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Failure to Thrive

What is “Failure to Thrive?”

As a child ages, doctors use certain standards determine normal growth. These include height and weight categories the child should fall into depending on their age, ethnicity, and biological sex. While what is considered “normal” can definitely vary, a child’s lack of certain developmental conditions could be an indicator of Failure to Thrive (FTT).  

Simply put, FTT is when a child does not grow at the same rate as their peers. Formally, this is defined as “decelerated or arrested physical growth (height and weight measurements fall below the third or fifth percentile, or a downward change in growth across two major growth percentiles) and is associated with abnormal growth and development,” according to experts at the Children’s Hospital of Pennsylvania. 

Explaining FTT

As further explained in STM Learning’s Child Abuse Quick Reference, Third Edition, FTT can occur as a result of neglect. It may also be an organic symptom of a medical condition, such as human immunodeficiency virus (HIV) or cystic fibrosis. Additionally, there are several subtle diagnoses that may contribute to FTT, including oral motor deficits, obstructive sleep apnea syndrome, and various food allergies. 

When FTT is caused by factors not pertaining to a medical condition, it is traditionally referred to as “nonorganic.” This category encompasses FTT caused by parental neglect, Factitious Disorder Imposed on Another —also known as Munchhausen Syndrome by Proxy— or chemical abuse. Most commonly, children present with “mixed FTT,” a combination of both environmental and medical factors (eg, poverty leading to malnutrition or poor living conditions).   

Several symptoms can be present in children with FTT. According to an article by Johns Hopkins, slow or nonexistent development of physical skills, such as standing and walking, is a common indicator. A lack of age-appropriate mental and social skills may also be a result of the child’s stunted development.

Monitoring the rate the child’s skills and size fluctuate over time, as opposed to merely focusing on the child’s measurements, can be helpful in determining whether FTT is actually the case. 

Treatment Options

Medical intervention is essential to determine the necessary steps for keeping the child’s growth on track. Children experiencing FTT are also at a higher risk for recurrent infection, therefore often requiring additional vaccines. 

Ultimately, a combination of factors can contribute to FTT. Creating a treatment plan for the child may mean considering hospitalization. Or, the best plan of care could focus on improving the family’s living conditions or understanding of nutrition.

For this reason, a multidisciplinary approach should be taken in treating the child. Professionals with medical, developmental, and social work backgrounds will be able to contribute different insights regarding proper care. 

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