Failure to thrive

Failure to thrive (FTT) is a descriptive term rather than a diagnosis, used in pediatric, adult, and geriatric care to indicate insufficient weight gain or inappropriate weight loss. In infants and children, it is characterized by an inability to obtain or use calories required for growth, leading to growth rates significantly below that of similar age and sex peers. In adults and the elderly, it describes a state where physical deterioration due to aging or disease leads to marked inability to maintain body weight.

Definition

Failure to thrive is not a single disease or condition. Instead, it is a manifestation of undernutrition and inadequate calorie intake or absorption. In children, the World Health Organization (WHO) growth standards are often used as a reference for weight and height to diagnose FTT. A child may be considered to have FTT when their weight or rate of weight gain is significantly lower than that of their peers, falling below the 5th percentile on standardized growth charts without any underlying medical explanation.

Causes

FTT can result from a variety of causes, which can be broadly categorized into four groups: inadequate caloric intake, inadequate absorption, increased metabolism, and defective utilization. Causes may include, but are not limited to:

• Inadequate caloric intake: Poor feeding techniques, neglect, poverty, or feeding disorders.
• Inadequate absorption: Conditions such as celiac disease or cystic fibrosis that affect the body's ability to absorb nutrients.
• Increased metabolism: Chronic infections or congenital heart disease that increase the body's caloric needs.
• Defective utilization: Genetic or metabolic disorders that affect how the body uses nutrients.

Symptoms

Symptoms of failure to thrive may vary depending on the underlying cause but generally include:

• Poor weight gain or weight loss
• Stunted growth
• Developmental delays
• Behavioral changes
• Fatigue
• Irritability

Diagnosis

Diagnosis of failure to thrive involves a comprehensive evaluation to identify potential underlying causes. This includes a detailed medical history, physical examination, growth measurements, and possibly laboratory tests and imaging studies. The goal is to rule out or confirm any medical conditions that could be contributing to the FTT and to assess the nutritional status and feeding practices of the individual.

Treatment

Treatment for failure to thrive focuses on addressing the underlying cause(s) and nutritional rehabilitation. This may involve:

• Dietary changes to increase calorie intake
• Treatment of underlying medical conditions
• Supplemental feeding through oral, enteral, or parenteral methods if necessary
• Counseling and support for families

Prognosis

The prognosis for individuals with failure to thrive depends on the underlying cause, the age of onset, and the timeliness and effectiveness of the intervention. Early detection and treatment are crucial for improving outcomes.

Prevention

Preventive measures for failure to thrive include ensuring adequate nutrition, regular monitoring of growth and development, and early intervention when growth concerns are identified.

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