Weight Loss/Failure To Thrive

Although weight may fluctuate in the short term, ongoing weight loss in children is pathologic. Weight loss is of grave concern to pediatricians because normally there should be steady, predictable weight gain from infancy through adolescence. Equally serious is inadequate rate of weight gain, weight less than the 3rd percentile for age and gender, or the crossing of two major percentiles on standard weight curves below a previously established rate of growth. These criteria all have been used to define “failure to thrive” in children.

Failure to thrive (FTT) has been classified further into organic or nonorganic (functional) in etiology. Classically, organic FTT was said to reflect an underlying medical condition that resulted in growth failure, and nonorganic FTT was ascribed to environmental or social problems extrinsic to the child without any diagnosable medical illness. More recently, nonorganic FTT has been defined as an interactional problem between caretaker and child that results in the infant’s nutritional needs not being met. Nonorganic FTT has accounted for about 70% of total cases.

Today, the understanding has developed that these two categories are not mutually exclusive. A mixed etiology may be present when the effects of organic disease are combined with concurrent psychosocial problems. A child in a stressed family also may have a medical barrier to thrive or a child who has a physical problem causing poor growth may create stress in the family that exacerbates nutritional inadequacy. Therefore, the traditional classification of FTT may be a false dichotomy. It may be best to view FTT as a spectrum, with purely organic and purely environmental at the two extremes. More often, these factors overlap. …