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...