Failure to thrive (FTT) is a historical medical term that describes when a child's growth is notably slower or less than expected compared to other children of the same age and sex. The term, however, has fallen out of favor in many medical communities due to its negative connotations, which could imply neglect or parental failure. Instead, more neutral and clinically descriptive language is now used to emphasize the medical concern related to inadequate growth rather than suggesting fault. The most prominent new terms include 'growth faltering,' 'weight faltering,' and 'growth deficit'.
What are the updated terms for failure to thrive?
Because the term "failure to thrive" is considered ambiguous and potentially stigmatizing, medical professionals now use several alternative terms. These modern synonyms focus on the observable medical issue rather than assigning blame, providing a more compassionate approach for families and caregivers.
The most common modern terms include:
- Growth Faltering: A broad term referring to any pattern of slow or insufficient physical growth in a child. It focuses on the growth pattern itself rather than an underlying cause.
- Weight Faltering: A more specific term that highlights insufficient weight gain as the primary concern. It is often the first sign of a nutritional problem before height or head circumference are affected.
- Growth Deficit: A clinical term that describes a quantifiable shortfall in a child's growth, often measured against standard growth charts.
Understanding the types and causes of growth faltering
Growth faltering is not a disease itself but a symptom of an underlying issue leading to malnutrition. The causes are typically categorized into three main types: organic, nonorganic, and a combination of both.
Types of growth faltering and their causes:
- Nonorganic (or Psychosocial) Growth Faltering: This type is caused by insufficient caloric intake due to environmental, social, or behavioral factors. It is the most common cause of faltering growth. Examples include feeding difficulties, poverty and food insecurity, complex caregiver-child feeding dynamics, or improperly prepared formula.
- Organic Growth Faltering: This type is caused by an underlying medical condition that interferes with the child's ability to absorb, metabolize, or use calories. The causes can range from gastrointestinal disorders to genetic conditions.
- Mixed Growth Faltering: In many cases, a child's faltering growth may involve a mix of both organic and nonorganic factors. For instance, a child with a medical condition may also experience environmental factors that compound the feeding issues.
Comparison: Organic vs. Nonorganic causes
| Feature | Organic Growth Faltering | Nonorganic Growth Faltering |
|---|---|---|
| Underlying Cause | A specific medical illness or condition. | Environmental, psychosocial, or behavioral factors. |
| Common Examples | Cystic fibrosis, congenital heart disease, Celiac disease, chronic kidney disease. | Inadequate food availability, difficulty with feeding techniques, caregiver depression, feeding aversion. |
| Nutritional Impact | Inadequate absorption, digestion, or increased metabolic needs. | Insufficient caloric intake. |
| Initial Signs | Often accompanied by other symptoms specific to the medical condition. | Typically presents first with a failure to gain weight, with length and head circumference affected later. |
| Prevalence | Less common than nonorganic types, though many cases are mixed. | Most common type, sometimes accounting for up to 80% of all cases. |
Signs, symptoms, and diagnosis
The most prominent sign of growth faltering is a weight or weight gain rate below expected measurements on a growth chart. However, other symptoms can accompany this sign, signaling a deeper issue.
Common signs and symptoms:
- Falling off a growth curve: A child's weight or height consistently drops across two or more major percentile lines on a growth chart.
- Delayed developmental milestones: Poor growth can negatively affect cognitive, motor, and language development.
- Apathy and poor interaction: The child may seem less engaged, sleepy, or less responsive compared to their developmental stage.
- Fatigue or low energy: A chronically malnourished child may lack the energy for feeding or daily activities.
Diagnosis involves a comprehensive assessment by a healthcare provider, which includes a thorough medical history, dietary intake evaluation, psychosocial history, and observing the caregiver-child feeding interaction.
Treatment and long-term outlook
The primary goal of treatment is to ensure the child receives sufficient nutrition to achieve healthy catch-up growth. The specific interventions will depend on the identified cause of the growth faltering.
Common treatment strategies:
- Nutritional Support: May involve adjusting feeding schedules, fortifying formula, adding calorie-dense foods, or addressing feeding techniques.
- Treating Underlying Conditions: For organic causes, therapy is aimed at the specific medical issue, such as treating Celiac disease or a heart condition.
- Behavioral Interventions: In nonorganic cases, a feeding team may provide psychological support and strategies to improve the caregiver-child feeding relationship.
- Multidisciplinary Approach: Successful management often involves a team of healthcare providers, including pediatricians, dietitians, social workers, and child psychologists.
With early and appropriate intervention, the overall outlook for infants and children with growth faltering can be very promising. However, if left untreated, severe malnutrition can lead to long-term developmental delays, intellectual disabilities, and persistent behavioral problems. Early diagnosis and personalized treatment are critical to ensuring a child can achieve their full growth and developmental potential.
Conclusion
Failure to thrive, now more appropriately called growth faltering or weight faltering, is a serious but treatable condition stemming from inadequate nutrition. The modern terminology reflects a move towards less stigmatizing and more clinically precise language. By identifying the root cause—whether medical, environmental, or a mix of both—healthcare providers can implement tailored, multidisciplinary treatment plans. Early intervention is crucial for a positive prognosis, highlighting the importance of regular pediatric check-ups where growth patterns are monitored closely to catch any concerns quickly. For further reading, an authoritative resource on the clinical management of faltering growth can be found at the Merck Manuals.
