Peds

Failure to Thrive

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

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

Incidence
1. Hospitalized children <2 years: 1-5%
2. Families with Medical, psychosocial problems: 10%

Low socioeconomic status
Children of Refugees
Children with Developmental Delay
1. Autism associated feeding difficulties are common (RR 4)
Low birth weight
Intrauterine Growth Retardation (IUGR)
Gastrointestinal Disorders
Congenital Disorders
Chronic Infections (e.g. HIV Infection, Tuberculosis)

Weight is affected first by Malnutrition
Length and Head Circumference affected in severe cases
Cognition and failure to meet Developmental Milestones may occur in very severe cases

See Growth Faltering Diagnosis (Failure to Thrive Diagnosis)
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
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)
Resources
1. Z-Score for ages 0 to 2 years (WHO)
  1. https://peditools.org/growthwho/
2. Z-Score for ages 2 to 20 years (CDC)
  1. https://peditools.org/growthpedi/