Failure to Thrive Robert Allan Shapiro, M.D.

Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio 513-636-7966

Robert A Shapiro, MD, Patricia A. Myers, MSW Failure to thrive is a term used to describe the child who is unhealthy in regard to his or her growth.

Robert A Shapiro, MD, Patricia A. Myers, MSW Definition • most definitions are imprecise • absolute deficiency – known normal weights (by age and sex) – weight below the 2nd percentile • crossing of percentiles – weight gain is less than expected

Robert A Shapiro, MD, Patricia A. Myers, MSW Types of FTT • Organic (30%) – physiologic cause – medical treatment needed for illness • Non-organic (70%) – environmental cause – requires a change in the child’s environment • Mixed Barton D. Schmitt, M.D.

Robert A Shapiro, MD, Patricia A. Myers, MSW Organic FTT Causes • Neurologic • Cardiac • Gastro-intestinal • Congenital anomalies • Cystic Fibrosis • Respiratory • Urinary • Endocrine

Robert A Shapiro, MD, Patricia A. Myers, MSW Non-organic FTT Causes • Lack of education/preparation for parenting • Lack of family resources • Parental dysfunction • Difficult infant • Parent-child interaction problems • Family system dysfunction

Modified from Ludwig, Kornberg

Robert A Shapiro, MD, Patricia A. Myers, MSW Determination of FTT etiology • child’s intake – amount – frequency – diet • feeding routine – caretaker – difficulties – daily routine • abnormal losses – vomiting – diarrhea • other health problems – developmental milestones – chronic illness • parental attitude

Robert A Shapiro, MD, Patricia A. Myers, MSW Historical Indications of Non-organic FTT • history of adequate intake • no history of abnormal losses • lack of recognition for the problem • pattern of neglect

Robert A Shapiro, MD, Patricia A. Myers, MSW Physical Indications of Non-organic FTT • prominent ribs and bones • thin limbs, wasted buttocks • sparse, fragile hair • protuberant belly • decreased activity, apathy • dull, vacant stare • low weight (2 S.D. below mean)

Robert A Shapiro, MD, Patricia A. Myers, MSW Changes in growth due to FTT • early finding – weight • late findings – length – head circumference

Robert A Shapiro, MD, Patricia A. Myers, MSW Growth charts of an 8 month old boy with Non-organic FTT

Observe the parent for...

Robert A Shapiro, MD, Patricia A. Myers, MSW • lack of cuddling • indifferent response to separation • lack of perception for the child’s needs • inability to feed the child

Laboratory work-up • urinalysis and culture • electrolyte analysis • daily weights with calorie count • optional – HIV testing – skeletal survey – other Robert A Shapiro, MD, Patricia A. Myers, MSW

Robert A Shapiro, MD, Patricia A. Myers, MSW Indications for hospitalization • weight below birth weight at 6 wks • signs of physical abuse • very young infant • failure of out-patient therapy • work-up needed for organic causes • unsafe home