The causes may be a single issue or many and multifactorial - social, medical, feeding. Support parents. Look for any causes.
- Insufficient weight gain or inappropriate weight loss in paediatric patients
- A centile space is the space between adjacent centile lines on the UK WHO growth charts)
- It is usually applied to infants and children up to two years of age who do not gain or maintain weight as they should.
Failure to thrive defined as
- A fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
- A fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles
- A fall across 3 or more weight centile spaces, if birthweight was above the 91st centile
- When current weight is below the 2nd centile for age, whatever the birthweight.
- It is common for infants to lose some weight during the early days of life but this usually stops after about 3 or 4 days of life and most infants have returned to their birth weight by 3 weeks of age.
- If there is a 10% loss the commonest reason is dehydration. Assess hydration, or of an illness or disorder that might account for the weight loss. Take a detailed history to assess feeding. Consider the direct observation of feeding. Ensure done by a person with appropriate training and expertise (for example, in relation to breastfeeding and bottle feeding) perform further investigations only if they are indicated based on the clinical assessment.
- If infants lose more than 10% of their birth weight in the early days of life, or they have not returned to their birth weight by 3 weeks of age, consider referral to paediatric services if there is evidence of illness, marked weight loss, or failure to respond to feeding support
- Failure to thrive is slow physical development in a baby or child. It is caused by a baby or child not having enough nutrition.
- A child with FTT is at risk for problems such as short height, behaviour problems, and developmental delays.
- FTT has many possible causes. A baby or child may not be getting enough nutrients and calories. Or a baby or child may take in enough food, but not be able to absorb enough nutrients and calories.
- A baby or child with an ongoing (chronic) health condition may also need more calories and nutrients than normal.
- In some cases, a family may not understand what a baby needs. In severe cases, neglect or abuse may lead to FTT if food is kept from a baby on purpose.
- FTT can be prevented by seeking early help with a child's nutritional needs
- Poor intake: breast feeding issues, neglect,poverty
- Difficult feeing, cleft lip/palate, abnormal suck, pylotic stenosis
- Malabsorption: Coeliac, CF, Cow's milt intolerance
- Malignancy, Congenital heart disease
- Inborn errors of metabolism
- Full history and Full examination
- Plot growth chart
- Plot midparental height
- Observe feeding, volume, frequency
- Food diary
- Not enough weight gain for age
- Low height (or length, if a baby) for age
- Irritability, Tiredness
- More sleepiness than normal
- Lack of age-appropriate social response, such as smiling
- No vocal sounds
- Delayed physical movement changes (motor development)
- Learning and behavior problems in older children
- FBC, U&E, Urine dipstick for urinary infection
- Anti TTG ? Coeliac
- Specific tests as indicated by assessment
- Plasma lead levels in specific cases
- Breast feeding support +/- supplement with formula milk
- Dietician review with supplements
- Interdisciplinary collaboration is ideal in evaluation and treatment.
- Hospitalisation should be reserved for severe or recalcitrant cases.
- Severe cases may need NG feeding