What is nonorganic failure thrive?

• Frequent weight monitoring

• Thorough medical, family, and social history

Children with organic FTT may present at any age depending on the underlying disorder. Most children with nonorganic FTT manifest growth failure before age 1 year and many by age 6 months. Age should be plotted against weight, height, and head size on growth standards and growth charts, such as those recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). (For children 0 to 2 years, see WHO Growth Charts; for children 2 years and older, see CDC Growth Charts.) Until premature infants reach 2 years of age, age should be corrected for gestation.

Weight is the most sensitive indicator of nutritional status. When FTT is due to inadequate caloric intake, weight falls from the baseline percentile before length does. Reduced linear growth usually indicates severe, prolonged undernutrition. Simultaneous fall off of length or height and weight suggests a primary disorder of growth or a prolonged inflammatory state. Because the brain is preferentially spared in protein-energy undernutrition Protein-Energy Undernutrition (PEU) Protein-energy undernutrition (PEU), previously called protein-energy malnutrition, is an energy deficit due to deficiency of all macronutrients. It commonly includes deficiencies of many micronutrients... read more , reduced growth in head circumference occurs late and indicates very severe or long-standing undernutrition. Children who are underweight may be smaller and shorter than their peers and may present with fussiness or crying, lethargy or sleepiness, and constipation Evaluation Constipation is responsible for up to 5% of pediatric office visits. It is defined as delay or difficulty in defecation. Normal frequency and consistency of stool varies with children's age... read more . FTT is associated with physical delays (eg, sitting, walking), social delays (eg, interacting, learning), and, if occurring in older children, delayed puberty Delayed Puberty Delayed puberty is absence of sexual maturation at the expected time. Diagnosis is by measurement of gonadal hormones (testosterone and estradiol), luteinizing hormone, and follicle-stimulating... read more .

Usually, when growth failure is noted, a history (including diet history— see Table: Essentials of the History for Failure to Thrive Essentials of the History for Failure to Thrive

Without historic or physical evidence of a specific underlying etiology for growth failure, no single clinical feature or test can reliably distinguish organic from nonorganic FTT. Because children may have both organic and nonorganic FTT, the physician should search simultaneously for an underlying physical problem and for personal, family, and child-family characteristics that support a psychosocial etiology. Optimally, evaluation is multidisciplinary, involving a physician, a nurse, a social worker, a nutritionist, an expert in child development, and often a psychiatrist or psychologist. The child’s feeding behaviors with health care practitioners and with the parents must be observed, whether the setting is inpatient or outpatient.

Engaging the parents as co-investigators is essential. It helps foster their self-esteem and avoids blaming parents who may already feel frustrated or guilty because of a perceived inability to nurture their child. The family should be encouraged to visit as often and as long as possible. Staff members should make them feel welcome, support their attempts to feed the child, and provide toys and ideas that promote parent-child play and other interactions.

Parental adequacy and sense of responsibility should be evaluated. Suspected neglect or abuse must be reported to social services, but in many instances, referral for preventive services that are targeted to meet the family’s needs for support and education (eg, additional food stamps, more accessible child care, parenting classes) is more appropriate.

During hospitalization, the child’s interaction with people in the environment is closely observed, and evidence of self-stimulatory behaviors (eg, rocking, head banging) is noted. Some children with nonorganic FTT have been described as hypervigilant and wary of close contact with people, preferring interactions with inanimate objects if they interact at all. Although nonorganic FTT is more consistent with neglectful than abusive parenting, the child should be examined closely for evidence of abuse Symptoms and Signs Child maltreatment is behavior toward a child that is outside the norms of conduct and entails substantial risk of causing physical or emotional harm. Four types of maltreatment are generally... read more