Poor weight gain, growth failure, and failure to thrive (FTT) are conditions that involve a vast array of potential causes. The root of the problem may involve (1) inadequate caloric intake, (2) decreased ability to metabolize the ingested food, (3) increased caloric expenditure, or (4) abnormal caloric requirement. Whatever be the cause, a child’s weight is a sensitive indicator of his or her general health. In the case of weight gain, health must be broadly defined and includes family, psychosocial, and socioeconomic causes as well as possible diseases and disorders.
Many cases of growth failure are diagnostically solved in the outpatient setting without the need for hospitalization. However, in some extreme cases, either because the growth delay is so significant or because the child is at a vulnerable age for long-term development, hospitalization is required. At times, the indication for hospitalization (Table 6-1) is a complex and/or obscure problem that requires a more intensive diagnostic evaluation.
Table 6-1. Indications of Hospitalization of Children with Failure to Thrive. |Favorite Table|Download (.pdf)
Table 6-1. Indications of Hospitalization of Children with Failure to Thrive.
Infants younger than 6 months of age
Below birth weight at 6 weeks
Head circumference falling below normal growth curve before 6 months of age
Signs of abuse
Signs of gross physical neglect
Persistent poor weight gain despite outpatient therapy
Underlying disease process being evaluated
Unsafe home environment
Caretaker deemed inappropriate
Growth failure is not a diagnosis on its own as it is a symptom of an underlying cause that must be identified to implement the appropriate intervention. The causes can be divided into broad categories of inadequate caloric intake, increased caloric wasting, increased caloric expenditure, and altered growth potential regulation (Table 6-2).
Table 6-2. Causes of Inadequate Weight Gain by Etiology. |Favorite Table|Download (.pdf)
Table 6-2. Causes of Inadequate Weight Gain by Etiology.
Inadequate Caloric Intake
- Lack of appetite
- Chronic disease (e.g., central nervous system pathology, gastrointestinal disorders, chronic infections)
- Anemia (e.g., iron deficiency)
- Cardiopulmonary disease
- Psychosocial problems (e.g., anorexia, apathy, depression)
- Difficulty with ingestion
- Feeding disorder
- Psychosocial problems (e.g., apathy, rumination)
- Neurologic disorders (e.g., cerebral palsy, hypertonia, hypotonia)
- Craniofacial anomalies (e.g., choanal atresia, cleft lip and palate, micro/retrognathia)
- Lack of suck/swallow coordination
- Generalized muscle weakness/pathology (e.g., myopathies)
- Tracheo-esophageal fistula
- Genetic syndromes
- Congenital syndromes (e.g., fetal alcohol syndrome)
- Unavailability of food
- Inadequate maternal lactation
- Inappropriate feeding technique
- Insufficient/inadequate volume of food
- Inappropriate food for age
- Withholding of food (abuse, neglect)
Caloric Wasting (from inadequate absorption or increased losses)
- Central nervous system pathology (increased intracranial pressure)
- Intestinal tract obstruction (e.g., pyloric stenosis, malrotation)
- Gastrointestinal reflux
- Metabolic disorders
- Biliary atresia/cirrhosis
- Celiac disease
- Inflammatory bowel disease
- Enzymatic deficiencies (lactose intolerance, cystic fibrosis)
- Food or protein sensitivity/intolerance
- Infectious diarrhea
- Short bowel ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.