Failure to thrive (FTT) is defined as a child
with deficiencies in weight and height as
compared to age related normals. Failure to
thrive includes children whose weight and
height are less than the 3rd percentile or
whose weight or height have decreased more
than 2 major percentiles (ex. 50 to 3rd
percentile on their growth charts). Below is a
chart so that you can understand "normal"
growth rates. Failure to thrive children do not
experience these "normal" rates.
Normal growth rates for height
children are:
Age
Growth in Height
0-6 months
7-10 inches/year
6-12 months 6-7 inches/year
1-2 years
4-5 inches/year
2-3 years
3-4 inches/year
3-4 years
2-3 inches/year
4-10 years
2 inches/year
Normal growth rates for weight in
children are:
Age
Growth in Weight
0-4 months
1 1/2 lbs/month
4-10 months
1 lb/month
10-24 months 1/2 lb/month
2-8 years
3-4 lbs/year
Fifty percent of failure to thrive is non-
organic and 50 % is due to organic processes.
Head size, motor function and IQ may be
affected also. If failure to thrive is seen in the
first year of life, 60-80 % will have an organic
etiology.
Primary skeletal growth deficiency has its
onset during the pregnancy and growth is slow
in height and weight from early life to
adulthood. These include children with
chromosomal problems (ex: Turner
Syndrome, Down's Syndrome), skeletal
dysplasias (ex: Achondroplasia, Osteogenesis
Imperfecta), and dwarfism syndromes (ex:
Russell Silver, Cornelia de Lange, etc.)
Secondary growth deficiency problems are
divided into before birth and after birth types.
The before birth failure to thrive may be due
to maternal malnutrition which causes smaller
infants. Maternal high blood pressure,
cigarette smoking, alcohol use (fetal alcohol
syndrome) will lower birth weight. Maternal
drug use, seizure medicine use (Dilantin) or
infections/viruses (rubella, cytomegalic
inclusions disease, toxo- plasmosis, syphilis)
will make the infants smaller.
After delivery, many factors will affect our
children's size - malnutrition due to inadequate
calories, poor feeding techniques, improper
mixing of formula is still seen frequently, even
in some of the best families. Emotional
deprivation causes failure to thrive. The
deprived social and emotional setting of the
child may not be apparent from the parental
history. This may be seen in early infancy or
as late as 2-3 years old. Their developmental
delay may be proportionate to their size, not
their age. Children with mental retardation
often have failure to thrive, which is
nutritional in origin.
GI problems such as reflux, malabsorption,
parasites, milk intolerance and diarrhea will
cause significant failure to thrive. Complex
heart problems, which are cyanotic, have a
40% rate of failure to thrive. Corrective
surgery usually allows catch-up growth.
Kidney problems or failure will lead to
acidosis, rickets and slow growth. Steroid use
will inhibit growth. Liver disease (Hepatitis)
will cause malabsorption of food and
vitamins, thus slowing growth.
Lung problems such as Cystic Fibrosis, severe
stridor and severe recurrent infections affect
growth. Thyroid hormone deficiency can
present from birth all the way through
childhood. The thyroid child may have normal
growth initially and then develop failure to
thrive. Growth hormone deficiency presents
with slowing of height more than weight and
they grow less than 2.0 inches/yr, have normal
body proportions and are often below the
growth chart (discussed in another brochure).
In general a child whose height, weight and
head size are small has a genetic or
chromosomal problem, or the pregnancy was
complicated by a serious infection. If the
child has a normal head size, but the height
and weight are less than the 3rd percentile (off
the growth curve) consider hormone problems,
skeletal deficiencies and delayed puberty. If
the child has a normal height and head size,
but the weight is below the growth curve think
of malnutrition and non-organic failure to
thrive.
If your child has failure to thrive by his/her
growth chart, have your physician assess and
determine which of these etiologies exists.
Only then can the failure to thrive be assessed
and corrected. Failure to thrive does not occur
without an etiology. See your child's doctor.
Failure
to
Thrive
Contributing Author:
Paul M. Desrosiers, M.D.
Pediatric Endocrinologist
Medical Director
Arnold Palmer Hospital for Children
Orlando, Florida
Major
Aspects of
Growth
In
Children
The MAGIC Foundation is a national
nonprofit organization created to provide
support services for the families of children
afflicted with a wide variety of chronic
and/or critical disorders, syndromes and
diseases that affect a child’s growth. Some
of the diagnoses are quite common while
others are very rare.
MAGIC
Continues and develops through
membership fees, corporate sponsorship,
private donations
and fundraising.
“Children have a short time to grow and a
lifetime to live with the results” ®
Failure to Thrive
M
The MAGIC
Foundation®
For Children’s Growth
Not an illusion or magical,
But the caring for children
and their families
* * * *
Dedicated to the growth
and overall development
of children
6645 W. North Avenue
Oak Park, IL 60302
708-383-0808/fax 708-383-0899
800-3 MAGIC 3
www.magicfoundation.org
This brochure is for informational
purposes only. Neither The MAGIC
Foundation nor the contributing physician
assumes any liability for its content.
Consult your physician for diagnosis
and treatment.
