Failure to Thrive: Who is at Risk, and How it is Treated

About this course

Failure to thrive (FTT) is used to describe young children or infants whose current weight or rate of weight gain is below that expected of similar children of the same age, sex, and ethnicity. In most cases, FTT is insidious and gradual, and parents may not notice the undernutrition until it is bought to their attention.2 Healthcare professionals who work closely with the family and community are in the best position to detect the problem. This course provides an overview of failure to thrive, the various categories, risk factors, how it is diagnosed, and options for treatment.

Learning objectives

• Define failure to thrive
• Describe the various categories of failure to thrive.
• Recognize the risk factors for failure to thrive and how they can impact future development.
• Understand how failure to thrive is diagnosed and weight parameters as recommended by the World Health Organization.
• Understand dietary and pharmacological treatment options to improve weight gain.

Course outline

16 sections · finish in any order across devices

1. 1

   Introduction

   Failure to thrive (FTT) is a term that is often used in conjunction with growth faltering, weight faltering, or poor weight gain, describes a primary and secondary undernutrition condition that usually occurs in younger children or infants.1 In simple terms, failure to thrive is used to describe you

   4 min

2. 2

   Organic Failure to Thrive

   Organic Failure to Thrive is a medical condition that is responsible for the imbalance between caloric intake and body consumption requirements.5,6 It also interferes with absorption, metabolism, and excretion, and increases energy requirements.5

   4 min

3. 3

   Non-Organic Failure to Thrive

   Non-Organic FTT is a medical condition where psychological or family issues are responsible for low calorie intake.6 The mental stress in the child may cause increased levels of counter-regulatory hormones (corticosteroids, catecholamines), which oppose the effects of growth hormone, resulting in gr

   4 min

4. 4

   Mixed Failure to Thrive

   Mixed FTT is a medical condition where organic and nonorganic causes overlap. For instance, children with organic disorders also have disturbed environments or dysfunctional parental/caregiver interactions. Likewise, children with severe undernutrition caused by nonorganic FTT can develop organic me

   4 min

5. 5

   Risk Factors

   As mentioned above, there are multiple factors, such as biological, psychosocial, developmental, and environmental factors, including deprivation, maternal educational level, family size, and a wide range of physical conditions that contribute to failure to thrive in infants and young children.2,3,4

   4 min

6. 6

   Diagnosis

   History taking and physical examination are essential to diagnose failure to thrive.2,5,6 Often, parents and caregivers do not recognize their child’s faltering growth and developmental delays because they see the children regularly, and do not recognize the slight changes in health,2 however a heal

   4 min

7. 7

   Weight Monitoring

   Weight is the most obvious indicator to check the nutritional status of a child or infant.5 Underweight children may be smaller and shorter than other children their age and may have symptoms like fussiness or crying, lethargy or sleepiness, and constipation.5 Furthermore, FTT is also associated wit

   4 min

8. 8

   Patient’s History

   To diagnose and distinguish between organic and non-organic FTT, healthcare professionals should collect information regarding family, medical, and social history.2,5 The evaluation should be multidisciplinary and include an expert in child development.5

   4 min

9. 9

   Physical Examination

   If the causes and etiology of FTT are not determined after obtaining the history and evaluation, physical examination is considered.2,5,6 In physical examination, the focus is given to the patient’s weight, height, and head circumference based on standards set by the WHO for their age.2

   4 min

10. 10

    Testing

    Investigations should be made based on history, evaluation, and physical examination.2 For further investigation; laboratory testing is conducted.2 Laboratory testing is unlikely to lead to a specific organic diagnosis in a child whose failure to thrive is unexplained after careful history taking an

    4 min

11. 11

    Treatment Options

    The treatment for failure to thrive focuses on replenishing nutritional value to increase weight in infants and young children, developing a care plan for the family, and guaranteeing adequate cognitive development.5,6,8 Interventional techniques focus on both nutritional and behavioral issues, and

    4 min

12. 12

    Pharmacotherapy

    The underlying disorder should be treated quickly in children with mixed or organic FTT.5 Pharmacotherapy, such as cyproheptadine or megestrol (Megace), has been studied and may be helpful for specific populations with significant underlying diseases, such as cystic fibrosis or chronic renal disease

    4 min

13. 13

    Supplements

    Diet habits are the cornerstone of FTT prevention and treatment, but both universal and individual supplementation can also play a key role.6 Not only is it necessary among high-risk groups and in emergencies, but it is also associated with a lower risk of deficiency even in well-nourished individua

    4 min

14. 14

    Behavioral Intervention

    Hospitalization is rarely required but should be considered for children who are at high risk.8 Following are some of the indications for hospitalization:8

    4 min

15. 15

    Management And Long-Term Outlook

    FTT still remains a widespread problem in pediatrics, but it is often overlooked, especially in the outpatient context.6 It also has serious implications if left untreated, especially in brain development.2 If malnutrition becomes severe and chronic during the first year of life, the child's neurolo

    4 min

16. 16

    Conclusion

    What we need to understand is that children referred with FTT have dynamic biopsychosocial characteristics that extend beyond “organic” and “nonorganic” characterization.3 Thus, a more comprehensive and multidisciplinary team approach to characterize children with FTT can be facilitated by assessing

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Tang MN, Adolphe S, Rogers SR, Frank DA. Failure to Thrive or Growth Faltering: Medical, Developmental/Behavioral, Nutritional, and Social Dimensions. Pediatrics In Review. 2021;42(11):590-603. doi:10.1542/pir.2020-001883
• Jeong SJ. Nutritional approach to failure to thrive. Korean Journal of Pediatrics. 2011;54(7):277. doi:10.3345/kjp.2011.54.7.277
• Mazze N, Cory E, Gardner J, et al. Biopsychosocial Factors in Children Referred With Failure to Thrive: Modern Characterization for Multidisciplinary Care. Global Pediatric Health. 2019;6:2333794X1985852. doi:10.1177/2333794x19858526
• Franceschi R, Rizzardi C, Maines E, Liguori A, Soffiati M, Tornese G. Failure to thrive in infant and toddlers: a practical flowchart-based approach in a hospital setting. Italian Journal of Pediatrics. 2021;47(1). doi:10.1186/s13052-021-01017-4
• Failure to Thrive (FTT) - Pediatrics. MSD Manual Professional Edition. Accessed August 24, 2022. https://www.msdmanuals.com/professional/pediatrics/miscellaneous-disorders-in-infants-and-children/failure-to-thrive-ftt#:~:text=Treatment%20of%20failure%20to%20thrive
• Lezo A, Baldini L, Asteggiano M. Failure to Thrive in the Outpatient Clinic: A New Insight. Nutrients. 2020;12(8):2202. doi:10.3390/nu12082202
• Failure to thrive: MedlinePlus Medical Encyclopedia. medlineplus.gov. https://medlineplus.gov/ency/article/000991.htm
• Homan GJ. Failure to Thrive: A Practical Guide. American Family Physician. 2016;94(4):295-299. https://www.aafp.org/pubs/afp/issues/2016/0815/p295.html
• ‌Wit J. Catch-up growth: Definition, mechanism, and models. Journal of pediatric endocrinology & metabolism : JPEM. 2003;15 Suppl 5.

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