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Title: Failure to Thrive in Childhood

Type of Paper: Review Article

Purpose: To overview the diagnostic criteria and treatment of failure to thrive (FTT) in childhood in developed countries.

Methods: Articles published between 1995 and October 2010 that contained the terms “failure to thrive,” “malnutrition,” “malabsorption,” “maldigestion,” “underweight,” and “refeeding syndrome” were reviewed.

Results: Results of the review could be summarized into five recommended steps to be taken in cases of FTT:\

  1. Diagnosis of FTT
    Weight, length and weight-for-length are the most objective parameters for establishing nutritional status. Deviations typical in children with FTT include:

    • Weight-for-length or BMI below the 3rd percentile
    • Weight below the 3rd percentile
    • Lack of weight and length gain with percentile deviations greater than 2 main percentiles

    Development should be assessed on percentile curves over time, using population-specific and time-related data.

  2. Identification of the cause of FTT

    FTT is not a disease in and of itself but a symptom that accompanies an underlying disease. Malnutrition/FTT is often caused by:
    • Insufficient food intake: This is with many chronic intestinal, psychosocial and psychiatric diseases.
    • Increased energy requirements: This may be due to metabolic diseases, or increased respiratory effort or increased restlessness in neurological diseases.
    • Malabsorption: This is often characterized by chronic diarrhea and/or increased fat content in the stools.
  3. Diagnosis and differential diagnoses of underlying diseases. Identifying underlying diseases requires a comprehensive clinical examination including, medical history, physical information and laboratory and other diagnostics.
  4. Specific and nonspecific treatment for FTT. Treating the underlying disease is the first step to treating FTT. Nutritional treatment is required if the underlying disease cannot be treated or in the case of psychosocial and psychiatric causes of FTT. Nutritional treatment may require the following adaptations:
    • Increased food intake
    • Enrichment of food
    • Nutritional drinks
    • Tube feeding
    • Parenteral (intravenous) feeding
  5. Monitoring of the symptoms of refeeding syndrome resulting from nutritional treatment. If not closely monitored, nutritional treatment can put children at risk for refeeding syndrome, a life-threatening condition in which electrolyte levels become disrupted and imbalanced.

Conclusions: Treating FTT in children involves addressing malnutrition and its underlying behavioral and non-behavioral causes.

Citation/Reference: Nutzenadel, W. Failure to Thrive in Childhood. Deutsches Arzteblatt International. 2011; 108(38): 642-649. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198227/

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