Failure To Thrive

How common is it?

It is reported in up to 10% of GP primary care settings and 5% inpatient settings. It is either caused by inadequate food intake or excessive loss of nutrients (diarrhoea). Inadequate food intake could be due to lack of appetite or excessive vomiting.

What are the signs and symptoms?

The signs and symptoms are dependent of the underlying medical conditions. Children with FTT means their growth (particularly height) have dropped of the expected linear growth centiles. They may have poor muscle bulk, feeling weak. They may experience bully due to being small size.

How is it diagnosed?

It is also very important to rule out potential medical conditions such as hypothyroidism, coeliac disease, Down syndrome, Turner syndrome, Silver-Russell syndrome, Crohn's disease, cystic fibrosis, congenital heart conditions, growth hormone deficiency and immune deficiency.

Children who presented with failure to thrive will need to have tests for coeliac disease, hypothyroidism, growth hormone, inborn errors of metabolism and also underlying genetic conditions.

Investigations should include thyroid function tests, coeliac disease, inflammatory markers (ESR, CRP, faecal calprotectin level - checking for Crohn's disease), ferritin, vitamin B12, folate, growth hormone, genetic screening and karyotype.

80% of failure to thrive is non-organic. Only 20% is organic.

What is the treatment?

A detailed history of food intake and nutritional analysis by a dietitian will provide useful information about the adequacy of food and nutrient intake. A child may require nutritional supplement to ensure adequate intake of nutrients. The treatment is dependent on the underlying medical condition.