Right Parenting - Not gaining weight? Is it Failure to thrive?

What is ‘failure to thrive’?

‘’Failure to thrive’’ means the child is lagging behind the normally expected weight gain and growth patterns without any apparent cause. It is not a single specific condition but rather an all-encompassing term having multiple causes that might be responsible for development of such abnormal pattern of growth.

At what age is it common?

Most commonly this complaint comes for the children before their third birthday. This is because growth and weight gain in infants and toddlers is rapid and obvious, and parents easily notice any negative change. But it can and does even occur in older children.

How is it diagnosed?

Maintaining a growth chart and looking for an abnormal pattern (a flat graph or a down-curve instead of the steady upward curve) is a simple way of diagnosing FTT. Growth charts are graphs plotting parameters like weight, length or head circumference against age. Weight against age is the most commonly used growth chart to diagnose FTT.

There is no absolute weight, which is considered as ideal or normal. There is a range of values, which is considered normal. Weight persistently below the normal range or sudden statistically significant weight loss at any age or static weights for consecutive three months in infancy- are indicative of FTT.

What is the usual pattern of weight gain in children?

Since weight for age is the most common indicator of FTT, it is useful to know the normal pattern of weight gain in children. In infancy the weight gain is rapid. Usually birth weight is doubled by 4th month and it is tripled by 12th month. Thereafter the weight gain pattern slows down till puberty and a gain of around 2 kg every year is considered normal. After puberty (12-18 years) again the weight gain is rapid (around 5 kg/ year).

What is non-organic FTT?

When FTT is not due to any physical illness but due to psychosocial or environmental deprivation, it is called non-organic FTT. Majority (70%) of cases of FTT fit into this category.

Most of the children who have this kind of non-organic FTT are victims of parental neglect due to socioeconomic reasons (poverty) or emotional reasons (e.g. unwanted child, parental conflicts, depressed mother etc.). In some, parental ignorance about feeding (proper preparation/pattern/presentation of foods) is responsible for FTT.

The term-‘Non-organic FTT’ is fast becoming obsolete now because even in so-called organic FTT, all these emotional and environmental factors do come into play frequently.

What are causes of organic FTT?

Conditions like prematurity, mental retardation, cerebral palsy and cleft lip/palate often lead to FTT. Inadequate intake and propensity for repeated infections are mostly the underlying mechanisms.

Reduced, faulty absorption and increased loss of nutrients is another mechanism, which is operative in conditions like celiac disease, cystic fibrosis, inflammatory bowel disease, chronic liver disease and some parasitic infestations.

Any severe chronic illness affecting any important organ like heart, lungs or kidneys can cause FTT through combination of increased requirements, decreased intake and increased losses of nutrients. This illness can be in the form of a congenital abnormality causing organ dysfunction/ failure, an infection, a malignancy or a metabolic/ hormonal imbalance.

How is it investigated?

Once diagnosis is confirmed and presence of emotional / environmental deprivation (Non-organic FTT) is ruled out, FTT needs at least basic and sometimes even advanced laboratory tests to pinpoint the causative organic condition.

Complete blood count, routine urine/ stool testing, serum electrolyte values and chest X-ray are the basic tests. Depending upon the suspected cause, doctor might ask for more tests like hormonal studies, chromosomal studies or metabolic screening tests.

What is the treatment of FTT?

FTT because of emotional or environmental factors is difficult to treat. Parental neglect, abuse or ignorance needs psychosocial counseling and community help. Economic reasons need to be tackled at governmental level. When a particular organic illness is causing FTT, then its treatment usually solves the problem.

Hospitalization is often the first step in the management of severe FTT. It changes the environment, allows proper evaluation and requisite calculated quantity of food can be administered. Often giving a formula through a tube passed from nose into stomach is the method employed to provide adequate nutrition. A weight gain of half a kilogram per week is taken as a good response to treatment.

Why is FTT important?

Since FTT is a condition occurring in the prime growth years of the child, its significance lies in its potential to affect the physical and emotional health for years to come. Maintaining a positive family atmosphere and being aware of correct nutrition and growth patterns is an important step in its prevention.

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