Failure To Thrive

FAILURE TO THRIVE
A. DEFINITION
Failure to thrive is a unique syndrome in which an infant falls below the fifth
percentile for weight and height on a standard growth chart or is falling in percentiles
on a growth chart.
B. RISK FACTORS
Risk factors for FTT admission and readmission were described in a retrospective
cohort study of 14,999 FTT hospitalizations. Approximately 41 percent of children
hospitalized for FTT had a complex chronic condition and 15 percent had ≥2 chronic
conditions. Five percent of children were readmitted for FTT within 30 days and 14
percent within three years. FTT readmission was associated with older age at
admission, lower median household income, and prematurity-related chronic medical
conditions.
C. CLINICAL MANIFESTATIONS
 Growth Failure – 5th percentile in weight only or weight and height

 Developmental delays – social, motor, adaptive, language
 Apathy
 Poor hygiene
 Withdrawn behavior
 Feeding/ eating disorder: vomiting, anorexia, pica, rumination
 No fear of strangers (stage when stranger anxiety is normal)
 Avoidance of eye contact
 Wide-eyed gaze & continual scan of environment (radar gaze)
 Stiff & unyielding or flaccid & unresponsive
 Minimal smiling
D. SIGNS AND SYMPTOMS
 Lethargy with poor muscle tone

 A loss of subcutaneous fat
 Skin breakdown
 Inability to resist the examiner’s manipulation the way the average infant does
 Staring hungrily at people who approach them as if they are starved from human
contact
 Little cuddling or conforming to being held by the second month life
 Achievement of development milestones in the prone position by third of fourth
month, but delays in other behaviors that should appear in later months
 Markedly delayed or absent speech
 Diminished or nonexistent crying
E. PATHOPHYSIOLOGY
The pathophysiology of failure to thrive depends on the underlying etiology. However, at

its base is a lack of necessary calories for adequate growth. This could be from not taking in
enough calories, losing too many calories, or increased caloric demand. There are multiple
formulas available for calculating caloric needs based on age and gender that can be helpful
for catch-up growth once the underlying etiology is identified.
F. NURSING CARE
 Ensure adequate nutrition. Keep a careful record of intake and output so that the
number of calories being consumed everyday can be evaluated. Assess stools for pH
and reducing substances (glucose) to be certain the child is absorbing nutrients.
 Nurture the child. Give effective parenting. Spend time rocking the child, giving a
leisurely bath, talking to the child, exposing the child to toys, and parenting the child
rather than just giving routine care.
 Support and encourage the parents. Encourage the parents to visit as much as
possible while the child hospitalized or in foster care. Encourage the parents to feed
the child if they want and interact with the child as they choose. Give some
suggestions about how the baby tries to communicate with them.
 Ensure evaluation and follow-up. Adequate follow up to ensure that the emotional
and physical needs continue to be met is a much larger issue, so big that the answer
lies not in treatment but in prevention. Give counseling and close follow up in the
postnatal period. Secure careful, thoughtful pregnancy histories to elicit information
about physiologic events that could lead to parenting breakdown.
G. PHARMACOLOGICAL MANAGEMENT
No medication is routinely needed unless an underlying condition is a factor (eg,
infection, gastroesophageal reflux, cardiac or lung disease).
H. MEDICAL AND SURGICAL MANAGEMENT
Management of infant with FTT is individualized according to severity and chronicity of

undernutrition, underlying medical disorders, and the needs of the child and family.
Successful management requires a plan to address contributing nutritional, medical,
developmental/behavioral, and psychosocial factors.
Support of the caregivers is critical. They should be involved as much as possible in the
formulation of the treatment plan. The involvement of a dietitian, occupational or speech
therapist, social worker, and/or developmental and behavioral pediatrician can be helpful
in formulating a management plan.
• Most of children with growth failure can be evaluated and manage as out patients,
with several important exceptions.
• Children with psychosocial failure to thrive should be hospitalized if they manifest

evidence of, or are at high risk for, physical abuse and/or severe neglect, are severely
malnourished or medically unstable, or have failed a trial of outpatient management.
•  The success of treatment often depend on the establishment of positive and caring
longitudinal alliance with the child and caretakers.
• Management of psychosocial failure to thrive must be individualized to the specific
needs of the child and family.
• Nutritional rehabilitation: efforts are focused on correcting the dysfunctional child-

parent interactions by addressing areas of parental misinformation, providing and helping
to implement specific feeding guidelines, and addressing the larger psychosocial needs of
the family.
• A multidisciplinary team approach involving the primarycare provider, nutritionist,

social worker, child behavior specialist, and community-based outreach services is often
most beneficial.
I. QUESTIONS
J. REFERENCES
Ladia, H.T. (2011, February 13) INTUSSUSCEPTION. Retrieved from

https://www.scribd.com/document/48730727/INTUSSUSCEPTION
Lucero, K. (2012, February 25) Failure to Thrive. Retrieved from
https://www.scribd.com/document/82780169/Failure-to-Thrive
Smith, A.E. & Badireddy, M. (2020, September 10) Failure To Thrive. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK459287/#:~:text=The%20pathophysiology
%20of%20failure%20to,calories%2C%20or%20increased%20caloric%20demand.
Suandi, I. G. (2014, March 12) Lecture 11 Failure to Thrive (FTT). Retrieved from
https://www.scribd.com/document/211978218/Lecture-11-Failure-to-Thrive-FTT.pdf
Susanto, N. (2019, July 3) failure to thrive. Retrieved from
https://www.scribd.com/document/415475239/failure-to-thrive.pdf

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FAILURE TO THRIVE

 Growth Failure – 5th percentile in weight only or weight and height

D. SIGNS AND SYMPTOMS

 Lethargy with poor muscle tone

The pathophysiology of failure to thrive depends on the underlying etiology. However, at

H. MEDICAL AND SURGICAL MANAGEMENT

Management of infant with FTT is individualized according to severity and chronicity of

• Children with psychosocial failure to thrive should be hospitalized if they manifest

• Nutritional rehabilitation: efforts are focused on correcting the dysfunctional child-

• A multidisciplinary team approach involving the primarycare provider, nutritionist,

Ladia, H.T. (2011, February 13) INTUSSUSCEPTION. Retrieved from

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