Failure To Thrive: An Old Nemesis in the New Millennium

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Abstract
1. I. David Schwartz, MD* 1. 2. *Associate Professor of Pediatrics, Section of Pediatric Endocrinology/Diabetes, The University of Missouri-Kansas City School of Medicine, The Children’s Mercy Hospital, Kansas City, MO. After completing this article, readers should be able to: 1. Plot growth data accurately. 2. Delineate the percentage of normal infants who experience a downward shift of growth between 3 and 18 months of life. 3. Describe the common bases for failure to thrive and the approximate percentages of patients who have these etiologies. 4. Characterize the mainstay of intervention for failure to thrive. 5. Describe the effect of failure to thrive on future development, behavior, and cognition. An early reference to an infant who “ ceased to thrive” can be traced to more than a century ago in the initial edition of The Diseases of Infancy and Childhood by L. Emmett Holt in 1897. Holt equated infantile wasting conditions with malnutrition, although he clearly recognized that this could be associated with a variety of clinical circumstances. The phrase “fail to thrive” first seems to have appeared in print in 1933 in the 10th edition of that classic text. In the late 1960s, the psychosocial aspects of failure to thrive became synonymous with maternal deprivation syndrome (more appropriately renamed the “ parental” deprivation syndrome) and earned an entry in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III) as “ reactive attachment disorder.” Thus, the long litany of metabolic, infectious, and nutritionally derived conditions were made distinct from the environmental aspects when evaluating poor growth during infancy and childhood. This article focuses on childhood aspects of failure to thrive. Considering the widespread use of the term failure to thrive, a consensus definition remains curiously elusive. By strict statistical definition, 3% of the pediatric population deviates from normal stature or weight for age and gender; indeed, some literature simply defines failure to thrive as a fall in weight below the 3rd percentile relative to age (weight-for-age). However, this definition would include children who experience transient weight …