Summary about Disease
Growth failure, also known as failure to thrive (FTT), is a term used to describe a condition where a child is not growing or gaining weight as expected for their age and sex. This can involve inadequate physical growth (height and weight) or developmental delays. It's not a specific disease but rather a sign that a child's nutritional needs are not being met.
Symptoms
Low weight for age (below the 3rd-5th percentile on growth charts)
Slow or no weight gain
Small height for age
Delayed developmental milestones (e.g., sitting, walking, talking)
Irritability
Fatigue
Decreased appetite or refusal to eat
Poor muscle tone
Hair loss
Dry skin
Visible ribs
Behavioral problems
Causes
Growth failure can be caused by a variety of factors, broadly categorized as:
Inadequate Calorie Intake:
Insufficient breast milk or formula intake
Improper formula preparation
Food insecurity or neglect
Feeding difficulties (e.g., cleft palate, neurological problems)
Behavioral feeding problems
Inadequate Calorie Absorption:
Cystic fibrosis
Celiac disease
Chronic diarrhea
Milk protein allergy
Liver disease
Increased Calorie Needs:
Congenital heart disease
Chronic lung disease
Infections
Hyperthyroidism
Psychosocial Factors:
Neglect
Abuse
Parental mental health issues
Disturbed parent-child interaction
Medicine Used
There is no specific medicine for growth failure itself. Treatment focuses on addressing the underlying cause. Medications might be used to treat:
Infections: Antibiotics, antivirals, antifungals
Malabsorption issues: Enzyme replacement therapy (e.g., for cystic fibrosis), corticosteroids (for certain inflammatory bowel diseases), hypoallergenic formulas
Appetite stimulants: In some cases, medications like cyproheptadine may be used under close medical supervision.
Vitamin and mineral supplements: To correct deficiencies (e.g., iron, zinc, vitamin D). Nutritional support is often the primary intervention, including:
High-calorie formulas or supplements
Enteral feeding (tube feeding) if oral intake is insufficient
Is Communicable
Growth failure itself is not communicable. However, if the underlying cause is an infection (e.g., pneumonia), that infection may be communicable.
Precautions
Precautions depend on the underlying cause. General precautions include:
Good hygiene: To prevent infections.
Proper food handling and preparation: To avoid foodborne illnesses.
Ensuring adequate nutrition: Following feeding guidelines and addressing any feeding difficulties.
Creating a positive and supportive feeding environment.
Addressing any underlying medical conditions promptly.
Parental education and support: To improve feeding practices and address psychosocial factors.
How long does an outbreak last?
Growth failure is not an outbreak. It's a chronic condition that persists until the underlying cause is identified and addressed, and adequate nutrition and growth are achieved. The duration can vary significantly depending on the severity and the complexity of the underlying problem, ranging from weeks to months or even years.
How is it diagnosed?
Diagnosis involves:
Detailed medical history: Including birth history, feeding history, developmental milestones, and family history.
Physical examination: Assessing growth parameters (weight, height, head circumference) and looking for signs of underlying medical conditions.
Growth charts: Plotting the child's growth over time to identify deviations from normal growth curves.
Laboratory tests:
Complete blood count (CBC)
Electrolytes
Liver function tests
Kidney function tests
Stool studies (to rule out malabsorption or infection)
Thyroid function tests
Cystic fibrosis sweat test
Celiac disease screening
Imaging studies: May be needed to evaluate for underlying anatomical abnormalities or medical conditions.
Feeding evaluation: By a speech therapist or occupational therapist to assess feeding skills and identify any feeding difficulties.
Psychosocial assessment: To evaluate for potential neglect, abuse, or parental mental health issues.
Timeline of Symptoms
The timeline of symptoms varies depending on the underlying cause and the severity of the growth failure. In some cases, growth failure may be evident from birth, while in others, it may develop gradually over several months. The following is a general progression:
Early stages: Slow weight gain, decreased appetite, irritability.
Later stages: Stalled growth in height, delayed developmental milestones, fatigue, poor muscle tone, visible ribs, hair loss, dry skin.
Severe cases: Significant developmental delays, increased susceptibility to infections, and potentially long-term health consequences.
Important Considerations
Early identification and intervention are crucial to prevent long-term complications of growth failure, such as impaired cognitive development and stunted growth.
A multidisciplinary approach involving physicians, nurses, dietitians, speech therapists, occupational therapists, and social workers is often necessary to effectively manage growth failure.
Addressing the underlying cause is essential for successful treatment.
Parental education and support are critical to ensure that the child receives adequate nutrition and care.
Regular follow-up appointments are necessary to monitor the child's growth and development and to adjust the treatment plan as needed.