pediatrics
Failure to Thrive (FTT) in Children
Treatment of Failure to Thrive in Children
Sufficient nutrition Treatment of underlying disorder Long-term social support Treatment of failure to thrive is aimed at providing sufficient health and environmental resources to promote satisfactory growth. A nutritious diet containing adequate calories for catch-up growth (about 150% of normal caloric requirement) and individualized medical and social supports are usually necessary. Ability to gain weight in the hospital does not always differentiate infants with nonorganic FTT from those with organic FTT; all children grow when given sufficient nutrition. However, some children with nonorganic FTT lose weight in the hospital, highlighting the complexity of this condition. For children with organic or mixed FTT, the underlying disorder should be treated quickly. For children with apparent nonorganic FTT or mixed FTT, management includes provision of education and emotional support to correct problems interfering with the parent-child relationship. Because long-term social support or psychiatric treatment is often required, the evaluation team may be able only to define the family’s needs, provide initial instruction and support, and institute appropriate referrals to community agencies. The parents should understand why the referrals are being made and, if options exist, should participate in decisions concerning which agencies will be involved. If the child is hospitalized in a tertiary care center, the referring physician should be consulted regarding local agencies and the level of expertise available in the community. A predischarge planning conference involving hospital-based personnel, representatives from the community agencies that will provide follow-up services, and the child’s primary physician is ideal. Areas of responsibility and lines of accountability must be clearly defined, preferably in writing, and distributed to everyone involved. The parents should be invited to a summary session after the conference so that they can meet the community workers, ask questions, and arrange follow-up appointments. In some cases, the child must be placed in foster care. If the child is expected to eventually return to the biologic parents, parenting skill training and psychologic counseling must be provided for them. Their child’s progress must be monitored scrupulously. Return to the biologic parents should be based on the parents’ demonstrated ability to care for the child adequately, not only on the passage of time. 