Failure to thrive (FTT)

Question 1

Definition

Answer 1

FTT is failure to gain expected weight,

• being below the 3rd percentile
• up to 2 yrs on ≥2 occasions.

It is an indicator of an underlying disorder, either:

• non-organic (psychosocial)
• or organic.

The main reasons for FTT (up to 90%) are nutritional deprivation and normal variants.

Question 2

Non-organic FTT can be caused by:

Answer 2

• emotional deprivation or
• by poor nutrition from inadequate intake.

A home visit to evaluate the home environment, including adequacy of parenting, is invaluable.

This includes liaison with a community nurse.

Question 3

Organic FTT includes

Answer 3

• kidney failure
• endocrine diseases (e.g. hypothyroidism)
• various causes of malabsorption (e.g. coeliac disease, cystic fibrosis)
• cardiac disorders
• various inborn errors of metabolism
• mental retardation and sleep apnoea.

Babies born to mothers who are HIV carriers present with FTT in the first 5 mths with or without signs of disease.

Question 4

Screening tests include

Answer 4

routine blood counts

urinalysis and culture

Guthrie tests for PKU, TFTs

urogram

chromosomal and hormone analysis.

Question 5

Guidelines for referral for physical maldevelopment

Answer 5

Weight <1 to 3 centiles or >99th centile

Persistent downward crossing of weight centiles

Length <1st centile or >99th centile

Head circumference <1st centile or >99th centile

Any suspicion of abnormality