Failure to Thrive

What is failure to thrive?

Failure to thrive (nonorganic, NOFTT; also called psychosocial failure to thrive) is defined as decelerated or arrested physical growth (height and weight measurements fall below the fifth percentile, or a downward change in growth across two major growth percentiles) associated with poor developmental and emotional functioning. Organic failure to thrive occurs when there is an underlying medical cause. Nonorganic (psychosocial) failure to thrive occurs in a child who is usually younger than 2 years old and has no known medical condition that causes poor growth.
What causes nonorganic failure to thrive?

Psychological, social, or economic problems within the family almost always play a role in the cause of NOFTT. Emotional or maternal deprivation is often related to the nutritional deprivation. The mother or primary caregiver may neglect proper feeding of the infant because of preoccupation with the demands or care of others, her own emotional problems, substance abuse, lack of knowledge about proper feeding, or lack of understanding of the infant's needs.

Organic failure to thrive is caused by medical complications of premature birth or other medical illnesses that interfere with feeding and normal bonding activities between parents and infants.

Who is affected by failure to thrive?

Infants born into families with psychological, social, or economic problems are more at risk of developing nonorganic failure to thrive. NOFTT occurs when maladaptive behaviors develop in both the infant and the primary caregiver. Maladaptive behaviors may develop around problems establishing regular, calm feeding routines, problems of attachment between the mother and the infant, and/or problems of separation. Other risk factors that put a child at risk for developing nonorganic failure to thrive include mother or primary caregiver with any, or several, of the following conditions present:

• depression
• alcohol or drug abuse
• psychosocial stress
• lack of affection or warmth shown toward infant

What are the symptoms of failure to thrive?

The following are the most common symptoms of failure to thrive. However, each child may experience symptoms differently. Symptoms may include:

• lack of appropriate weight gain
• irritability
• easily fatigued
• excessive sleepiness
• lack of age-appropriate social response (i.e., smile)
• avoids eye contact
• lack of molding to the mother's body
• does not make vocal sounds
• delayed motor development

The symptoms of failure to thrive may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is failure to thrive diagnosed?

Failure to thrive is usually discovered and diagnosed by the infant's physician. Infants are always weighed and measured when seen by their physicians for well-baby check-ups. The physician initiates a more complete evaluation when the infant's development and functioning are found to be delayed.

Treatment for failure to thrive:

Specific treatment for failure to thrive will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of your child's symptoms
• cause of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The first year of life is an important time for brain growth. Children with NOFTT that are not treated for an extended period of time may have difficulty "catching up" developmentally and socially. About 50 percent of children who experienced failure to thrive as an infant or young child continue to have social and emotional problems or eating problems later in life.

The individual issues involved in causing NOFTT are almost always complex. Treatment planning usually requires the involvement of a pediatrician, nutritionist, social worker, physical or occupational therapist, and a psychiatrist or other qualified mental health provider.

Prevention of failure to thrive:

NOFTT occurs because of social, emotional, economic, and interpersonal problems. Community efforts to educate and encourage people to seek help for their problems may help to reduce the incidence of NOFTT. Encouraging parenting education courses in high school and educational and community programs may help new parents enter parenthood with an increased knowledge of an infant's needs. Early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by infants and children.