Failure to Thrive


Failure to Thrive, Failure to Thrive in Children, Pediatric Failure to Thrive, Weight Faltering, Growth Faltering, FTT

  • Definitions
  1. Growth Faltering (previously known as Failure to Thrive)
    1. Inadequate weight gain (or Weight Faltering) over time
    2. Malnutrition due to inadequate Caloric Intake or absorption, or excessive caloric expenditure
  • Epidemiology
  1. Incidence
    1. Hospitalized children <2 years: 1-5%
    2. Families with Medical, psychosocial problems: 10%
  • Risk Factors
  1. Low socioeconomic status
  2. Children of Refugees
  3. Children with Developmental Delay
    1. Autism associated feeding difficulties are common (RR 4)
  4. Low birth weight
  5. Intrauterine Growth Retardation (IUGR)
  6. Gastrointestinal Disorders
  7. Congenital Disorders
  8. Chronic Infections (e.g. HIV Infection, Tuberculosis)
  • Signs
  1. Weight is affected first by Malnutrition
  2. Length and Head Circumference affected in severe cases
  3. Cognition and failure to meet Developmental Milestones may occur in very severe cases
  • Diagnosis
  • Growth Faltering (Failure to Thrive)
  1. See Growth Faltering Diagnosis (Failure to Thrive Diagnosis)
  2. Growth Faltering Screening relies on accurately recorded weight and height on growth chart over time
    1. Weight below 5th percentile for gender and Corrected age OR
    2. Weight for Length <5th percentile OR
    3. BMI for age <5th percentile OR
    4. Decreased Growth Velocity with Weight for Length falling by more than 2 major percentile lines
  3. Growth Faltering Diagnosis is based on anthropometric Z-Scores
    1. Z Scores are calculated from Weight for Length or BMI for age and range from -3 to +3
    2. Negative Z Scores represent lower than expected weight
    3. More negative values represent more severe Malnutrition (-1=mild, -2=moderate, -3=severe)
    4. Drop in Z-Score over time is also used to determine severity (drop of 1 = mild, drop of 2 = moderate, drop of 3 = severe)
  4. Resources
    1. Z-Score for ages 0 to 2 years (WHO)
    2. Z-Score for ages 2 to 20 years (CDC)
  • Prognosis
  1. Nonorganic Failure to Thrive risks poor outcomes
    1. Risk of cognitive delay and school difficulty
      1. Lower Wechsler Intelligence Scale for Children
      2. Poorer language development and reading skills
    2. Social immaturity
      1. More frequent behavior problems
  2. References
    1. Oates (1985) Pediatrics 75:36 [PubMed]