Growth and weight faltering (formerly known as failure to thrive) is a lack of expected weight gain and physical growth that can lead to delays in development and maturation.
Medical disorders and a lack of proper nutrition are causes of growth and weight faltering.
The diagnosis is based on a child's growth chart values, physical examination, health history, and home environment.
Children who are undernourished during the first year of life may have developmental delays.
Treatment includes a nutritious diet and treatment of medical disorders.
During the first year of life, an infant's weight and length are charted at each doctor's visit to make sure that growth is proceeding at a steady rate (see Physical Growth of Infants and Children). Percentiles are a way of comparing infants of the same age and sex. For example, saying that an infant is at the 10th percentile for weight means that of 100 babies of the same age and sex, about 90 weigh more and about 10 weigh less. Although some infants are smaller and some are larger, infants typically stay at about the same percentile as they grow.
Growth and weight Faltering is a diagnosis considered in children whose weight or body mass index drops below the expected measurement or whose height or length dropped below the expected measurement when compared to children of the same age and sex. Weight faltering is also considered in infants who have a steady drop in their weight percentile even though their actual weight is not low. For example, doctors would be concerned about an infant who dropped from the 90th percentile to the 50th percentile (average weight) in a short period of time.
There are many causes.
Causes of Growth and Weight Faltering in Children
Causes of growth and weight faltering can involve
Environmental and social factors
Medical disorders
Whatever the cause, inadequate nutrition can affect the growth of a child’s body and brain.
Environmental and social factors are the most common reasons why children do not get the nutrition they need. Growth and weight faltering for these reasons results from not taking in enough calories.
Caregiver neglect or abuse, parental mental health conditions (such as depression), food insecurity, and chaotic family situations all increase the risk that routine, nutritious meals will not be provided. Such stressful situations or unstimulating environments also may blunt the child's appetite and decrease the child's intake of food.
Sometimes caregivers provide food with poor nutritional value, which can lead to poor intake and poor weight gain. Caregivers may not fully understand infant feeding techniques and may improperly prepare formula, or the child may have feeding difficulties that caregivers are unable to handle. When caregivers need help with infant feeding skills and their infant has feeding difficulties, growth and weight faltering may occur.
Rarely, some mothers do not produce enough breast milk (chest milk) or, rarer still, produce reduced-calorie milk.
Infants and children who have stressful family situations or have a dysfunctional relationship with a caregiver may have growth and weight faltering because the stress they are feeling may make them produce hormones that reduce the effects of growth hormones. This stress-related reduction in growth hormone can lead to poor growth.
Medical disorders sometimes cause growth and weight faltering. Medical disorders, such as difficulty chewing or swallowing (as with a cleft lip or cleft palate), gastroesophageal reflux, narrowing of the esophagus, or intestinal malabsorption, may also affect a child's ability to eat, retain, absorb, or process food. Eating disorders may also cause growth and weight faltering.
Infections, tumors, hormonal or metabolic disorders (such as diabetes or cystic fibrosis), heart disease, kidney disease, liver disease, genetic disorders (such as Down syndrome or hereditary metabolic disorders), digestive disorders (such as celiac disease and inflammatory bowel disease), trauma, and human immunodeficiency virus (HIV) infection are other medical reasons for growth and weight faltering.
In some children, growth and weight faltering is caused by a combination of environmental and social factors and medical disorders. For example, children who have medical disorders also can have stressful home environments or dysfunctional relationships with caregivers. Likewise, children with growth and weight faltering caused by environmental and social factors can develop medical disorders.
Diagnosis of Growth and Weight Faltering in Children
Monitoring of weight and height or length
Questions about feeding and medical, social, and family history
Laboratory tests if needed
Doctors consider a diagnosis of growth and weight faltering when a child's weight or body mass index (BMI) is well below what it should be when compared with past measurements or standard height-weight charts (see Physical Growth of Infants and Children). If growth and weight faltering affects an infant's weight severely enough, height and head (brain) growth rates are also affected.
To determine why a child may be faltering in growth or weight gain, doctors ask caregivers specific questions about
Feeding (for infants) and eating (for older children)
Bowel habits
The social, emotional, housing, and financial stability of the family, which might affect the child's access to food
Illnesses that the child has, has had, or that run in the family
The doctor examines the child, looking for signs of conditions that could explain the child's low weight or reduced growth. The doctor makes decisions about doing blood, stool, and urine tests and x-rays based on this evaluation. More extensive testing is done if the doctor suspects an underlying disorder.
Treatment of Growth and Weight Faltering in Children
Nutritious feedings or meals
Specific treatment for medical disorders
Treatment of growth and weight faltering depends on the cause. If a medical disorder is found, specific treatment for that disorder is given. Regardless of the cause, all children who have growth and weight faltering are given a nutritious diet that contains enough calories to promote growth and weight gain.
Mild to moderate growth and weight faltering is treated with nutritious, high-calorie feedings or meals given on a regular schedule. Caregivers may be counseled about family interactions that are damaging to the child and about financial and social resources available to them.
Severe growth and weight faltering is treated in the hospital where social workers, nutritionists, feeding specialists, psychiatrists, and other specialists work together to determine the most likely causes of the child's growth and weight faltering and the best approach to feedings or meals.
Children whose growth and weight faltering is the result of abuse or neglect may need to be placed in foster care. If they are returned to their parents or previous home situation, the children's growth progress is monitored.
Prognosis for Growth and Weight Faltering in Children
Because the first year of life is important for brain development, children who become undernourished during this time may fall permanently behind their peers, even if their physical growth improves.
In about half of these children, mental development, especially verbal and math skills, remains below normal.
