Failure to Thrive
Failure to thrive is a delay in physical growth and weight gain that can lead to delays in development and maturation.
Failure to thrive is a diagnosis given to children who are consistently underweight or who do not gain weight for unclear reasons. There are many causes. Failure to thrive may be the result of environmental, emotional, physical, and medical factors that prevent a child from growing normally.
Many environmental and social factors can interact to keep the child from getting the nutrition he needs. Parental neglect or abuse, parental mental health disorders, and chaotic family situations in which routine, nutritious meals are insufficiently provided, may all blunt a child's growth, appetite, and intake of food. The amount of money a family has to spend on food and the nutritional value of the food they buy also affect growth. Inadequate intake of food may reflect inadequate parenting and environmental stimulation.
Sometimes failure to thrive is caused by a medical disorder in the child; sometimes the disorder is as minor as difficulty chewing or swallowing. Medical disorders, such as gastroesophageal reflux, narrowing of the esophagus, or intestinal malabsorption, may also affect a child's ability to retain, absorb, or process food. Infection, tumor, hormonal or metabolic disorders, heart disease, kidney disease, genetic disorders, and human immunodeficiency virus (HIV) infection are other physical reasons for failure to thrive.
Diagnosis
Doctors diagnose failure to thrive when a child's weight or rate of growth is well below what it should be when compared with past measurements or standard height-weight charts (see Section 23, Chapter 268). If the rate of growth is adequate, the child may be small for his or her age but still growing normally.
To determine why a child may be failing to thrive, doctors ask parents specific questions about feeding; bowel habits; social and financial stability of the family, which might affect the child's access to food; and illnesses that the child has had or that run in the family. The doctor examines the child, looking for signs of conditions that could explain the child's growth delay. The doctor makes decisions about blood and urine tests and x-rays based on this evaluation. More extensive testing is performed only if the doctor suspects an underlying disease.
Treatment and Prognosis
Treatment depends on the underlying cause. If a physical cause is found, specific treatment is given. Otherwise, treatment depends on how far below normal the child's weight is. Mild to moderate failure to thrive is treated with nutritious, high-calorie feedings given on a regular schedule. Parents may be counseled about family interactions that are damaging to the child and about financial and social resources available to them. Severe failure to thrive is treated in the hospital where social workers, nutritionists, feeding specialists, psychiatrists, and other specialists work together to determine the most likely causes of the child's failure to thrive and the best approach to feeding.
Because the first year of life is important for brain development, children who become undernourished during this time may fall permanently behind their peers, even if their physical growth improves. In about half of these children, mental development, especially verbal skills, remains below normal, and these children often have social and emotional problems in adulthood.
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