Infant Growth: Is Your Child on Track?

Understanding 'Failure to Thrive'

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What do doctors say about child growth concerns? Read on for the causes and the many descriptions of “failure to thrive.”

Have you heard of the medical term “failure to thrive?” You may have heard your child’s pediatrician mention this concern if your child has fallen two or more percentiles on his or her growth chart over a fairly brief time span. This becomes a serious issue when your child stays on the very bottom percentile or grows inadequately over time. Faced with one of those three situations, your child’s healthcare provider will need to investigate the reasons for your little one experiencing a “failure to thrive.”

Here’s a look at two examples and how doctors discover failure-to-thrive cases:

CASE 1: Martin brings his seven-month-old daughter, Jade, to the doctor because she has a runny nose and a slight cough. The doctor’s impression is that Jade has a minor cold, but she notes that the baby also looks thin. She plots the baby’s length and weight on a standard growth chart and tells Martin that his daughter has fallen from the middle of both charts at birth to the bottom percentile today.

The pediatrician explains that the possible reasons for this poor growth are many, and begins asking an extensive list of questions. She suggests that Jade undergo lab tests. Martin, whose original concern was his daughter’s runny nose, is now worried and confused.

CASE 2: Jennifer brings her 12-month-old son, Patrick, to his pediatrician with the concern that he is not growing as well as he should. Compared to the way he ate at four months, she explains, Patrick is much less interested in food. He crawls constantly and Jennifer feels that he isn’t eating more to make up for the calories he uses moving around. She asks for tests to see if anything serious is wrong.

After asking some questions and examining Patrick, the pediatrician shows Jennifer his growth chart. He is tracking nicely along the 25 percentile for length and weight, and Jennifer is told not to be concerned. The doctor is concerned, however, about Patrick’s long-standing eczema and writes some new prescriptions for his skin. Jennifer, who leaves with a prescription she didn’t anticipate and no lab testing, is also confused.

Definition of a Thriving Child

A “thriving child” is healthy in several different ways; He is growing and developing well emotionally, intellectually and physically. So, technically, a child can “fail to thrive” in many ways as well, though the term as used in pediatrics refers to the young child (usually under age three) who is not physically growing the way it is felt that he should. Normal growth is seen as an important indicator of a healthy body; thus, “abnormal” growth demands an explanation.

Descriptions of Failure to Thrive

There isn’t one neat and tidy definition of failure to thrive (FTT) in medicine, though it is usually defined using one of two parameters. The first is normative. It compares a particular child’s growth with the growth of other children his age. This is what is meant by the percentile rank on a growth chart. A rank of 25 percentile in length for a seven-month old means that if 100 babies where lined up side by side from the shortest to the longest, that seven-month old would be 25th from the short end, with 75 babies being longer.

The other method is longitudinal and compares the child to himself over time. Knowing the expected changes in length, weight, and head size through infancy, we ask: Is this child meeting those expectations? So a small baby when compared to others might be growing well over time while remaining “small,” while a baby who was quite large at birth might still be in the middle percentile a few months later because of sluggish growth due to a serious illness.

Roughly speaking, the concern of failure to thrive comes up when a child falls two or more percentile groupings on a growth chart over a fairly brief time span, is on the very bottom percentile, or grows inadequately over time. Faced with one of those three situations, it is now up to the health care provider to explain FTT. Which children are small but perfectly healthy? Which children were born large and to small parents and are falling in the growth charts as they slowly assume their smaller genetic destiny (which happens in the first few years of life)? For which children does poor growth reflect a serious illness? As opposed to extensive lab testing, most of the clues usually come by asking a series of questions and performing a thorough physical exam.

Causes of Failure to Thrive

The causes will ultimately fall into one of four categories:

  • Not enough calories are being consumed. Reasons for this range from a cleft lip/palate with the wrong feeding apparatus to extreme poverty, to chaotic feeding due to caretaker mental illness or substance abuse, to mistaken beliefs by the parents that children should not eat foods that will make them “fat.”
  • Calories are taken in but not kept in or properly absorbed by the gut. Chronic diarrhea, severe reflux, celiac disease and cystic fibrosis all fit into this category.
  • The body’s need for calories is increased and the demand cannot be met. Children with certain heart diseases, lung diseases, hyperthyroidism and cancer can fit into this situation.
  • The body cannot use the available calories properly. Diabetes and certain liver and kidney diseases fit here.

Ideally, after the medical history and physical exam are completed, only a few lab tests make sense, though there are scores that could be done. Often, a general blood test looking for hidden infections and anemia and a urine test screening for infections of the urinary tract and other kidney problems are the only initial tests done, with further testing depending upon the suspected causes. Only very rarely does this testing require hospitalization.

Treatment Options

The treatment is a two-pronged approach. The first involves treating any medical causes and intervening in any psychosocial ones. Yet regardless of the causes, there is an inadequately nourished child at stake and the second effort is always to renourish that child. This can be as simple as educating parents about misguided feeding practices to assembling an entire team of doctors, nutritionists, and social service workers to address a complicated situation. The end goal is always a thriving, healthy, growing child.

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