FAILURE TO THRIVE

A child whose physical growth is significantly below expected for age is said to have failure to thrive. Failure to thrive is placed in two categories, non-organic and organic.

NON-ORGANIC FAILURE TO THRIVE

In this category, the child is usually less than 5 years with no underlying medical condition. The failure to thrive may be due to maternal emotional problems, the child may have been unwanted, or there may be severe poverty. This form of
failure to thrive could be a form of child abuse.

Clinical Features

  • Small size
  • Child is often unkempt
  • Delayed social motor and speech development
  • poor parent–child interaction.

ORGANIC FAILURE TO THRIVE

The child in this category of failure to thrive has an underlying medical condition

  • Chronic illnesses, for example a chronic infection like TB, HIV, or kala azar
  • Major congenital malformations
  • Endocrine or metabolic disorder.

A complete history including nutritional, social and growth monitoring is essential.
In non-organic FTT the mother’s history may be inconsistent, or show no concern for the child. A thorough physical examination for all forms of failure to thrive is essential.

Investigations

  • Stool for ova and cysts
  • Haemogram and blood film
  • Urea and electrolytes creatinine
  • Urinalysis
  • Mantoux test
  • CXR – to rule out chronic chest infections
  • HIV test
  • Additional tests as indicated

Management

  • Feed the child depending on the degree of malnutrition.
  • Treat the cause if known and treatable and counsel the mother on how to cope and manage at home.
  • Counsel the mother in case of non-organic FTT to try to resolve the underlying issues.