Failure to Thrive (FTT) in Pediatrics: Etiology, Diagnosis & Management

Failure to Thrive (FTT)
Pediatric Growth Disorders

Definition: A descriptive term for infants/children (up to 5 years) whose physical growth is significantly less than peers.

Criteria for FTT:
  • ➢ Weight < 3rd or 5th centile.
  • ➢ Failure to gain weight over time.
  • ➢ Crossing two major centiles (e.g., 50th → 10th) over time.

1. Etiology

Traditionally classified into Organic and Non-organic. Note that they often coexist (e.g., in Cerebral Palsy).

★ Non-organic causes account for up to 80% of cases.
System Causes (Organic)
Gastrointestinal GERD, Malabsorption, IBD, Pyloric stenosis.
Infections Chronic parasitic (GI), TB, HIV.
Cardiopulmonary Congenital Heart Disease, Cystic Fibrosis, Asthma.
Endocrine Hypothyroidism, Diabetes Mellitus.
Neuro/Renal Cerebral Palsy, Renal Tubular Acidosis, CKD.
Miscellaneous Lead poisoning, Malignancy, Genetic (Inborn errors).
Non-Organic Causes
  • ➢ Poverty / Misperceptions about diet.
  • ➢ Lack of breastfeeding / Diluted formulae.
  • ➢ Dysfunctional parent-child relationship.

2. Clinical Features

Failure to thrive
Failure to thrive

These children present with:

  • ➢ Poor physical growth.
  • ➢ Poor development.
  • ➢ Impaired cognitive functioning.

3. Diagnosis

History, physical exam, and observation of parent-child interaction are important.

Investigation Flow

History & Physical Exam
↓
Observation of Feeding/Interaction
↓
Initial Screen:
CBC + ESR
Urine & Stool (Microscopy + Culture)
KFT, LFT, Serum Electrolytes
↓
Detailed Labs (Only if Organic suspected)
Diagnostic Clue: Weight gain in response to adequate calorie feeding establishes the diagnosis of Psychosocial FTT.

4. Management

Goals: Nutritional rehabilitation, treatment of organic causes, and remedial psychosocial measures.

⚠ Indications for Hospitalization
  • ➢ Severe malnutrition.
  • ➢ Need for diagnostic/lab evaluation for organic cause.
  • ➢ Lack of catch-up growth during outpatient treatment.
  • ➢ Suspected child abuse or neglect.

5. Prognosis

Physical Growth
Good recovery if managed early/adequately.
+
Cognitive/Behavioral
Variable and less certain outcome.
Failure to thrive

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