Medical Abbreviation: A Closer Look at Failure to Thrive

A basic definition of failure to thrive (FTT) is a child that does not receive or is unable to take in, retain or utilize the calories needed to gain weight. More simply stated, it’s when babies or children do not meet expected growth milestones. There are many causes for FTT. The two main categories are those forms of FTT that are organic or non-organic. Organic FTT in itself is multi-factorial. When the cause is organic, it is important for healthcare providers to determine the underlying cause for FTT and treat that cause. Typically, when the underlying cause is treated, the FTT is resolved.

This article will focus more on non-organic FTT. Non-organic FTT also has many causes including; lack of parenting knowledge, abuse/neglect, improper breastfeeding techniques, poverty, dysfunctional parenting behaviors, and lack of parenting resources. The child’s primary healthcare provider is usually the first person who has the ability to recognize and diagnose FTT. Recognition and diagnosis is critical in regards to the growth and development of the child. The child’s brain grows as much in the first year of life as it does for the rest of their life and therefore poor nutrition can affect mental development.

When FTT is caused by child neglect, there are risk factors that are often present including:

• Parents may exhibit inadequate adaptive social interaction behaviors
• Adolescent parents
• Parents were abused themselves as a child
• Premature or low birth weight (especially those children who were separated from caregivers because of prolong hospitalization)
• Lack of available extended family to help with child rearing
• Alcohol/substance abuse
• Family violence
• Single parenthood
• Employment instability
• Parents who are engaged in career development or activities away from home
• Inconsistent feeding pattern

Parental attachment is an important factor but is not synonymous with FTT. Whenever FTT is recognized as a potential diagnoses, the healthcare practitioner should evaluate to either determine or rule out neglect or abuse. The following factors are critical to further assess for FTT and its causes;

• Comprehensive medical and social history
• Physical examination
• Feeding observation
• Home visit by healthcare professional
• A feeding diary filled out by the family to determine proper feeding amounts can provide helpful insights

FTT should be considered a medical emergency. It is important for the healthcare provider to accurately document height, weight and head circumference measurements. Clinically, FTT is considered to be less than 5% on the weight curve for the child’s age.
Those children who are diagnosed with non-organic FTT which is determined to be considered as a result of abuse or neglect should be placed in protective custody.

Often times, when these children are placed in protective custody and understand that they are safe, they begin to eagerly eat. Their liberal intake then allows for an above average weight gain which then supports the diagnosis of abuse or neglect as the cause of FTT. When a child is placed is foster care it is important that foster parents are well educated on what interventions will be necessary to improve the nutritional and physical status of the child. These techniques include; feeding techniques (types of bottles needed), prescribed feeding regimen and need for social interaction.

FTT as a result of poverty, lack of resources or lack of understanding of nutritional needs should also be considered medical emergencies. Sometimes it may be a need to provide education to parents regarding amount of food a child needs or the assistance of a lactation consultant to help a mom with breastfeeding issues. Obviously those who have poverty or lack of resources deserve a referral to social agencies such as WIC.

FTT related to abuse and neglect will need accurate and comprehensive documentation of the interventions that have been attempted by healthcare providers. This includes;

• Evidence of specific instructions given to parents
• Evidence that parents understood the instructions provided
• Evidence that parents understood the consequences of not following specific instructions
• Evidence of parental failure to follow prescribed interventions

FTT is a significant cause of mortality in infants and children. It can also have long-term consequences for a child. These children are at risk for short stature, behavioral problems, and developmental delays. In those children under the age of five with FTT, cognitive development is often affected.

Cases involving FTT have been very involved. The review of the medical record is vital in determining when FTT was first noticed (or should have been noted), documentation of parental involvement with diagnosis, determination of organic vs. non-organic FTT, and medical interventions to resolve FTT. Our medical legal consulting services can provide needed assistance with these cases. Contact our office today at 630-551-0978 or paulette@medicaljurisprudence.com.