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Failure to Thrive (FTT) / Faltering Growth
⚠️ Failure to thrive (FTT), or faltering growth, can result from social, medical, and feeding issues — often overlapping.
Always support parents and investigate thoroughly.
📖 Introduction
- FTT = insufficient weight gain or inappropriate weight loss in infancy/early childhood.
- Defined using centile spaces on UK WHO growth charts.
- Most often applied to children <2 years of age.
📏 FTT Defined As
- ⬇️ Fall across 1+ centile space if birth weight < 9th percentile.
- ⬇️ Fall across 2+ centile spaces if birth weight 9th–91st percentile.
- ⬇️ Fall across 3+ centile spaces if birth weight > 91st percentile.
- 📉 Current weight < 2nd percentile for age (any birth weight).
🍼 Background
- Weight loss in early days is normal → should regain by 3 weeks.
- Loss >10% of birth weight = dehydration until proven otherwise → assess and treat.
- Failure to regain by 3 weeks → consider referral to paediatrics.
💡 Main Points
- FTT = slow physical development → risk of short stature, behavioural issues, developmental delay.
- Causes: inadequate intake, malabsorption, ↑ metabolic demand, chronic disease.
- Severe cases → neglect or abuse may be contributory.
- Early intervention prevents long-term consequences.
🔍 Causes of Failure to Thrive / Poor Growth
- 🍽️ Nutritional
- Inadequate intake: poor feeding, neglect, dysphagia, food insecurity
- Malabsorption: coeliac disease, cystic fibrosis, chronic diarrhoea, food allergy, parasites
- Increased requirements: CHD, CLD, hyperthyroidism, infection, prematurity
- ⚕️ Organic / Medical
- GI disorders: GERD, Crohn’s, ulcerative colitis, pyloric stenosis
- Endocrine: hypothyroidism, GH deficiency, diabetes, adrenal insufficiency
- Chronic infections: HIV, TB, recurrent UTIs, chronic otitis media, parasites
- 🧠 Psychosocial
- Neglect/abuse: food withheld, hostile environment
- Parent–child interaction: maternal depression, poor bonding, misreading feeding cues
- 🧬 Genetic / Developmental
- Syndromes: Down, Turner, Prader–Willi, metabolic disorders, cleft palate
- Developmental delays: cerebral palsy, global delay → feeding difficulty
🔍 General Assessment
- 📊 Plot weight/height/head circumference on growth chart.
- 👨👩👧 Midparental height calculation.
- 🍼 Observe feeding behaviour, intake volume/frequency.
- 📝 Food diary.
- 🏠 Consider psychosocial and environmental context.
🧩 Clinical Signs
- Persistent underweight / poor weight gain.
- Short stature for age.
- 🛌 Irritability, fatigue, lethargy.
- 😐 Lack of social responsiveness.
- 🚶 Delayed motor milestones.
- 📚 Learning and behavioural problems (later).
🧪 Investigations
- FBC, U&E, LFT, urine dipstick (UTI).
- Anti-TTG ± IgA (coeliac screen).
- Directed tests: lead levels, sweat test, endocrine panel depending on suspicion.
💊 Management
- 🍼 Support breastfeeding, formula if needed.
- 🥗 Dietitian input, supplements, high-calorie feeds.
- 👨👩⚕️ Multidisciplinary approach (paeds, dietetics, social work).
- 🏥 Hospitalise if severe / unsafe / refractory.
- 🚑 NG feeding if severe malnutrition or poor oral intake.
- ⚠️ Safeguarding: consider neglect/abuse if concerns raised.
📚 References
