failure to thrive

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Failure to Thrive

 

Definition

Failure to thrive (FTT) is used to describe a delay in a child's growth or development. It is usually applied to infants and children up to two years of age who do not gain or maintain weight as they should. Failure to thrive is not a specific disease, but rather a cluster of symptoms which may come from a variety of sources.

Description

Shortly after birth most infants loose some weight. After that expected loss, babies should gain weight at a steady and predictable rate. When a baby does not gain weigh as expected, or continues to loose weight, it is not thriving. Failure to thrive may be due to one or more conditions.
Organic failure to thrive (OFTT) implies that the organs involved with digestion and absorption of food are malformed or incomplete so the baby cannot digest its food. Non-organic failure to thrive (NOFTT) is the most common cause of FTT and implies the baby is not receiving enough food due to economic factors or parental neglect, or do to psychosocial problems.

Causes and symptoms

Occasionally, there may be an underlying physical condition that inhibits the baby's ability to take in, digest, or process food. These defects can occur in the esophagus, stomach, small or large intestine, rectum or anus. Usually the defect is an incomplete development of the organ, and it must be surgically corrected. Most physical defects can be detected shortly after birth.
Failure to thrive may also result from lack of available food or the quality of the food offered. This can be due to economic factors in the family, parental beliefs and concepts of nutrition, or neglect of the child. In addition, if the baby is being breast fed, the quality or quantity of the mother's milk may be the source of the problem.
Psychosocial problems, often stemming from a lack of nurturing parent-child relations can lead to a failure to thrive. The child may exhibit poor appetite due to depression from insufficient attention from parents.
Infants and toddlers, whose growth is substantially less than expected, are considered to be suffering from FTT.

Diagnosis

Most babies are weighed at birth and that weight is used as a base line for future well-baby check-ups. If the baby is not gaining weight at a predictable rate, the doctor will do a more extensive examination. If there are no apparent physical deformities in the digestive tract, the doctor will examine the child's environment. As part of that examination, the doctor will look at the family history of height and weight. In addition, the parents will be asked about feedings, illnesses, and family routines. If the mother is breastfeeding the doctor will also evaluate her diet, general health, and well being as it affects the quantity and quality of her milk.
Diagnosis of FTT is confirmed by a positive growth and behavioral response to increased nutrition.

Treatment

If there is an underlying physical reason for failure to thrive, such as a disorder of swallowing mechanism or intestinal problems, correcting that problem should reverse the condition. If the condition is caused by environmental factors, the physician will suggest several ways parents may provide adequate food for the child. Maternal education and parental counseling may also be recommended. In extreme cases, hospitalization or a more nurturing home may be necessary.

Prognosis

The first year of life is important as a foundation for growth and physical and intellectual development in the future. Children with extreme failure to thrive in the first year may never catch up to their peers even if their physical growth improves. In about one third of these extreme cases, mental development remains below normal and roughly half will continue to have psychosocial and eating problems throughout life.
When failure to thrive is identified and corrected early, most children catch up to their peers and remain healthy and well developed.

Prevention

Initial failure to thrive caused by physical defects cannot be prevented but can often be corrected before they become a danger to the child. Maternal education and emotional and economic support systems all help to prevent failure to thrive in those cases where there is no physical deformity.

Resources

Organizations

American Humane Association, Children's Division. 63 Inverness Drive East, Englewood, CO 80112-5117. (800) 227-4645. www.americanhumane.org.
Federation for Children With Special Needs. 1135 Tremont Street, Suite 420, Boston, MA 02120. (617) 236-7210. http://www.fcsn.org.
National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389. http://www.niddk.nih.gov/health/digest/nddic.htm.

Key terms

Esophagus — The muscular tube which connects the mouth and stomach.
Psychosocial — A term referring to the mind's ability to, consciously or unconsciously, adjust and relate the body to its social environment.

failure

 [fāl´yer]
inability to perform or to function properly.
adult failure to thrive a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a progressive functional deterioration of a physical and cognitive nature. The individual's ability to live with multisystem diseases, cope with ensuing problems, and manage his/her care are remarkably diminished.
bone marrow failure failure of the hematopoietic function of the bone marrow; see also bone marrow suppression.
congestive heart failure see congestive heart failure.
heart failure see heart failure.
kidney failure renal failure.
multiple organ failure failure of two or more organ systems in a critically ill patient; see also multiple organ failure.
renal failure see renal failure.
respiratory failure see respiratory failure.
failure to thrive (failure to thrive syndrome) physical and developmental retardation in infants and small children. The syndrome can be seen in children with a physical illness, but the term is most often taken to mean failure to thrive due to psychosocial effects such as maternal deprivation. The syndrome was first noticed when European psychiatrists studied the development of babies who had spent the first five years of their lives in institutions where they were deprived of the emotional warmth of a mother, father, or other primary caregiver.

Characteristics of the failure to thrive syndrome include lack of physical growth (for example, weight and height below the third percentile for age) and below normal achievement in fine and gross motor, social-adaptive, and language skills as assessed by psychometric testing using a tool such as the Denver Developmental Screening Test. Additionally, the child with this syndrome displays withdrawing behavior, avoidance of eye contact, and stiffness or flaccid posture when held. These children often have a history of irritability, feeding problems, and disturbed sleep patterns.

Parents of infants with failure to thrive syndrome typically display feelings of concern and inadequacy. The infant who is feeding poorly and is irritable may elicit a response in the caregiver that reflects tension and frustration. The need for comfort and nurturing by the infant may not be met, and this may lead to a cycle that exacerbates feeding problems.

Intervention encompasses identification of infants and mothers at risk for the syndrome and care of both mother or primary caregiver and infant. The major goals are to encourage the mother to express her feelings without fear of rejection, to model the role of mother and teach her nurturing behaviors, and to promote her self-esteem and confidence. Important nursing goals in the care of the infant include providing optimal nutrition, comfort, and rest; meeting the infant's psychosocial needs; and supplying emotional nurturance and sensory stimulation appropriate to the assessed developmental level.
ventilatory failure respiratory failure.

fail·ure to thrive

a condition in which an infant's weight gain and growth are far below usual levels for age.

failure to thrive

n.
A significant delay in the physical growth of an infant or young child, caused by an organic, psychological, or environmental disturbance.

failure to thrive

Pediatrics The inability of a child to gain weight or loss of weight without discernible cause Etiology-environmental deprivation More common; children have poor appetites, are apathetic and withdrawn; these findings are typical of abused children, offspring of schizophrenics or in children with physical deformities or 2º problems causing the parents to subconsciously reject them Organic disease Cerebral lesions, chromosome defects, chronic infection or inflammation, cystic fibrosis, eclampsia, endocrinopathy, congenital heart disease, idiopathic hypercalcemia, malabsorption, CA, renal failure or renal tube defects, TORCH complex. See Child abuse. Cf Infanticide.

fail·ure to thrive

(fāl'yŭr thrīv)
A condition in which an infant's weight gain and growth are significantly below usual levels for age.

fail·ure to thrive

(fāl'yŭr thrīv)
Condition in which an infant's weight gain and growth are far below usual levels for age.
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