowledge about proper feeding or child’s nutritional needs
  • Postpartum depression
  • Alcoholism or substance abuse.
• Premature birth: Many times, a child born prematurely may not be able to gain weight just as baby of his age would.

• Poor Health: Genetic disorders or illnesses which interfere with feeding and bonding with the parents also play a role in causing Failure To Thrive in babies.

Treatment for FTT

Most often, a child can be treated for FTT at home itself under the proper guidance of the doctor. In severe cases, the infant/child may have to be hospitalised. At home, the child has be given a nutritious diet with high calorie. In severe cases when a baby is hospitalised, he may be given food and all the necessary nutrients through a pipe.

However, a child with NOFTT or mixed FTT will have to be examined by a Paediatrician first. She may then refer the child to speech therapists to help the child in swallowing or sucking, psychologists for any behavioural issues, specialists like cardiologists, gastroenterologists, endocrinologists, haematologists etc. in accordance to the health issues detected in the child. Apart from all of these, the parents or the caregiver may also be counselled by the doctor or taught certain things like breastfeeding the baby correctly or the correct amount of food to be given to the child (since some parents may not know it).

Is Low Weight Gain Means Your Child Will Always Be Smaller Than He Should Be?

This depends on the reason behind his Failure To Thrive. If FTT is due to a disease that will be with him for lifelong, then he may not grow as much as children of his age do but if it is due to something which can be treated, then his growth may be at par with others. For example a pre-mature child (one of the reasons for Failure To Thrive) may gain weight and height after treatment and being fed well.

When Should You Call The Doctor?

Failure To Thrive in infants can be due to an amalgamation of psycho-socio-economic causes but it could even be due to underlying health reasons. Poor weight gain in children is the most prominent factor seen among children having FTT.

Failure To Thrive in a child could trigger a number of health hazards and that is when a doctor should be called for.

• Child has breathing problems
• Child faints
• Child loses weight at an alarming rate
• Child is weak and listless
• Child keeps on crying

Thriving does not only mean getting bigger. It means growing to one’s potential, physically and emotionally. However, the mother’s health must also be taken care of while she is pregnant so as to avoid pre-term birth which could lead to Failure To Thrive issues in the child. Moreover, taking care of the socio-economic and psychological issues of a child could also help in averting FTT.