By Stacey Bucklin
CP Family Network Editor
Children grow more quickly in their first few years than they do at almost any other time in their lives. However, some children lag behind and fail to gain weight or grow as quickly as their peers. Failure to thrive is a term used to describe children whose current weight or rate of weight gain falls significantly below that of other children their age. Many factors can contribute to failure to thrive, but it is often one of the first warning signs of cerebral palsy.
Failure to thrive may be due to medical factors such as disease or disability (organic failure to thrive) or environmental factors such as abuse or neglect (non-organic failure to thrive). Here, we’ll focus on organic failure to thrive and its links to cerebral palsy and other disabilities. Organic failure to thrive occurs when a child is unable to take in, maintain or use the calories required to gain weight and grow normally due to medical reasons.
Medical causes of failure to thrive include:
- Brain injury or damage to the central nervous system
- Cerebral palsy
- Complications due to low birth weight (especially common in multiple births)
- Chromosomal conditions including Down syndrome and Turner syndrome
- Organ problems
- Heart or lung (cardiopulmonary) problems
- Anemia or other blood disorders
- Growth hormone deficiency or other hormone deficiencies
- Metabolic disorders
- Conditions involving the gastrointestinal system, including gastroesophageal reflux disease (GERD)
- Chronic infections
Cerebral palsy can cause changes to a child’s brain and body that make it difficult for them to obtain nourishment and grow at a normal rate. Children with CP may have difficulty swallowing their food or feeding themselves, making it hard for them to consume enough calories. They may also experience loss of muscle mass due to inadequate exercise. Some children with cerebral palsy have damage to the parts of the brain that control growth and development.
Although there are many causes of failure to thrive, the symptoms are often the same. If you notice your child is experiencing any of the following symptoms, seek the advice of your child’s doctor. It is important to diagnose failure to thrive early so that corrective actions can be taken as soon as possible.
Symptoms of failure to thrive include:
- Weight, height and head circumference do not correspond with standard growth charts
- Weight is lower than 3rd percentile or 20% below the ideal weight for their height – Most babies double their birth weight by 4 months and triple it by age 1, but kids with failure to thrive often don’t meet those milestones.
- Growth may have slowed or stopped after a previously established growth curve
- Delays in rolling over, sitting, standing and walking
- Underdeveloped mental and social skills
- Delayed puberty in adolescents
- Poor feeding due to lack of interest or trouble receiving nutrition
- Excessive crying
- Excessive sleepiness (lethargy)
Although failure to thrive is not difficult to diagnose, determining the underlying cause can be harder. Your child’s doctor will perform a physical exam and compare your child’s height and weight to the normal ranges for children of the same age and gender. Your pediatrician will discuss your child’s medical and dietary history with you, and may involve a dietician to assess your child’s nutritional requirements.
Sometimes, a fairly simple change in your child’s food intake can significantly improve his or her growth rate. However, your doctor may decide to perform additional tests such as the Denver Developmental Screening Test, a test specifically designed to reveal developmental delays.
Other tests used to assess failure to thrive include:
- Hemoglobin electrophoresis to check for conditions such as sickle cell anemia
- Complete blood count (CBC)
- X-rays to determine bone age and condition
- Electrolyte balance
- Hormone studies, including thyroid function tests
Treating a child that has failed to thrive depends on the cause of the delayed growth and development. When medical conditions are responsible for the delay, treating the underlying condition is of the utmost importance. This may involve physical therapy, occupational therapy, corrective surgery, special diets or other medical interventions.
The primary goal of treatment is to make sure the child receives sufficient calories and any other support necessary to grow at a healthy rate. Adjusting your child’s diet to ensure their nutritional needs are met should always be done in consultation with your pediatrician.
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