CAUSES OF FAILURE TO THRIVE

According to American Family Physician (AFP), Failure to thrive (FTT) is a disease

affecting 5 to 10 percent of children. It's not a disease or disorder, but instead a cluster of
symptoms and measurements that, when viewed together, indicate problem. Children are
diagnosed with FTT when, depending on their age and gender, they fall below the 5th percentile
for weight. AFP indicates that insufficient calorie intake, which is considered nonorganic FTT,
also often called psycho-social FTT, is the most common explanation for FTT. A non-organic
diagnosis occurs when there are no known medical causes for the condition; when the child's
environment or home life issues cause FTT.
Based to Children’s National Healthy System, it happens when the signs are triggered by
an underlying medical condition. Children undergo FTT from a combination of both organic and
nonorganic causes in many instances. As such, to help the child heal and continue to develop
normally, each cause needs to be assessed and addressed. About FTT, here's what you need to
hear. If you care about the weight of your infant, see your pediatrician first and foremost.
FTT, like chronic diarrhea, celiac disease, Crohn's disease, or gastroesophageal reflux
(GERD), may result in many different medical conditions affecting the digestive tract. According
to GI Kids, all these conditions can lead to malabsorption due to frequent diarrhea or vomiting,
which prevents the body from absorbing calories properly. This can also lead to issues with
weight gain, even though your child eats enough calories. Eating can also be unpleasant in the
case of GERD, due to acid flowing from the stomach. Your child will not get enough calories if
she or she refuses to eat.
Exposure to that food can cause an anaphylactic reaction when a child has a food allergy
that, if serious enough, can be life-threatening. Children with food allergies can need to avoid
dairy, nuts, or other essential sources of protein from calorie-dense foods, restrict their food
choices, and contribute to poor weight gain and FTT. Food allergy, on the other hand, is not
immediately life-threatening and can differ in severity. After consuming a particular food, a
common symptom of food intolerance is diarrhea, stomach pain, or other digestive problems.
Intolerances are caused, according to Enzyme Theory, by a lack of enzymes required to digest
certain foods, causing gas, bloating, and diarrhea. These digestive symptoms caused by food
intolerance may inhibit proper calorie absorption or inhibit a child from consuming a wide range
of nutritious foods, leading to growth problems and probably FTTT.
According to John Hopkins, hereditary disorders such as Down syndrome or Turner’s
syndrome can cause FTT, which can lead to improper calorie use. Chronic Infections. Parasite
infections, recurrent urinary tract infections, or chronic infections can lead to a decrease in
appetite and a decrease in nutrient absorption. When these diseases are treated, the FTT usually
increases.
FTT may be caused by pregnancy and birth complications, such as pre-term birth or low
birth weight. In a variety of ways, premature birth can lead to FTT, according to Emory
University of Medicine. Children born prematurely may have suffered prenatal under nutrition
already. For children born prematurely, gastrointestinal problems are also common, suggests
Emory, including reflux and GERD. Oral aversion can also be encountered by these children,
which can reduce their calorie intake.
Metabolic disorders are illnesses that affect the metabolism or chemical processes of the
body and can lead to FTT, according to CHOC Children’s Hospital. These can be discovered at
birth or later in life. They can cause extreme fatigue, weight loss, and problems with eating.
Non-organic FTT affects 80 percent of children who are diagnosed with the disorder,
according to pediatricians at duPont Hospital for Children. There are many non-organic causes of
FTT; keep reading to learn about those which are most common. In certain cases of failure to
thrive, due to insufficient nutrition or difficulties with nutrition, the infant does not obtain
enough calories. According to the College of Family Physicians of Canada, when a baby is
breastfed, FTT can be the outcome of three possible problems: "maternal milk production, breast
milk transfer, and the baby's quantity and quality of milk intake." In Nutritional Approach to
Failure to Thrive, report authors explain that if a baby is formula fed, FTT can be caused by
improper preparation of the formula or not enough consumed to meet caloric needs. or not
providing enough to support growth. Failure to thrive can also occur when a child is transitioning
to solids from breast milk or formula.
Lower socioeconomic status is frequently correlated with FTT, and 11.8% of American
families were food insecure in 2017. A child does not get enough calories in this situation, so
there may be a food supply problem.
There is always more than one underlying cause if a child is diagnosed with failure to
thrive. To help the child heal and start to develop properly, all causes must be found and
discussed. As it is a multi-factorial disorder, a FTT diagnosis can take time as the child's doctor
collects all the necessary information and tracks the development of the child. Treatment will
begin after the diagnosis is made and the causes are determined. Daily visits to speech therapy,
occupational therapy, a Registered Dietitian, or a psychologist can require treatment. It may also
be important to involve medical doctors who are experts in different fields, especially if there is
an underlying medical cause.
When you work closely with the necessary professionals, you can begin to address
challenges and allow your child to begin growing at the expected rate. Speak with your child’s
pediatrician if you’re concerned about their growth. The content in the Healthy Height Growth
and Nutrition Guide is not intended to be a substitute for professional medical advice, diagnosis,
or treatment. Always seek the advice of your physician or other qualified health provider with
any questions you may have regarding a medical condition.
FAILURE TO THRIVE IN THE OUTPATIENT CLINIC
According to Lezo, A., et al. (2020), Failure to thrive (FTT) is a pattern of irregular
growth dictated by insufficient nutrition. There are many FTT concepts in use, each expressing a
specific aspect of faltering development. In general, diagnosis is based on anthropometric
parameter assessment, including a sustained decrease in growth velocity. Of all the diagnostic
criteria for FTT, the few studies that compared various definitions found weak agreement, with
no single test consistently identifying children with severe under nutrition. FTT is not a
diagnosis, but rather a physical indication of insufficient nutrition to sustain development, it has
been argued. In order to express the disparity between nutritional intake and macro- and
micronutrient requirements, the more recent concept of "faltering growth" (FG) and malnutrition
are sometimes linked. This mismatch hampers overall growth, first affecting weight, then length
and head circumference; the primary manifestation of FTT is anthropometric degradation, but it
may also affect the development of cognitive skills and suitable immune function, resulting in
failure to achieve developmental milestones and good health. On the one hand, many acute or
chronic conditions may result in insufficient nutritional status; on the other, it contributes to an
increase in the burden of disease, mostly due to a decrease in resistance to infections. In
comparison to anthropometric development, the prevalence of nutrient deficiencies in children
and infants is little known. While they need less trace minerals from their diet, due to rapid
growth and irregular consumption, they may be more likely to be deficient than adults.
Failure to thrive is a commonly used term that suggests a disorder in infants and young
children of substandard growth for age and gender. Substitute the term FTT with the term
"faltering development" (FG) based on the latest indications, which is more suitable and could be
viewed by caregivers and parents as less negative or worrying. Even if FG is a condition which is
frequently encountered, there is still no consensus on its meaning. The definition of FG is closely
related to malnutrition, as it is generally attributed to inadequate caloric intake to sustain
development. Malnutrition can be characterized as an imbalance of requirements and intakes for
macro- and micronutrients. In addition, malnutrition diagnosis should not be limited to under
nutrition, but should also include patients with MNDs (overweight, obesity and micronutrient
deficiencies). MNDs are less apparent than others as a means of under nutrition and are thus
referred to as 'secret hunger.' Multiple MNDs coexist often and may be associated with protein or
energy deficiency. MNDs not only have a direct effect on individuals and communities, resulting
in poorer health , reduced educational achievement and reduced job ability, but they may also
have a negative impact on immune function, increasing vulnerability to infections, as many
vitamins and oligoelements are known to contribute to the normal functioning of the immune
system.
In infants, GF is a common concern, representing % to 10 % of patients seen in an
outpatient setting. Up to 5 per cent of babies and children in the United States are estimated to
have FG, but there is no data on the worldwide prevalence of this disease. Patients of all sexes,
races, and ages can be affected by FG, but it is most common in infants and younger children. A
recent research on children admitted to a tertiary care hospital for FG found that most of them
had primary non-organic FG, which is more common in public health insurance for children; this
implies that socio-economic factors may play a role, according to a previous observation that FG
is far more common in economically deprived and rural areas. Social and/or family problems are
closely correlated with FG. First of all, it may be an indicator of parental instability, and can be
attributed to many causes, ranging from psychological pressures (i.e., depression, low self-
esteem), to marital conflict, insanity, or overwhelming work. Secondly, FG may be a symptom
of neglect and/or abuse of children. Neglect should always be taken into consideration,
particularly when there is a significant risk of medical complications, a deterioration of medical
conditions despite a multidisciplinary approach, or a failure to comply with the treatment plan.
Breastfeeding attachment should be observed and encouraged, if appropriate, for
breastfed infants; adequate preparation of formula should be ensured for formula-fed infants. On
nutrient-rich balanced food options, parents of toddlers and older children should be advised,
preferably provided with three meals and three snacks a day. The Food-Based Dietary Guidelines
(FBDGs) have been described as science-based recommendations for various food assumptions
in the European population and can be a useful tool to advice caregivers on foods, food groups,
and dietary patterns. Social work assistance or other community services should be provided to
families with difficulties consuming nutritious foods (food insecurity). Adding modular or full
oral nutritional supplements is an alternative when caloric requirements are difficult to fulfill.
FG still remains a widespread problem in pediatrics, but it is often overlooked, especially
in the outpatient context. The lack of a uniform definition may be responsible for under-
recognition of the prevalence of FG, and have an impact on outcomes in children. Many
definitions have been proposed, solely based on anthropometric deterioration. In light of the
recent redefinition of pediatric malnutrition, a wider conception of FG as an unsatisfactory
nutritional status related to poor growth and health is necessary. Micronutrient deficiencies are
more frequent than expected and have relevant effects on growth and health. Even if accurate
measurement remains crucial in monitoring a child’s growth, this new insight integrates the
“classical” anthropometric criteria in its definition and treatment, aiming to guarantee both a
regular increase in size and an overall adequate health status and development.
 References:
 Shamir, R. (2020, October). 10 COMMON CAUSES OF FAILURE TO THRIVE.
Healthy Height.
https://www.healthy-height.com/blogs/growth-nutrition-guide/causes-for-failure-to-
thrive?
fbclid=IwAR0QcpNLBCl5u8qR9k8mzVW3Ke4mBXHYTFbwMz5VpPYejvP6tGE1q8t
MURc

 Lezo, A., et al. (2020, June 30). FAILURE TO THRIVE IN THE OUTPATIENT
CLINIC: A NEW INSIGHT
https://www.mdpi.com/20726643/12/8/2202/htm?
fbclid=IwAR1vxLRrCSQ3BpHLP2vWKfNr-
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