Although each baby is different, most conform to a general growth and development curve. If a baby is not gaining weight or height compared with other children his age, it's a red flag for health professionals because the problem could be caused by underlying health or environmental issues. Known as Failure to Thrive (FTT), this is a serious form of arrested growth that can affect a child's long-term health and emotional development.

Failure to thrive is diagnosed when a child's growth rate drops below the 5th percentile for his age, or falls by two major percentiles on his growth chart. What does this mean? If your child is at the 5^th percentile, it means that 95 percent of children his age weigh more than him, and only 5 percent weigh less.

If the problem for the failure to grow is an underlying medical condition or disease, then it is known as Organic Failure to Thrive (OFTT). If your child does not have any underlying disease, then the problem may be due to other reasons, such as poor nutrition or psychosocial factors, and is deemed Non-Organic Failure to Thrive (NOFTT).

Of course, many children are simply petite, and their measurements fall below the norm because they are naturally small. If a child is growing steadily and has a genetic history of small stature and no other physical symptoms, then the doctor will likely rule out FTT. Physicians become concerned in cases where a child does not show steady, regular weight gain, and his growth curve is flat.

The long-term prognosis for children with FTT is not clear in part because the research is sketchy. Researchers do know that children with FTT are at risk for developmental delays and behavior problems (as well as short stature) later on in life. In fact, about half of infants and children who experience FTT exhibit social, emotional, or eating problems later.

Still, experts caution that it is tricky to determine a clear cause-and-effect relationship between growth and other factors that contribute to the problem, such as poverty, poor parenting, or family stress, according to the authors of a study published in American Family Physician.

Besides arrested growth, symptoms of Failure to Thrive can include excessive sleepiness; irritability; delays in developmental milestones, such as smiling, making vocal sounds, and motor development delays.

A range of medical problems can contribute to OFTT, including food allergies, certain metabolic diseases, parasites, hyperthyroidism, congenital heart disease, lung problems, diabetes, or cystic fibrosis. Premature birth and its complications can also trigger FTT.

Non-organic FTT is almost always caused by nutritional or psychosocial factors in the newborn's environment. A newborn whose mother or primary caregiver abuses alcohol or drugs, or is seriously depressed is at higher risk for NOFTT than a newborn whose caregiver doesn't have these problems. A stressful or disorganized household, where feeding times are erratic and chaos reigns, can also put a baby at risk for FTT. About half of all cases of FTT are non-organic.

But experts argue that drawing a sharp distinction between organic and non-organic FTT is a mistake, since the problem usually has both medical and environmental roots. There is a vicious cycle in some cases of FTT: A baby has an underlying medical problem that affects his ability to eat; a stressful home situation makes the problem worse, and then aggravated eating problem adds still more stress to the household.

Parental attitudes and feeding practices can also contribute to NOFTT. For example, one recent study established a link between excessive fruit juice consumption and FTT. Researchers found that the children they examined (all FTT patients) received as much as 25 to 60 percent of their daily caloric intake from fruit juice. Fruit juice contains a lot of sugar and also reduces a child's appetite for nutritious food. It lacks the fats, protein, and vitamins a child needs to grow and develop. When the children's diets were changed and fruit juice consumption limited, their weight gain significantly increased.

Another study found that some parents restrict their children's diets because of concerns about obesity and related health problems. The children examined for this study received a diet appropriate for an adult at high risk for heart disease, but this diet doesn't provide enough sustenance for a growing child. Fortunately, once treated, these children quickly caught up with their peers.

Once FTT is detected, the child's doctor will evaluate your child's health, diet, feeding habits, home environment, and family history. The practitioner will also evaluate the child for developmental delays.

Treating the problem, whether or not the cause is medical, involves a team approach with your doctor, a pediatric nutritionist, a psychologist, and possibly other specialists. This may involve educating parents in how and what to feed the baby to help him gain weight. Some nutritionists ask parents to keep a three-day diary of what the baby eats. Having parents write down the types of food and amounts a child eats helps the team determine how many calories the baby gets. It can also make parents aware of how much a baby is or is not eating. Keeping feeding times regular, concentrating formula, and adding cereal to pureed foods can also increase the baby's calorie intake.

In the end, you and your baby's health care team will work with you to keep his growth on schedule.

-- Connie Matthiessen is a former staff writer for the Center for Investigative Reporting who has written widely on health and medical issues.

References

First published July 28, 2005
Last updated May 8, 2007
Copyright © 2005 Consumer Health Interactive

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