Failure To Thrive

WHAT YOU SHOULD KNOW:

Failure to thrive (FTT) is when your baby or child does not gain weight or grow as fast as he should. Children with FTT may not get enough nutrition (food) to support growth. Some children with FTT may not be able to store or fully use the nutrition they receive. Children need lots of energy and nutrients (food substances) as they grow, about three times as much as adults. It is very important that your child gets enough nutrients, especially during the early weeks of his life. If he does not, the growth of his body and brain will greatly slow down. This may cause problems with his health or with the development of his mental abilities. FTT can affect babies or children of families from all types of backgrounds, regardless of education or social class.

AFTER YOU LEAVE:

Causes of my child's failure to thrive: Your child can have FTT when he does not get enough nutrition or proper care. Medical conditions, or problems in the family or in your child's surroundings, can disturb his growth. Any of the following causes may lead to FTT:

• Medical problems: Your child's FTT may be caused by one or more of the following medical conditions:
  
  
  • Increased metabolism: Metabolism refers to energy use in the body. Certain conditions, such as hyperthyroidism, heart failure, asthma, or chronic infection, can increase the metabolism. If your child has such a condition, his body uses up energy and nutrients at a faster rate. This can leave little or none of these for his body to use for growth.
    
    
  • Problems with swallowing: Your child may have congenital problems (problems he was born with) that affect feeding or swallowing. A common such problem is cleft palate, which is an opening at the roof of the mouth. This can make it hard for him to swallow liquids or food. Damage to his brain can also affect swallowing and drinking.
    
    
  • Problems with nutrient absorption: The process of digestion includes breaking down nutrients into small pieces that can then be absorbed by the body. After your child's body breaks down food, the nutrients have to be absorbed before they can be used. Even if your child is getting enough food and liquids, nutrients may not be getting absorbed properly. Conditions such as cystic fibrosis, celiac disease, biliary atresia, and necrotizing enterocolitis can disturb the absorption of nutrients.
    
    
  • Problems with nutrient storage: Your child's body runs on nutrients that he has just eaten plus stored nutrition. Your child's body should be able to store extra nutrients to be used later on when needed. Without stored nutrition, the body has no reserves to fuel activities and growth. Certain metabolic (processing of substances within the body) conditions, such as storage diseases and amino acid disorders, can affect the storage of nutrients. If your child is born with an infection, he may also have storage problems.
  
  
• Non-medical problems: Most babies or children have non-medical conditions causing their FTT. Your child may have FTT when he is not cared for properly or if there are problems with his surroundings. Non-medical causes include the following:
  
  
  • Incorrect feeding: Your child may not be getting fed enough, or may be eating the wrong kinds of foods. He may be drinking milk formula accidently made with too much or too little water. He may be having problems with breastfeeding. He may be drinking a lot of liquids with too much sugar, such as fruit juices. He may not get the right types of food to supply all the nutrients he needs. Your child may also have a poor appetite or may be a picky eater.
    
    
  • Family problems: A family with limited money may not give a child proper food or care. Families that have a lot of stress, disruption, or too much going on can neglect their children's care. Major life events, such as job loss or the death of a family member, can add more stress. Families with no help from relatives or without other support systems may not function well when problems come. Family members with unhealthy behaviors, such as alcohol or drug abuse, or domestic violence, usually do not function well. In some families, family members may even harm or abuse children.
    
    
  • Neglect: Your child may not be getting as much attention or care as he should. A child growing up in a house with many other children may not get enough attention from an adult. Young parents may not know enough about proper feeding or care for their child. A mother who gets postpartum (period after giving birth) depression may not be able to adequately care for her baby. A depressed or mentally ill mother may not be able to give her child enough positive, nurturing attention. Children need to have a positive emotional relationship with someone who cares for them in order to grow.
  
  
• Mixed: FTT is often caused by a mix of any of the medical and non-medical conditions.

Telling caregivers about my child's failure to thrive:

• Tell your child's caregiver about how you feed your child. This includes how much, how often, and what kind of formula or foods he eats. Tell the caregiver about any special rules, beliefs, or concerns your family has about food, such as being vegetarian. Tell him if any of your child's relatives have food allergies. Tell the caregiver about any problems or defects you may see in your child's body. Tell him if your child was premature (born before his due date) and if he has had any medical problems. Tell him about your child's abilities, such as when he first sat up, crawled, and walked.
  
  
• Tell your caregiver about your family, how large it is, and how you relate with each other. Tell him about your family's finances, and if you get help from your relatives or friends when you need it. Tell him about any other people who take care of your child and how well your child is cared for. Tell him if you find it hard to care for your child or if you feel your child does not like you. It is important that you tell him at once if you think your child is being harmed or abused.

Signs and symptoms that may be related to my child's failure to thrive: Your child's height, weight, or head size is less than that of other children his age. Your child may also have one or more of the following:

• Decreased or no appetite at all, or being a picky eater.
  
  
• Diarrhea (loose bowel movement) or vomiting (throwing up).
  
  
• Hair that is dry and brittle, or growing thinly.
  
  
• Has a very low body temperature (his skin feels cooler than yours).
  
  
• Looks weak, thin, and fussy, and does not want to be around people.
  
  
• Not able to do things that he should be able to do at certain ages, such as sitting, rolling over or crawling.
  
  
• Trouble with sucking and swallowing during bottle or breast feeding, or with swallowing food or liquids.

Treatment: Your child's caregiver will try to find conditions that may be causing your child's FTT. FTT can be treated and cured most of the time. He will ask about your child and your family's medical conditions. He will ask about any problems while he was still in his mother's womb. He will ask what and how much he is being fed. He may also ask about how your family cares for your child. Your child's caregiver may use any of the following to treat his condition:

• Growth charts:
  
  
  • Diagnosis: Your child's primary caregiver keeps a record to follow your child's growth. He will measure your child's weight, length or height, and head size. He then compares your child's measurements with standard measurements for your child's age. FTT is diagnosed when your child is far below where he should be for one or more of these measurements. It is also diagnosed if at some point his rate of growth undergoes a large slow down.
    
    
  • Monitoring after diagnosis: You or your caregiver will measure your child's height, weight, and head size over time, and record it in a growth chart. Your child's caregiver can adjust treatment according to your child's measurements in this chart.
  
  
• Food diary: You may be asked to keep a written record of what and how much your child eats over several days. Your child's caregiver can then review this record to see if your child is being fed the proper kinds and amount of food.
  
  
• Dietary treatment:
  
  
  • Dietary changes: Your child may need a different formula or one with added vitamins, such as iron and zinc, to help him grow. He may need to be put on a high calorie diet. He may be given high energy foods, such as cheese, peanut butter, or whole milk, when he is old enough.
    
    
  • Nutrition management: A caregiver will determine how much your child needs to eat or drink to gain weight. If you child cannot eat or drink, his caregiver may put a tube which goes to his stomach through his mouth or nose. Your child will then get formula through the tube until he is able to eat on his own again.
  
  
• Feeding advice: Your child's caregiver may teach you or those caring for your child how to feed him correctly. He may watch you while you feed your child to check for problems with your way of feeding. You may do any of the following:
  
  
  • Encourage, but do not force, your child to eat.
    
    
  • Feed your child at a pace that is just right and not too fast.
    
    
  • Give your child snacks only at certain times, so his appetite for a regular meal is not reduced.
    
    
  • Have meals at regular times with other family members.
    
    
  • Limit you child's daily intake of fruit juice to 8 to 16 ounces.
    
    
  • Praise your child when he opens his mouth to take in food.
    
    
  • Start feeding your child with small amounts of food. Offer bigger servings later on.
  
  
• Home health visitors: Caregivers may visit from time to time to check on your child's health and growth development. They can check how well your child's treatments are being followed, such as the proper feeding techniques. They can check for problems with family relationships and ways of caring for your child. They may give some advice to decrease stress and help your child develop normally.
  
  
• Hospital admission: A hospital stay is needed when treatment outside the hospital has failed or when your child's FTT is severe (very bad). Your child may also need to be protected from neglect, abuse, or harm. Your child may need to stay so that caregivers can watch his health and development more closely. In the hospital, your child can be fed properly in a more relaxed, calm place.
  
  
• Reflux: If your child has reflux, he may need medicine. Reflux is when acidic stomach contents move back up into the esophagus (tube between the mouth and stomach). This causes pain and damage to the esophagus. Babies with reflux may vomit frequently and be irritable. Sometimes surgery is needed to stop the stomach contents from entering the esophagus. Ask your caregivers for more information about gastroesophageal reflux.

Caring for your child:

• Family planning. Having too many children too soon can put a lot of stress on your family. You may not have enough time, energy, or resources to properly take care of all of them at the same time. Planning when to have children can help you give enough attention and care to all of your children.
  
  
• Regular visits to your child's caregiver. Visiting your child's caregiver frequently will help him check your child's health and development closely. Your child's caregiver can detect disorders that may give your child symptoms later on, such as problems in the digestive system. He can watch how fast your child gains weight and grows. He can also check your child's abilities, such as talking or walking, to check his development.
  
  
• Proper feeding. Your child's caregiver may give advice on what to feed your child and how to feed him. Taking time to learn recommended feeding methods, such as breast feeding techniques, can improve your baby's nutrient intake. With practice, you should become more comfortable with feeding your baby in ways that work best for him. Having successful feeding experiences will help strengthen your relationship with your baby. Ask your caregiver for more information about proper ways of feeding your child.
  
  
• Solve family problems as soon as possible. If you feel that your family may be having problems, ask for help from your friends or relatives. You may also talk with members of your family to help solve any family problems. Solving problems as soon as possible can help you get back to taking care of your child. If your family problems continue, you may want to ask your caregiver for advice or referral to a family counseling professional.

Appointments with other caregivers: You may need to see a dietician to teach you or those caring for your child what and how much to feed him. If your child is still breast feeding, you may need a lactation counselor. This caregiver can teach proper breast feeding techniques. Social service workers may give vouchers or other financial assistance to help your child get the proper foods. Your child may need to see a pediatric gastroenterologist to check for problems with his digestive system. If you are feeling depressed or emotionally distant from your infant or child, you may need medication or mental health counseling. Your child may need a mental health worker to check for problems with his behavior or mental development. Child protective services may be called if someone is suspected of harming or abusing your child.

What to expect with time or treatment: Children with FTT have an increased risk for getting infections. Even with treatment, these children usually have slow increases in weight, height, and head growth. Depending on how early and how successful treatment for FTT has been, your child may have permanent problems from it. He may be smaller and shorter in height than he should have been. You child's mental abilities may develop at a slower rate and may leave him with problems in thinking later on. He may be more at risk for having problems with his behavior, which may cause family problems.

CONTACT A CAREGIVER IF:

• Your child is very irritable and cannot be consoled, and you are feeling very stressed or angry about it.
  
  
• Your child is vomiting frequently or having frequent diarrhea.
  
  
• Your child has fever, swelling, or redness of his skin or other parts of his body.
  
  
• Your child is acting unusually difficult or irritable.
  
  
• Your child is not growing or gaining more weight as fast as he should, even with treatment.
  
  
• Your child is still not speaking, walking, or doing other things other children his age can do.

SEEK CARE IMMEDIATELY IF:

• Your baby has had less than 4 to 6 wet diapers in the last 24 hours, or is weak and sleeping more than usual.
  
  
• Your baby's soft spot on the top of his head is sunken when he's quiet.
  
  
• Your child cries without having tears, has sunken eyes, and a dry mouth.
  
  
• Your child is listless and not responsive to you.
  
  
• Your child looks unusually thin, with his cheeks sunken and his bones bulging through his skin.
  
  
• Your child's body, including his and arms and legs, are swollen and his skin has an abnormal color and may be peeling.
  
  
• Your child has bruises, redness on his skin, or other injuries and you suspect that someone may be harming or abusing your child.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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