Common Growth Concerns

Causes for Failure to Thrive

Failure to thrive (FTT) is a condition affecting 5-10% of children that describes a problem with growth. It is not a disease or illness, but instead a cluster of symptoms and measurements that when interpreted together indicate problem. It is usually caused by a child not getting enough calories to help them grow or an underlying medical problem that is not allowing them to correctly process the calories they are eating. Children born in families with significant economic, psychological, or social problems are more likely to develop FTT. It is also more common in lower socioeconomic urban or rural areas. Although certain children are at risk for FTT, it can happen to any child. FTT has many underlying causes and the cause must be determined before proper treatment can be initiated.

Causes of failure to thrive

The causes of failure to thrive fall into two main categories: organic and nonorganic. Organic FTT occurs when there is an underlying medical problem that is the cause of the condition. Some examples of conditions that may lead to FTT include Celiac disease, thyroid disorders, or premature birth. Non-organic FTT, also sometimes called psycho-social FTT, is when there are no known medical reasons for the condition, but instead may be caused by problems in the child’s environment or home life. When a child is determined to have FTT, it usually has both organic and nonorganic causes. Each cause needs to be evaluated and addressed to help the child recover and begin to grow normally. 

Causes of Organic Failure to Thrive

Digestive Problems

Several different medical conditions affecting the digestive tract can lead to FTT. These may include chronic diarrhea, celiac disease, Crohn’s disease, or gastroesophageal reflux (GERD). All of these conditions can lead to malabsorption, due to frequent diarrhea, which prevents the body from properly absorbing calories. The child can in turn have problems with gaining weight, even if they are eating enough calories. In the case of GERD, eating can be painful due to acid coming up from the stomach and the child may refuse to eat.

Food Allergies or Intolerances

Food allergies are different from food intolerances, but both may lead to FTT. When a child has an allergy to a food, exposure to that food may cause an anaphylactic reaction that, if severe enough, can be life=threatening. Children with food allergies, may need to avoid calorie-dense foods such as dairy or other sources of protein, limiting their food choices and leading to poor weight gain and FTT. 

On the other hand, a food intolerance is not immediately life-threatening and can vary in severity. But, a common symptom of food intolerance is diarrhea, abdominal pain, or other digestive problems after eating a specific food. A food intolerance you may be familiar with is lactose intolerance, where the body does not have enough of the enzymes needed to digest milk products, causing gas, bloating, and diarrhea. Digestive symptoms caused by food intolerances can prevent proper absorption of calories or prevent a child from eating a wide variety of nutritious foods, leading to problems with growth and possibly FTT. 

Chromosomal Abnormalities

Genetic conditions such as Down’s syndrome or Turner’s syndrome can impact the utilization of calories, ability to eat properly, and result in FTT.

Chronic Infections

An infection with parasites, recurring urinary tract infections, or chronic infections can cause a decrease in appetite and problems with the absorption of nutrients. Once these illnesses are treated, usually the FTT improves.

Birth or pregnancy complications

Pregnancy and birth complications, such as pre-term birth or low-birth weight, can impact a child’s ability to eat. A premature infant may not have a strong enough suck reflex to consume enough calories which may affect their growth.

Metabolic Disorders

Metabolic disorders are illnesses that affect the metabolism or chemical processes of the body. These can be discovered at birth or later in life. They can cause extreme fatigue, weight loss, and problems with eating.

Hormonal Problems

Hormones impact our body’s ability to use calories properly. Diseases of the thyroid or pancreas can affect how our body processes food, leading to failure to thrive. Deficiencies in hormones related to growth, such as growth hormone, can also be an underlying cause.

Other Medical Problems

Other medical conditions can impact the body’s ability to absorb nutrients. Some of these include: liver disease, cystic fibrosis, cerebral palsy, or cleft palate. These may all impact the child’s ability to use or consume enough calories. Other conditions, involving hormones, such as thyroid disease, or the lungs, such as pulmonary disease, can increase the amount of calories a child needs and make it challenging for them to eat enough.

Causes of Non-organic Failure to Thrive

Not enough calories provided

In some cases of failure to thrive, the child is not receiving enough calories due to improper feeding or problems with feeding. If an infant is exclusively breastfed, the mother may not be making enough milk to help the baby grow. Or the baby may not be latching correctly or often enough to get adequate calories.

If a baby is formula fed, the parents may be mixing the formula incorrectly or not providing enough to support growth. Failure to thrive can also occur when a child is transitioning to solids from breastmilk or formula, as they may not accept the solid food as readily or the caregiver may not know how to appropriately introduce solid food.

At times, a child may not get enough calories because there may be a problem with food availability due to economic issues in the family or neglect of the child’s nutrition needs. If FTT is caused by not getting enough calories, once this is corrected, the child can frequently recover.

The child doesn’t eat enough

At times, children simply don’t eat enough to support their growth even if they are provided with enough food. It is normal for kids to go through phases of picky eating, but most of them do get enough calories at the end of the day. 

But, some children take picky eating to an extreme because of underlying conditions that prevent them from eating enough. Some kids have difficulty with certain textures or conditions that prevent proper swallowing and chewing. These problems with eating may be caused by developmental delays, prematurity, or underlying medical conditions. Any situation that is impacting a child’s ability to eat enough needs to be addressed by a specialist to help improve the child’s intake.

Family economic problems

Some families have economic difficulties that make it challenging to provide enough food or the right types of foods to their children. Approximately 8% of families in the United States are food insecure, meaning they are not sure where their next meal will come from or do not have enough income to provide balanced meals for their families. Food insecurity is especially a problem for families headed by single mothers. Social programs, such as WIC, have been developed to help reduce food insecurity for children because inadequate nutrition over time can result in growth delays, including FTT. 

Mental health of parents or caregivers

Maternal mental significantly impacts the child’s ability to grow and thrive. The bonding between mothers and infants and may influence a child’s ability or desire to eat. Mothers with postpartum depression, who are under excessive stress, or who have other mental health issues are more likely to have problems with breastfeeding or milk production, leading to inadequate calorie intake and possibly failure to thrive. Pediatricians should be trained in how to identify the signs of mental health issues in mothers in order to help provide support, which in turn can help the infant grow properly.

Neglect or Abuse

Unfortunately, some children do not receive enough calories due to neglect or abuse. Physical, mental, or sexual abuse can also impact a child’s desire to eat. Children with FTT are four times as likely to have been victims of abuse. 

At times, abuse or neglect is caused by mental health or substance abuse problems of the parents or caregivers. Helping address mental health and social issues for the child and family should be part of the treatment plan for FTT, if this is the underlying cause.

Many Causes of Failure to Thrive

Usually, if a child is diagnosed with failure to thrive, there is more than one underlying cause. All causes must be discovered and addressed to help the child recover and begin to grow properly. Since it is a multi-factorial condition, a diagnosis of FTT may take time as the child’s doctor gathers all of the information necessary and monitors the child’s growth. Once the diagnosis is made and the causes are determined, treatment can begin. 

A child with FTT will likely be referred to multiple specialists who can support the family and help treat the child. Treatment may involve regular visits to speech therapy, occupational therapy, a Registered Dietitian, or a psychologist. Medical doctors who are specialists in various areas may also need to be involved, if it is determined that there is an underlying medical cause. Families may need financial support or help with receiving social services if there is a problem with food insecurity or poverty. Any issues of neglect or abuse should be evaluated by a social worker to determine the best course of action for the child. Most treatments can be done on an out-patient basis, but in rare cases children may need to be hospitalized depending on the severity of their condition. Also, treatment of the condition will usually take months to a few years because it takes time to begin to see improvements in growth.

With all these causes of FTT, is important to note that sometimes the underlying cause of FTT cannot be determined. This makes it a challenging condition to treat because there is no specific reason for the poor growth. 

What is the prognosis?

The prognosis of a child diagnosed with failure to thrive depends on the severity of the condition, how soon it was diagnosed, and the underlying cause. If the cause is simply a lack of education on proper feeding or an issue with getting enough calories, once that is corrected, the child has a chance of a full recovery. If the cause is an underlying medical condition, the child may need more extensive or on-going treatment for a full recovery. 

Most children have fully recovered from FTT by the age of 8, as long as they receive treatment. FTT has a larger risk of causing long-term consequences in low birth weight preterm infants or in children in developing countries who may not have the resources to receive treatment. If a child does not receive treatment soon enough, FTT can result in long-term complications that may include learning disabilities, short stature, and emotional problems.

Prevention of failure to thrive is the best way to reduce long-term complications. If you see your child is losing weight or not growing as you think they should, be sure to speak to your doctor. Be sure to attend all medical appointments and keep an open communication with your child’s pediatrician. If you need help with providing enough food for your child or family, there are many social programs that can help. WIC is a federal program specifically designed to support women, infants, and children with proper nutrition. A child who receives an early intervention on any growth issues is much more likely to either avoid FTT completely, or recovery quickly if they are diagnosed and go on to live completely healthy lives. 

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