FAILURE TO THRIVE

Mary Alice Dombrowski

Overview

Failure to thrive (FTT) describes the occurrence of insufficient weight gain over a period. Although there are varying definitions, commonly used criteria for FTT include a consistent weight gain less than 3% to 5% and/or crossing over two major percentiles with consecutive measurement over a period (Jaffe, 2011; Keane, 2015). Although FTT could occur in any age group, FTT in pediatrics is typically reserved to describe poor weight gain during the first 2 to 3 years of life. Untreated FTT is associated with poor linear growth (height), disease, behavioral challenges, and cognitive delay (McLean & Price, 2015). All children, regardless of socioeconomic status or race, should be monitored for FTT. Careful nursing assessment, application of appropriate nursing intervention, and comprehensive parental education are essential components of nursing care. Successful and early interventions have lifelong implications for improved mental and physical health (Cole & Lanham, 2011; Motil & Duryea, 2015).

Background

In the United States, FTT occurs in approximately 5% to 10% of children in primary care settings and 3% to 5% of those in the hospital setting (Cole & Lanham, 2011; Kirkland et al., 2015). Eighty percent of children present with FTT before the first 18 months of life (Cole & Lanham, 2011). Poor linear growth, a natural consequence of early FTT, is estimated to be much higher throughout the world especially in developing countries given the poor access to adequate nutrition and medical care (Karra, Subramanian, & Fink, 2016). Gender is affected equally (Habibzadeh, Jafarizadeh, & Didarloo, 2015). During this period of critical brain growth, untreated FTT can lead to significant developmental delay (Jaffe, 2011; McLean & Price, 2015). FTT may occur secondary to underlying biological, psychosocial, and environmental circumstances, or a combination of these circumstances (Jaffe, 2011, Kirkland et al., 2015). Regardless of its contributing factors, FTT occurs when there are too little calories ingested to meet energy demands of the body (Jaffe, 2011).

Biological risk factors may begin prenatally. Intrauterine growth retardation and exposure to a harmful substance in utero puts an infant at risk for developing FTT. Children born with chromosomal disorders or birth defects, such as cleft lip, can have early challenges with feeding mechanics. Others may have medical conditions with high-energy demands (i.e., heart disease, chronic infection, or endocrine disorders) or poor intestinal absorption (i.e., cystic fibrosis, or short bowel syndrome) necessitating high-calorie diets (Jaffe, 2011; McLean & Price, 2015).

64Many psychosocial conditions contribute to the development of failure to thrive. Children raised in poverty with little food or poor living conditions may find it difficult to obtain food (Habibzadeh et al., 2015). Parents with mental illness, addiction, poor education, or little social support are at increased risk of having children with FTT (Habibzadeh et al., 2015). Lack of parental guidance and role modeling may encourage children to develop disordered eating patterns (Jaffe, 2011; McLean & Price, 2015) or choose foods with little nutritional value. Often, parents have unrealistic expectations regarding food. Some very young children develop phobias associated with eating (Kirkland et al., 2015).

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