failure to thrive A description applied to a child whose weight or rate of weight gain is significantly below others of similar age and sex. Failure to thrive can be caused by a wide variety of problems, such as genetic, physical, psychological, or social factors.

Although it is not unusual for newborns to lose a little weight in the first few days, some infants fail to pick up on expected weight gain and growth. Usually caused by inadequate nutrition or a feeding problem, failure to thrive is most common in children younger than age three. Failure to thrive also may be a symptom of a physical problem such as an infection. Child neglect or abuse also may be associated with failure to thrive.

During the first few years of life, most children gain weight and grow very quickly. Many children who lag behind these standards are perfectly nor-mal—they simply fall at the lower end of the growth chart. Others, however, are considered to suffer from "failure to thrive."

Because this general diagnosis has many possible causes, it is important to identify any underlying problems for children who fail to thrive. Once the cause is understood, doctors and the family can work together to encourage the child to maintain a healthy growth pattern.

Although it has been recognized for more than a century, there is no one precise definition for "failure to thrive," primarily because it describes a condition rather than a specific disease. Children who fail to thrive do not receive, or are unable to take in or retain, adequate nutrition to gain weight and grow as expected. The condition is common in babies born prematurely, usually in conjunction with other medical problems linked to prematurity.


Typically, a child who is failing to thrive starts out growing well but over time begins to lag behind, first in weight and then in height. Symptoms of failure to thrive include height, weight, and head circumference in an infant or young child that do not progress normally according to standard growth charts (weight is lower than the third percentile, weight is 20 percent below ideal weight for height, or drops off from a previously established growth curve). Physical skills such as rolling over, sitting, standing, and walking are slow to develop, and mental and social skills are delayed.

If the condition is allowed to continue, the undernourished child may become apathetic and irritable and may begin to miss developmental milestones such as sitting up, walking, and talking at the usual age.


Some children fail to thrive because of a medical problem. There are multiple causes of failure to thrive that will disturb the body's metabolism enough to result in delayed growth. These include:

• chromosome problems such as down syndrome and Turner's syndrome

• defects in major organ systems

• endocrine abnormalities, such as thyroid or growth hormone deficiency

• brain or central nervous system damage

• abnormalities in the cardiac and respiratory systems causing disturbed mechanisms to deliver oxygen and nutrients

• anemia or other blood disorders

• abnormalities in the gastrointestinal system, which may result in malabsorption or absence of digestive enzymes resulting in inadequate nutrition

Some conditions such as cerebral palsy, chronic gastroenteritis, and gastroesophageal reflux (usually temporary) may contribute to this problem. psychological and social causes may include emotional deprivation as a result of parental withdrawal, rejection, or hostility. Economic factors can affect nutrition, living conditions, and parental attitudes. Environmental factors may include exposure to infections, parasites, or toxins. Sometimes the cause is undetermined.

With reflux, the esophagus may become so irritated and painful that the child refuses to eat. persistent diarrhea can interfere with the body's ability to use the calories from food. problems with absorption such as cystic fibrosis, chronic liver disease, and celiac disease all interfere with the body's ability to absorb nutrients, so that no matter how much the infant eats, the body does not retain enough of that food.

An intolerance of milk protein can lead to restrictions of the child's diet. infections or parasites place great demands on the body, and can trigger short- or long-term failure to thrive. inborn errors of metabolism can also limit a child's capacity to make the most of calories. Many other medical causes, such as neurologic, cardiac, endocrine, and respiratory problems can be suspects as well.

Sometimes doctors find that parents' attitudes or behaviors are causing the failure to thrive. Some parents restrict the amount of calories they give their infants out of fear that the child will get fat. Other children fail to thrive as a result of neg-lect—the parents simply do not feed them enough. Although in the past doctors tended to categorize cases of failure to thrive as either organic (caused by an underlying medical disorder) or inorganic (caused by caregiver actions), they are less likely to make such sharp distinctions today. This is because medical and behavioral causes often appear together. For example, a baby with a cleft palate who is reluctant to eat may cause stressful feeding times for a parent, who then becomes tense and frustrated, making it hard to sustain attempts to feed the child adequate amounts of food.

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