Failure to Thrive
This is when a child has poor weight gain/growth and falls through the centile groups. Head circumference is usually preserved relative to height (compared to some other causes of growth restriction in neonates e.g. IUGR), which is also conserved relative to weight. (I.e. these children look small but normal proportions). NB Head circumference may be increased relative to weight/height.
This is a common presentation of children by concerned parents, often around 10-12 month stage.
- It is most commonly due to failure of nutrition (especially worldwide) and problems with (breast)feeding need to be addressed.
- If there are any signs of abuse/neglect, suspicion should be raised and addressed.
- Not uncommonly, children reported failing to thrive are actually constitutionally small and there has been an error of recording details at birth.
- Diseases of almost any organ system can cause FtT
- A detailed history and examination- to assess for pathological causes is important. E.g. evidence of diarrhoea, UTI, thyroid disease, renal disease, anaemia etc
If nutrition and stature have been excluded as causes, further investigations should be done, including:
- Full blood works (FBC/U&E/LFT/TFT/Coeliac screen/immunoglobulins etc)
- Stool cultures and stool reducing substances
- Sweat test (if not already done)
- The mainstay of management is increasing nutritional intake (if this is the underlying problem- if not, treat this appropriately first)
- try also to encourage good diet habit and encourage eating (ignore when child doesn’t eat)
- Snacks may be used- particularly if they are calorie dense
- Malnutrition can lower the body’s natural host defences and predispose to infection. Unfortunately this can cause further malnutrition and a cycle can spiral down.
- Refeeding syndrome can occasionally occur in these kids, so care should be taken when increasing their nutritional intake
A child with height <3rd centile.
Most commonly (almost by definition) is genetic short stature. The next most common is probably constitutional growth restriction (i.e. normal growth velocity but abnormal for parent height).
However, any chronic disease can cause short stature, particularly hypothyroidism (normally can be diagnosed >2 years old- with associated weight gain) and Growth Hormone (GH) deficiency (diagnosed by insulin test).