Growth Failure in Infancy
Richard B. Goldbloom MD1
1 Professor of Pediatrics at Dalhousie University in Halifax, Nova Scotia, Canada
Infants who exhibit growth failure, whatever the root cause, often acquire the label "failure to thrive." This term has outlived its usefulness, being purely descriptive and telling us nothing about the process that caused the infant to gain or grow inadequately. Furthermore, in practice its application as an initial diagnostic label can trigger unfocused and sometimes extravagant protocols of investigation whose yield is small.
Nutritional and growth failure almost never occurs in a vacuum, ie, in the absence of other phenomena that should guide the pediatrician toward a logical explanation of cause and a rational plan of investigation and management. For many years, attention has been given to distinguishing between "organic" and "nonorganic" failure to thrive. It is now clear that, whether a primary organic disorder is present or not, the final common pathway leading to growth failure is an energy intake that is inadequate to the infant's needs. Ascribing growth failure (an organic condition) to nonorganic causes—child neglect or environmental deprivation—should be based on positive features of the history, simple observation, physical examination, and family assessment and never on the exclusion of organic disease. Also, organic disease and psychosocial deprivation are not mutually exclusive.
HISTORICAL LANDMARKS
The term failure to thrive came into use at the beginning of this century to describe the malnourished and depressed condition of many babies living in institutions.
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