Explaining “Failure to Thrive” or FTT

Failure to thriveWhen a mother gives birth to a baby, her hope is to be the best mother that she can be. In the first few years of life, a mother is expected to meet her baby’s nutritional needs by making sure that baby is well fed and well nourished. A few weeks after the birth, proud mothers will take baby off to their local clinic or to their paediatrician for their first weigh-in and they are horrified to discover that their baby is not gaining weight as it should be.

An infant who does not meet the average or expected weight gain rates will be considered as failing to thrive. FTT or Failure to Thrive is not necessarily a diagnosis but more an observation, and even though babies have been labelled with FTT for more than a hundred years, the term does not carry an exact meaning or definition and as such, is used to describe a condition rather than an illness.

For many new mothers who believe that they have been caring for their newborns -by the book’, may feel that the letters -FTT written on her baby’s weight-gain record is an indication that they are failing as a mother. This is far from the truth and when FTT is understood – mothers will quickly regain their confidence.


What is Failure to Thrive?

Pediatricians or clinic workers will use the term Failure to Thrive when the baby’s physical growth does not meet average standards. It does not mean that the baby’s development (both physically and emotional) is abnormal. There is no agreed upon consensus on what actually constitutes failure to thrive but it broadly refers to an infant or child whose growth is below the 3rd or 5th percentiles for their age. The -diagnosis’ – or rather the observation – is often made by health workers in the first year of life as this period is crucial for normal physical and mental development. During the first year of a child’s life, their brain grows as much in this period than it ever will in later years. Understandably, the first year of life is critically important and in the event that the child is not receiving adequate nutrition during the first 12 months of life, long-lasting and negative effects on mental development will result.

As a rule of thumb, babies double their birth weight by the age of 4 months and triple it by the age of a year, while kids who are given the FTT label are not able to meet this average. When talking of averages, there are children who don’t and will never meet expected standards of growth, but they will still have their own unique regular growth pattern which will vary slightly from the standard. A baby who does not follow a regular growth pattern is then considered to have “Failure To Thrive.”


Underlying conditions that may cause FTT

A chronic illness or an underlying medical disorder may be the root cause of FTT. A baby who has difficulty eating due to prematurity or a cleft lip or palate, may not be able to ingest sufficient calories to allow for normal growth. The other conditions that could lead to failure to thrive include cardiac and respiratory disorders which may increase the baby’s calorie needs thus making it difficult to meet the elevated requirements.

An allergy or an intolerance to milk protein may make it difficult for the child to absorb the essential nutrients. Parasites and infections result in major energy demands on the body and the body will burn up or use nutrients rapidly and this, coupled with a diminished appetite due to an illness, may frequently lead to or cause either short- or long-term failure to thrive.

What’s more, genetics are also an important factor in weight gain and growth, and this means that if you and your partner are slimmer than average or are small boned, the baby will not necessarily pile on the kilos. If an infant is not gaining weight steadily and their family genetic makeup is considered, it’s important to monitor weight to make sure that weight gain and growth remains stable.

Certain diseases such as gastroesophageal reflux disease (GERD), chronic diarrhoea, cystic fibrosis, chronic liver disease, and celiac disease may all be linked to the baby’s inability to gain weight. With certain conditions like GERD for instance, the infant’s oesophagus becomes sore and irritated and because of the pain, the child will refuse to eat. Chronic diarrhoea will lead to all the essential nutrients and calories from food to be lost.

Cystic fibrosis, chronic liver disease, and celiac disease are all disorders which restrict the body from absorbing nutrients from the food. Although the baby eats sufficient food, their body is unable to absorb and retain the nutrients. Celiac disease results in the baby developing an allergy or intolerance to dietary protein that is present in wheat and in various grains. Due to the abnormal response the immune system causes the lining of the intestines to become damaged and this reduces the body’s ability to absorb any nutrients.

A metabolic disorder will significantly limit the body’s ability to make the most of the calories which are consumed. The body may not be able to break down, process, or derive energy from the food which is ingested and this will lead to a build up of toxins.

In some cases, health workers and doctors will be unable to ascertain a definite cause for FTT.


Treating Failure to Thrive

Once an accurate diagnosis has been made, the necessary steps will be taken to reduce the effects of the disease or illness. Depending on the nature of the ailment, a team of medical professionals may be used to assess the baby’s actual dietary needs and the team could include a nutritionist, cardiologist, and a neurologist.

In severe cases where a child’s immediate health is at risk, a doctor may advise tube feedings where a tube is inserted into the infant’s nose and into the stomach. In extreme cases of FTT, the child may need to be hospitalized in order to be tube fed and receive continual monitoring and evaluation. If hospitalisation does result, any underlying causes will then be correctly diagnosed and treated.


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