Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
What is Failure to Thrive?

What is failure to thrive?
When should I be concerned?
What causes growth failure?

WHAT IS FAILURE TO THRIVE?
"Failure to thrive" is often used to refer to the depressed rate of growth of an infant or child. It is also called undernutrition, delayed growth, growth faltering, and failure to grow. The term is often used somewhat ambiguously, but usually describes weight loss or a decreased rate of weight gain. Clinicians use professional judgement to evaluate anthropometric and clinical indicators as well as diet information.

The National Pediatric Nutrition Surveillance System defines undernutrition as weight for age, height for age, or weight for height below the 5th percentile on NCHS charts.

When should I be concerned about growth failure?
In general, when a child’s weight for age or weight for height falls more than two percentile channels or is below the tenth percentile, a "red flag" should be raised and a nutrition assessment might be warranted. Although a "low" weight for age is not necessarily indicative of undernutrition, it should trigger further attention to growth.

What causes growth failure?
Growth failure, also known as failure to thrive, or undernutrition, is not a primary disorder. Rather, the decreased growth rate is a result of other conditions. Growth delays might be associated with a medical condition in which short stature is common (e.g., cerebral palsy, Down syndrome, and Prader Willi syndrome) or where compromised growth is a complication of a medical condition (e.g., cerebral palsy, cystic fibrosis).

Growth is also compromised by prolonged, repeated, or severe illness (e.g., bronchopulmonary dysplasia and chronic otitis media). External factors (e.g., poor feeding technique, feeding dysfunction, lack of food, and impaired parent-child relationship) can lead to compromised growth as well.

Growth failure is usually a result of a combination of physiologic and environmental factors. Preterm infants can appear to be failing to thrive, if standards are applied to chronological versus gestational age. Therefore, growth parameters should be plotted at corrected age. Preterm infants have a greater incidence of conditions associated with compromised growth as well (e.g., chronic lung disease, gut dysfunction).