It is vital to screen patients and their caretakers for psychiatric conditions such as depression or anxiety, as well as screen children for signs and symptoms of child abuse, neglect, or emotional deprivation.Children who have FTT caused by a genetic or medical problem may have differences in growth patterns compared to children with FTT due to inadequate food intake. A decrease in length with a proportional drop in weight can be related to long-standing nutritional factors as well as genetic or endocrine causes. Head circumference, as well, can be an indicator for the etiology of FTT. If head circumference is affected initially in addition to weight or length, other factors are more likely causes than inadequate intake. Some of these include intrauterine infection, teratogens, and some congenital syndromes.Children who have a medical condition causing FTT may have additional signs and symptoms specific to their condition. Fetal alcohol syndrome (FAS) has been associated with FTT, and can present with characteristic findings including microcephaly, short palpebral fissures, a smooth philtrum and a thin vermillion border. Disorders that cause difficulties absorbing or digesting nutrients, such as Crohns disease, cystic fibrosis, or celiac disease, can present with abdominal symptoms. Symptoms can include abdominal pain, abdominal distention, hyperactive bowel sounds, bloody stools, or diarrhea. Cause
Traditionally, causes of FTT have been divided into endogenous and exogenous causes. These causes can also be largely grouped into three categories: inadequate caloric intake, malabsorption/caloric retention defect, and increased metabolic demands. Endogenous (or "organic")
Endogenous causes are due to physical or mental issues affecting the child.
Yet, a child with severe acid reflux who appears to be in pain while eating may also make a caregiver hesitant to offer sufficient feedings. Inadequate caloric intake
Inadequate caloric intake indicates that an insufficient amount of food and nutrition is entering the body, whether due to lack of food, anatomical differences causing difficulty eating, or psychosocial reasons for decreased food intake. Malabsorption/caloric retention defect
Malabsorption and caloric retention defects cause the body to the unable to absorb and use nutrients from food, despite an adequate amount of food physically entering the body. Increased metabolic demand
Increased metabolic demand suggests a state of increased energy needs and caloric expenditure. This state causes greater difficulty taking in enough nutrition to meet the bodys energy needs and allow for normal growth. Epidemiology
Failure to thrive is a common presenting problem in the pediatric population in both resource-abundant and resource-poor countries. While epidemiology may vary by region, inadequate caloric intake remains the most common cause of FTT in both developed and developing countries, and poverty is the greatest risk factor for FTT worldwide. Resource-abundant regions
Failure to thrive is prevalent in developed countries, with literature from Western studies demonstrating a prevalence of about 8% among pediatric patients. Presentations of FTT comprise about 5-10% of children seen as outpatients by primary care physicians and 3-5% of hospital admissions for children. Failure to thrive is more prevalent in children of lower socioeconomic status in both rural and urban areas. FTT is also associated with lower parental education levels.