Failure to Thrive

A child whose height and weight does not fall within the normal limits of children of comparable age and gender is diagnosed with failure to thrive. There may a great many causes for this condition, ranging from genetic defects to disease conditions to environmental inadequacies. Any child who fails to thrive needs to be thoroughly examined physically and if necessary, the home environment may be investigated and evaluated.

Reasons for Failure to Thrive

Reasons for a child's failure to thrive may be simple or complex. It is essential that the child's individual situation be carefully evaluated so that hopefully it can be remedied. In many cases, with appropriate intervention, the child can begin to grow and develop normally. There are two basic reasons for failure to thrive.

Medical Reasons

The reasons for a child's failure to thrive may involve the child's own physical condition, resulting from:

  • Genetic defect, such as Down Syndrome or Achrondoplasia
  • Metabolic disorder
  • Chronic illness
  • Underlying infection
  • Gastrointestinal abnormality
  • Hormonal imbalance
  • Heart, lung or circulatory disorder
  • Neurological disorder
  • Blood disorder

Regular medical checkups are essential since abnormal growth patterns may be the first sign of a serious medical problem that needs to be addressed.

Environmental Reasons

There are numerous reasons, apart from individual physiology and anatomy, that a child may fail to thrive. These may include:

  • Poverty, resulting in malnutrition
  • Extreme detachment of parent or caregiver
  • Exposure to environmental parasites or toxins
  • Poorly balanced meals resulting from parental ignorance
  • Child abuse or neglect

In attempting to solve the mystery of why a child is failing to thrive, other specialists beside the patient's pediatrician may be consulted. These may include a gastroenterologist, an endocrinologist, a cardiologist, a psychologist or a neurologist.

Symptoms of Failure to Thrive

Infants who exhibit poor feeding habits and are small for their age, may initially show some or all of the following symptoms:

  • Constipation
  • Excessive crying
  • Lethargy
  • Irritability

Usually, a short time later, the most obvious, measurable symptoms of failure to thrive are noted:

  • Low height
  • Low weight
  • Small head circumference

It is important for the pediatrician to chart the rate of growth as well as the present statistics. In general, height lower than the 3rd percentile or weight 20 percent below ideal projected weight are considered cause for concern. Other considerations focus on the child's motor development in terms of reaching normal milestones. These milestones may be those of an infant or toddler, such as rolling over, sitting, standing or walking. They may also involve cognitive and social skills, such as smiling, making eye contact, vocalizing or speaking. Later, physical signs of delays in maturation, such as the appearance of secondary sexual characteristics, and of more advanced intellectual activities, such as reading, may be cause for concern.

Diagnosis of Failure to Thrive

Pediatricians usually diagnose failure to thrive through a combination of abnormally low weight and height measurements, observation of the child's abilities and discussions with the child's parents or caregivers. If the condition is suspected, other tests may be administered to confirm the diagnosis, including:

  • Complete blood test (CBC)
  • Hemoglobin tests for sickle cell disease
  • Blood tests for electrolyte balance
  • Hormone tests, especially for thyroid function
  • Urinalysis
  • X-rays to determine bone age

In addition to taking a careful family history, the doctor will most likely administer a Denver Developmental Screening Test.

Treatment of Failure to Thrive

If the failure to thrive is the result of an underlying medical condition, once that condition is treated the child may regain normal growth patterns. If the child is not being fed a nourishing diet, parents and other caregivers are instructed in ways to provide a well-balanced diet with additional calories, and to correct any vitamin or mineral deficiencies. It is possible that the child will have to be hospitalized for a time in order to boost energy level and get the body back in balance.

If the environment the child is living in is impoverished, toxic or abusive, familial issues must be addressed to ensure the child's well-being. In this case, social workers, psychiatrists, and law enforcement officials may have to become involved. Whatever the cause, it is essential that any child's failure to thrive be addressed as quickly as possible to prevent permanently stunted mental, emotional, or physical development.

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