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FAILURE TO THRIVE
Spring 2004
| Failure to
thrive, or FTT |
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Failure to
thrive, or FTT,
is a condition in which a child's
weight:
- Is below 3rd percentile, but with normal head
circumference and height, or
- Has fallen two major growth percentiles (for example,
from above 75th to below 25th)
- May be a symptom of child abuse or neglect
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Symptoms of
FTT
-
Anemia
- Appetite - poor (severe FTT)
- Appetite - excessive (less severe FTT)
- Edema
- Emaciation
- Fatigue
- Hair - dry, brittle
- Hepatomegaly
- Hygiene - poor
- Infection - more common
- Posture - poor
- Skin - dry, thin, scaly; diaper dermatitis
- Tooth decay
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Consequences of
FTT
- Chronic liver disease, especially with severe FTT
- Decreased resistance to infection
- Reduction of number of neurons in the brain; delayed
motor, intellectual, perceptual development
- 4-15% mortality with severe FTT
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OFTT and NOFTT |
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Organic failure
to thrive (OFTT) is caused by a physical condition, such as a metabolic
abnormality.
Non-organic
failure to thrive (NOFTT) is caused by inadequate
caloric/protein intake. NOFTT may lead to OFTT. NOFTT diagnosis
requires:
- Organic pathology ruled out
- Normal/above normal weight gain is made and maintained
with no other treatment than age-appropriate feeding
- Child typically shows significant catch-up growth
Lab work-up to
differentiate organic FTT from NOFTT:
- CBC, ESR, Free RBC protoporphyrin, lead, liver
function tests
- Electrolytes, BUN, creatinine
- Urinalysis, urine culture
- Stool tests (pH, occult blood, culture, ova and
parasites, reducing substances)
- Chest X-ray, sweat test
- PPD, HIV, VDRL-RPR
- Skeletal survey; this is especially important since
NOFTT is often associated with physical abuse.
- Additional studies, as situation indicates:
- Growth hormone
- Testing for bone age (< 2y/o)
- Metabolic and chromosomal studies if needed; not
routinely recommended
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