Evaluation and Management of the Child With Failure to Thrive

Abstract

Background: Failure to thrive (FTT) is a common problem in pediatric practice, affecting 5-10% of children under five years of age in developed countries with a higher incidence in developing countries.

Objective: To outline a simplified but detailed approach to determining the etiology of FTT and highlight the need for high-calorie diet for catch-up growth and a careful follow up.

Methods:  Data were collected using manual search for relevant journals at the University of Benin Medical Library, internet (medline) search and textbooks.

Results: The majority of cases of FTT are due to a combination of nutritional and environmental deprivation secondary to parental poverty and/or ignorance. The key to diagnosing FTT is by accurately measuring and plotting a child’s weight, height and head circumference overtime and comparing the results with the appropriate growth charts and then assess the trend. In the evaluation of the child who has failed to thrive, three initial steps are required to develop an economical treatment-centered approach: a thorough history including itemized psychosocial review, careful physical examination, and direct observation of the child’s behavior and of parent-child interaction. Laboratory evaluation should be guided by history and physical examination findings only. Two principles that hold true, irrespective of etiology, are that all children with FTT need a high-calorie diet for catch-up growth and all children with FTT need a careful follow up. Social issues of the family must also be addressed.

Conclusion: A multidisciplinary approach is recommended when FTT persists despite intervention or when it is severe.

Keywords: Failure to thrive, growth deficiency, undernutrition.