Overview

Failure to thrive (FTT) in infants is a medical condition characterized by inadequate growth or the inability to maintain expected weight gain during early childhood. It is not a disease itself but rather a descriptive term for insufficient physical growth, often accompanied by delayed developmental milestones. Failure to thrive can be due to a variety of medical, nutritional, or psychosocial factors. Early identification and intervention are crucial to prevent long-term developmental and health complications.

Causes

The causes of failure to thrive are broadly categorized into three groups: inadequate intake, malabsorption, and increased metabolic demand. Common causes include:

• Inadequate nutritional intake: Insufficient feeding, improper formula preparation, difficulty breastfeeding, or neglect.
• Feeding difficulties: Poor latch, cleft palate, gastroesophageal reflux, or oral motor dysfunction.
• Malabsorption: Conditions like celiac disease, cystic fibrosis, or chronic diarrhea leading to poor nutrient absorption.
• Chronic medical conditions: Congenital heart disease, chronic kidney disease, or other systemic illnesses that impact growth.
• Increased metabolic demands: Chronic infections or hyperthyroidism can increase calorie needs, leading to weight loss if intake is insufficient.
• Psychosocial factors: Parental depression, family stress, or neglect can affect feeding patterns and infant care.

Symptoms

Failure to thrive may present with a range of signs and symptoms, including:

• Poor weight gain: The most noticeable symptom, where infants fall below growth chart percentiles or cross downward percentiles over time.
• Delayed growth in length and head circumference: Especially in prolonged cases.
• Delayed developmental milestones: Slow motor, language, or social development.
• Reduced muscle mass and fat stores: Leading to a thin appearance.
• Feeding difficulties: Poor appetite, difficulty sucking or swallowing, or frequent vomiting.
• Behavioral changes: Excessive sleepiness, irritability, or lack of interest in the environment.

Diagnosis

Diagnosing failure to thrive involves a comprehensive evaluation to identify growth concerns and underlying causes:

• Growth measurements: Tracking weight, length, and head circumference against standardized growth charts.
• Feeding history: Assessing feeding patterns, formula preparation, frequency, and duration of feeds.
• Medical history and physical examination: Reviewing prenatal, birth, and family history along with a detailed physical exam.
• Laboratory tests: Blood tests to check for anemia, nutritional deficiencies, or underlying medical conditions.
• Imaging studies: In some cases, abdominal ultrasounds or imaging may be done to rule out anatomical problems.
• Developmental screening: To assess developmental delays associated with poor growth.

Treatment

Treatment focuses on addressing the underlying cause and ensuring adequate nutrition to promote healthy growth:

• Nutritional rehabilitation: Increasing calorie and protein intake through breast milk, formula, or nutritional supplements.
• Feeding therapy: Assistance from feeding specialists for infants with oral motor or feeding difficulties.
• Medical management: Treating any underlying medical conditions contributing to malnutrition or poor absorption.
• Behavioral support: Counseling or social work interventions in cases of psychosocial neglect or feeding aversion.
• Parental education: Teaching caregivers about proper feeding techniques, frequency, and nutritional requirements.
• Regular follow-up: Close monitoring of growth and development with pediatric visits.

Prognosis

The prognosis for infants with failure to thrive largely depends on the underlying cause and the timeliness of intervention. When identified early and managed appropriately, most infants experience catch-up growth and reach normal developmental milestones. However, if left untreated, prolonged failure to thrive can result in permanent growth impairment, cognitive delays, and weakened immunity.

With multidisciplinary care involving pediatricians, nutritionists, and developmental specialists, most children with FTT can recover well and lead healthy lives. Early intervention remains the key to optimal outcomes.