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Objectives After completing this article, readers should be able to: 1. Recognize three common presentations in the physician's office of failure to thrive. 2. Identify three principal mechanisms that lead to a mismatch between caloric intake and caloric expenditure. 3. Understand the complex interaction between psychosocial and biomedical risks th...
Contexts in source publication
Context 1
... complete physical examination emphasizing neurode- velopmental status, evaluation of skin for neurocutane- ous markings, dysmorphic features, and assessment of nutritional status is performed, remembering that very rare conditions may present as inadequate growth (Fig. 3) Signs of acute medical problems such as dehydration may prompt hospitalization for further evaluation and ...
Context 2
... routine laboratory tests are recommended. A shot- gun approach to laboratory testing for FTT is not cost- effective. Rather, tests are performed based on positive findings from history and physical examination (Fig. 3). Additional laboratory and radiologic tests are completed for children who do not respond to dietary intervention. It is wise to review the newborn metabolic screening tests for a young infant who is not growing adequately. Hy- pothyroidism and inborn errors of metabolism can cause feeding problems as well as poor growth. Routine labo- ...
Context 3
... child's growth parameters are the basis for a system- atic approach to the differential diagnosis. Figure 3 is a diagnostic schema outlining this strategy, although no attempt has been made to itemize all possible diagnoses. Three categories of growth patterns are used to help the clinician think through the broad differential diagnosis: 1) FTT with microcephaly, 2) FTT with short stature, and 3) FTT characterized by adequate height for age and normal head circumference. ...
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Citations
... Poor growth in children is a result of the interaction between a child's health, development, behavior, and the environment [1]. In the United States, children presenting with poor growth account for 5% to 10% of primary-care pediatric patients and 3% to 5% of pediatric hospital admissions [1]. ...
... Poor growth in children is a result of the interaction between a child's health, development, behavior, and the environment [1]. In the United States, children presenting with poor growth account for 5% to 10% of primary-care pediatric patients and 3% to 5% of pediatric hospital admissions [1]. Feeding difficulties are common in children with poor growth [2,3]. ...
The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother–child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of −2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = −0.40, −0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = −0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = −0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.
... In addition, the anthropometric indicators can reflect the quality of child nutrition and physical activity, quality of health care services, environmental conditions, implemented prevention and healthy lifestyle programs, and their need [1][2][3]. Low height and low body mass index (BMI) usually is caused by poor living conditions, malnutrition, and it is associated with child's poor growth and development [4,5], increased risk of infectious diseases [6,7], anemia [8], psychological and behavioural problems [9]. Furthermore, overweight and obesity reflect poor nutritional conditions, an unbalanced diet rich in calories and low in nutrients [10]. ...
Introduction
The monitoring of children’s growth plays a crucial role in assessing their growth patterns and indicating their weight status. Overweight and obesity, determined by cut-offs of body mass index (BMI), are most commonly associated with unhealthy nutrition, non-communicable diseases, and other health disorders. The World Health Organization (WHO) initiated the WHO European Childhood Obesity Surveillance Initiative (COSI) to measure routinely trends in children’s anthropometric changes, which allow intercountry comparisons within the European Region. Lithuania joined the COSI initiative. Our study aims to evaluate and compare underweight, normal and elevated weight (overweight and obesity) changes of Lithuanian first-graders during eleven years period.
Methods
This study was composed according to the COSI study protocol, and it compares the five rounds of anthropometric measurements of Lithuanian first-graders (7-8-year-old) from 2008 to 2019. The main analysed variables were weight and height; calculated BMI, weight-for-age (W/A), height-for-age (H/A) and body mass index-for-age (BMI/A) z-scores. Changes of the indicators were evaluated according to the International Obesity Task Force (IOTF) cut-offs and WHO child growth standards, grouped by 4 estimates: underweight (thinness), normal weight, overweight and obesity. All comparisons were performed between age groups, gender and COSI round year.
Results
The mean values for weight, height, W/A and H/A Z-scores were significantly higher for both age and gender groups when comparing later COSI round years (2016 or 2019) to earlier years (2008–2013, in some cases 2016 is included in this range). Time trends of the WHO growth standards and IOTF cut-offs indicate significant decrease among 7-year-old overweight group for boys and girls. Also, a significant decrease was indicated among boys aged 8 years in the overweight group according to the WHO definitions. The only significant increase in trend were expressed in girl’s group with obesity aged 8 years according to IOTF cut-offs.
Conclusion
The prevalence of overweight and obesity of first-grade children in Lithuania indicates positive changes, that is the proportion of children with elevated body weight decreased, during eleven-year period. However, it is important to continue the monitoring of children’s growth tendencies.
... Failure to Thrive BACKGROUND Failure to thrive (FTT) is a common diagnosis made in otherwise healthy infants and can be a consequence of factors intrinsic to the infant and/or the environment. 1 Whether undernutrition is secondary to inadequate caloric intake, excessive caloric requirement, or malabsorption, the pathways lead to the same clinical phenomenon. Of infants diagnosed with FTT, 60% to 90% have laboratory or imaging studies performed in an attempt to delineate a possible etiology, including genetic, metabolic, and renal disease, among others. ...
Introduction:
Laboratory investigations pursued for infants with failure to thrive (FTT) often show mild transaminase elevations, the incidence and significance of which are unknown.
Methods:
This retrospective chart review included infants diagnosed with simple nutritional FTT at a single academic tertiary care system. Comparisons of diagnostic studies and outcomes between children with and without transaminase elevation were performed using chi-square and Wilcoxon rank sum tests.
Results:
None of the infants with abnormal transaminases required additional follow-up or developed alternative diagnoses in the following year.
Discussion:
Transaminase elevation may be common in infants with FTT and may not warrant further investigation if the history indicates an isolated etiology of insufficient nutrition.
... among pediatric patients therefore, similar to the present study, percentages were distributed equally among the different types of PID with no gender difference. There is not enough study evaluating malnutrition in patients with PID thus, studies assessing failure to thrive as a consequence of malnutrition are also found to be valuable (19)(20)(21). In the previous literature it was concluded that FTT is a referral criteria for suspected PID cases with high sensitivity and specificity (22,23). ...
Background
Nutritional status in primary immunodeficiencies (PID) is a major factor influencing immune defence. We aimed to evaluate the nutritional status in patients with PID.
Methods
Demographic findings, anthropometric measurements of 104 patients were recorded for this cross-sectional study.
Results
Combined immunodeficiencies (n=49), predominantly antibody deficiencies (n=28) and phagocytic system disorders (n=17) were the major groups. In total, 44 (42.3%) patients had at least one or more anthropometric measurements below -2SD. Chronic, acute and mixed-type malnutrition were detected in 18.3%, 16.3%, 7.7% of the patients respectively. No significant difference was detected among groups regarding anthropometric measurements; higher malnutrition rates were observed in combined immune deficiency less profound than severe combined immunodeficiency (SCID) (52%), chronic granulomatous disease (66.6%), and X-linked agammaglobulinemia (50%) patients. Severe malnutrition was present in 22 (21.2%) of the patients, though not significant, it was more common in phagocytic system disorder group. All patients in SCID group were after hematopoietic stem cell transplantation (HSCT) and 50% of them had malnutrition. There was also no significant difference regarding age, sex, anthropometric indexes (WfA, L/HfA, BMI Z-scores), malnutrition types, and prevalence of malnutrition among three groups. Only the hospitalization history inversely affected body mass index (BMI) and weight for age Z-scores (p<0.0001). In patients with malnutrition, daily caloric intake was at least 20% or more below the requirement.
Conclusions
Regardless of the type of immunodeficiency, nutritional status was poor in PID and hospitalization is the most important determinant of nutritional status. Even in post-HSCT status, nutritional support should be continued.
... Despite overwhelming rates, 80-90%, of nutritional pediatric failure to thrive (FTT), nutrition evaluation is not routine prior to extensive testing and subspecialty referral [1][2][3][4]. FTT management is challenged by the absence of consensus diagnostic criteria and lack of a practical nutritional assessment tool in clinics [3,4]. The importance of nutritional causes and low utility of exhaustive testing have been shown in both populations with underlying medical conditions and otherwise healthy children [4][5][6][7]. ...
... The preference for subspecialist evaluation indicates the concern for a single organ system and for an undiagnosed medical condition. The uncertain diagnosis as motivating factor for referral is concerning due to the breadth of literature demonstrating that over 80% of pediatric FTT is not due to a medical underlying diagnosis [1][2][3]. This study did not capture if concern is due to clinical features, time pressures in primary care, restricted nutritional history, or medico-legal issues around a missed diagnosis. ...
... A clear underlying medical etiology cannot be identified in more than 80% of cases. 3 malnutrition has on a children's future growth and cognitive development. 4 Long-chain fatty acyl-CoA synthetases constitute an essential enzyme family for lipid metabolism, catalyzing the esterification of fatty acids with coenzyme A. This necessary activation of fatty acids for downstream biosynthetic or catabolic metabolism is catalyzed in mammals by thirteen different isoenzymes; apparently redundant coexpression of several isoforms is commonly observed. ...
Failure to thrive (FTT) causes significant morbidity, often without clear etiologies. Six individuals of a large consanguineous family presented in the neonatal period with recurrent vomiting and diarrhea, leading to severe FTT. Standard diagnostic work up did not ascertain an etiology. Autozygosity mapping and whole exome sequencing identified homozygosity for a novel genetic variant of the long chain fatty acyl‐CoA synthetase 5 (ACSL5) shared among the affected individuals (NM_203379.1:c.1358C>A:p.(Thr453Lys)). Autosomal recessive genotype–phenotype segregation was confirmed by Sanger sequencing. Functional in vitro analysis of the ACSL5 variant by immunofluorescence, western blotting and enzyme assay suggested that Thr453Lys is a loss‐of‐function mutation without any remaining activity. ACSL5 belongs to an essential enzyme family required for lipid metabolism and is known to contribute the major activity in the mouse intestine. Based on the function of ACSL5 in intestinal long chain fatty acid metabolism and the gastroenterological symptoms, affected individuals were treated with total parenteral nutrition or medium‐chain triglyceride‐based formula restricted in long‐chain triglycerides. The patients responded well and follow up suggests that treatment is only required during early life.
... Failure to thrive (FTT) patients may deal with recurrent gastrointestinal and respiratory tract infections, cognitive defects, developmental delay, and emotional and socioeconomic problems [4]. So, it can cause a heavy economic burden on the health system [5]. ...
Synbiotic (probiotic bacteria and prebiotic) has beneficial effects on the gastrointestinal tract. This study was designed to investigate the effect of synbiotic supplementation on the growth of mild to moderate failure to thrive (FTT) children. A randomized, triple-blind, placebo-controlled trial was conducted involving 80 children aged 2–5 years with mild to moderate FTT, who were assigned at random to receive synbiotic supplementation (10⁹ colony-forming units) or placebo for 30 days. The weights, height, and BMI were recorded in a structured diary, and the questionnaires were completed to monitor the numbers of infection episodes, gastrointestinal problems, admission to hospital, and appetite improvement during the study. Sixty-nine children completed the study. There were no differences in the demographic characteristic between the two groups. The mean weight was similar at baseline. After 30 days of intervention, the mean weight of the participants in the synbiotic group increased significantly than those in the placebo group (600 ± 37 vs. 74 ± 32 g/month P 0.000). BMI changes in synbiotic and placebo group were 0.44 and 0.07 kg/m², and that the differences among the two groups were significant.(P 0.045) Furthermore, the height increment in synbiotic and placebo group was 0.41 and 0.37 cm respectively with no significant difference (P 0.761). Administration of 30-day synbiotic supplementation may significantly improve weight and BMI in Iranian children with mild to moderate FTT, but there is no effect on the height in this study. Further studies should be designed to found out the effect of synbiotic on growth parameters in undernourished and well-nourished children.
... Bahan dan Metode: Penelitian ini merupakan suatu penelitian potong-lintang pada anak-anak berusia 6-24 bulan, menggunakan total sampling dari anak-anak yang menghadiri posyandu di Kecamatan Kenjeran Surabaya dari tanggal 1 Mei 2018 sampai 31 Mei 2018. Hasil: Penelitian ini mendapatkan 45 anak dengan usia median 15,13 (6,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)67) bulan, 17 (37,8%) anak berusia 6-12 bulan dan 28 (62,2%) anak berusia 13-24 bulan. Jenis kelamin lelaki sebanyak 25 (55,6%). ...
... 4,[8][9][10] However, some researchers have advocated to abandon the use of the dichotomous "organic" versus "nonorganic" description of FTT. 1,11,12 The dichotomous division is thought to be too simplistic for clinical and research purposes and does not capture the complexity of patients presetting with FTT. Several researchers make the case that FTT is explained by multiple biopsychosocial factors and arises from the interaction between these factors. ...
... Several researchers make the case that FTT is explained by multiple biopsychosocial factors and arises from the interaction between these factors. 9,11 Feeding difficulties are common in children with FTT. 13 The term "feeding difficulties" is commonly used as an umbrella term that refers to a "feeding problem of some sort." 14(p345) These problems can include 858526G PHXXX10.1177/2333794X19858526Global ...
... Although some authors still emphasize the use of the "organic" versus "nonorganic" model to describe FTT etiologies, 4 others have stressed the importance to use a biopsychosocial model to describe the complex interaction between the different factors. 1,9,11,12 Our study supports using the conceptual framework created by Huh et al 16 to obtain a more comprehensive understanding of the different contributing factors to FTT in the different domains (medical, nutritional, feeding skills, and psychosocial). This framework can also facilitate a multidisciplinary approach in children with FTT. ...
The objective of this study was to characterize biopsychosocial characteristics in children with failure to thrive with a focus on 4 domains: medical, nutrition, feeding skills, and psychosocial characteristics. A retrospective cross-sectional chart review was conducted of children assessed at the Infant and Toddler Growth and Feeding Clinic from 2015 to 2016. Descriptive statistics were used to analyze the data. One hundred thirty-eight children, 53.6% male, mean age 16.9 months (SD = 10.8), were included. Approximately one quarter of the children had complex medical conditions, medical comorbidities, and developmental delays. The mean weight-for-age percentile was 15.5 (SD = 23.9), and mean weight-for-length z score was −1.51 (SD = 1.4). A total of 22.5% of children had delayed oral-motor skills and 28.3% had oral aversion symptoms. Caregiver feeding strategies included force feeding (14.5%) and the use of distractions (47.1%). The multifactorial assessment of failure to thrive according to the 4 domains allowed for a better understanding of contributing factors and could facilitate multidisciplinary collaboration.
... It is mainly related to non-organic causes, and underlying organic diseases are found in only about 10% of children with FTT. 2 During the third trimester of pregnancy, accretion of protein, glycogen, fat-soluble vitamins, minerals, and trace elements occurs. 3,4 Preterm infants experience significant energy and nutrient deficit due to inadequate nutritional intake along with comorbid disease, incomplete digestion and absorption in the immature gastrointestinal tract, and limited reserves of trace elements. ...
Background:
We aimed to analyze the effect of oral zinc supplementation on serum insulin-like growth factor-1 (IGF-1) levels and catch-up growth in infants with non-organic failure to thrive (NOFTT) who were born preterm as compared to those born at term.
Methods:
Totally, 105 NOFTT infants aged 2 years or less were enrolled and divided into two groups according to gestational age at birth. Oral zinc sulfate was administered for 6 months to 49/66 children born at term, and 21/39 children born preterm. Serum zinc, IGF-1, weight, and height were measured at baseline and at 6 months.
Results:
There were no differences in baseline serum zinc levels between the two groups. In preterm NOFTT infants, zinc supplementation significantly increased serum zinc levels compared to those in the non-supplementation group (Δ zinc 0-6 month 10.3 ± 26.4 μg/dL vs. -8.8 ± 23.7 μg/dL, p = 0.018), but it did not significantly change serum IGF-1 levels or weight- and height for age Z-scores. In NOFTT infants born at term who received zinc supplementation, serum zinc levels, IGF-1, weight for age Z-score, and height for age Z-score increased at 6 months (p = 0.001, p = 0.014, p = 0.049, and p = 0.029, respectively), but this increase was not significantly greater than in the non-supplementation group. Only the increase in serum zinc levels was significant after 6 months (Δ zinc 0-6 month 16.8 ± 32.0 μg/dL vs. -10.0 ± 22.6 μg/dL, p = 0.002).
Conclusion:
Zinc supplementation in NOFTT infants improves serum zinc status, regardless of gestational age at birth. Zinc supplementation in NOFTT infants born at term may improve serum IGF-1 levels and growth, but it does not in NOFTT infants born preterm. Overall nutritional support rather than supplementation of a single nutrient may be more effective for catch-up growth in NOFTT infants born preterm.
