Failure to thrive

It is normal that the birth weight of a newborn decreases initially but then starts to increase gradually in course of time. Each baby grows in its own pace and you need not be worried as long as they show some amount of growth in their height and weight every month. Ideally, the baby grows very fast in the first year of their life compared to the toddler stage where they are very playful and dodge from eating. Thus, it is expected for an infant to gain weight and height against age as given in the growth chart.

Failure to thrive (FTT) is not a disease but a symptom of an underlying disease. There need not be always a disease behind it because FTT can be present due to different reasons. It is important to identify or diagnose the cause of FTT in order to correct the problem. Infancy is a stage where growth happens at its peak, not just externally (physically) but also internally (mentally). Hence, diagnosing FTT and treating them at the earliest is good for their future as well as to survive the period of infancy.

The reason why an infant fails to thrive are as follows:

1. Poor socio-economic status (especially in under developed and developing countries).
2. Poor hygienic methods used by the mother or the significant care taker.
3. Poor knowledge about nutrition and hygiene of the mother or care taker.
4. Poor child care due to family situations.
5. Child abuse.
6. Congenital problems like cleft lip or cleft palate.
7. Certain cardiac, respiratory or endocrinological problems demanding more nutrients to meet their basal metabolism.
8. Mal-absorption causing chronic diarrhea in celiac disease, chronic liver disease and cystic fibrosis.
9. Intolerance to milk protein causing profuse vomiting.
10. Allergies to certain foods like milk or egg which is the main source of body building.
11. Certain infections caused by worms or parasites leading to poor appetite.
12. Other water borne infections like cholera and air borne infections like tuberculosis.

Diagnosing failure to thrive:

The medical professionals use growth chart and the history to diagnose FTT. It is not a single result of weight loss that decides FTT, three consecutive readings of weight loss is necessary to confirm the diagnosis. There is an obvious decrease in body mass especially over the cheeks, axilla, chest, abdomen, sacrum, buttock, arms and legs which are identified by checking the head, chest, mid-arm and mid-thigh circumference and the height by checking their length.

The other symptoms includes

1. Baby not being active or is very lethargic and does not have strength to shake his hands or legs.

2. Baby reaches all milestones little late than expected. The head control is not attained in 3 months and the baby starts to crawl only by 8 months.

3. Baby not feeding on well at the breast on its regular feeds, skips at least 3 consecutive feeds.

4. Baby crying unusually for longer time. The cry may be shrill or sometimes weak due to lack of energy.

5. Baby not playing and being withdrawn.

6. Baby will have poor eye contact.

7. Baby having diarrhea or vomiting soon after feeds indicating intolerance or malabsorption.

8. Physical examination showing cleft lip or cleft palate.

9. Blood and urine analysis proving some infection.

10. History indicating poverty, poor hygiene and knowledge of the care givers.

The good news is, babies diagnosed with FTT do well when they are cared adequately. Imparting knowledge to care givers of infants about immunization, well balanced diet and hygiene can make a big difference. Treating problems either congenital or acquired by surgery or medicine also solves certain problems. Identifying and avoiding the foods that causes intolerance or allergies is important.

There are government agencies which provide nutritious food to the economically backward people and the families who need help should be informed about this. Those who can afford can be referred to dietitians who can counsel regarding good nutrition. More than anything, good parental bonding (love and warmth) is necessary for the infant to grow physically and emotionally which is the magic that prevents FTT.