Failure to thrive (FTT) in early childhood is associated with subsequent developmental delay and is recognised to reflect relative undernutrition. Although the concept of FTT is widely used, no consensus exists regarding a specific definition, and it is unclear to what extent different anthropometric definitions concur. The operative definition of “non-organic” FTT in developed societies is not agreed upon, resulting in difficulty in establishing a clear diagnosis and in blurring the divide between a normal extreme and clinical illness; the latter perhaps associated with impaired development.
However, a suboptimal nutritional state is usually recognized as one of the hallmarks of this entity.2 Olsen et al evaluated growth data from 6090 Danish children examined between 1 to 5 weeks of age, 2 to 6 months of age, and 6 to11 months of age in an effort to establish the prevalence of this growth pattern. Utilizing 7 anthropometric criteria of FTT (Table), they examined the concurrence of these criteria in establishing its presence. In this population of infants, 27% met one or more of the anthropometric criteria at either the earlier (3-6 months) or later (6-11 months) examinations.
Only 1.3% of infants met the criterion “weight <80% of median weight for length,” and they were a good deal longer than other infants. Twenty-two percent of infants crossed 2 major weight percentiles downward, but they were substantially heavier at birth and throughout the study than were other children with FTT. None of the infants in this study were concordant for all 7 criteria, and approximately 70% of subjects with FTT met only one criterion. Significant under-nutrition, defined as BMI <5th percentile for chronological age, was present in only 2% of children screened.
No single measurement on its own seems to be adequate for identifying nutritional growth delay. Further longitudinal population studies are needed to investigate the discriminating power of different criteria in detecting significant undernutrition and subsequent outcomes.
Anthropometric Criteria of Failure to Thrive
*Conditional weight gain was determined by the “thrive index” – the change in weight z-scores between 2 points, from birth to the later age, adjusted for regression to the mean.
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References
- Olsen EM, Petersen J, Skovgaard AM, Weile B, Jørgensen T, Wright CM.
- Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population. Arch Dis Child. 2007 Feb;92(2):109-14. Epub 2006 Mar 10.
- Hughes I. Confusing terminology attempts to define the undefinable. Arch Dis Child. 2007;92:97-8.
- Spencer NJ. Failure to think about failure to thrive. Arch Dis Child. 2007;92:95-96.
- Emond A, Drewett R, Blair P, Emmett P. Post natal factors associated with failure to thrive in term infants in the Avon Longitudinal Study of Parents and Children. Arch Dis Child. 2007;92:115-9.
- Lucas P, Arai L, Baird J, Kleijnen J, Law C, Roberts H. A systematic review of lay views about infant size and growth. Arch Dis Child 2007;92:120-7.
- Blair PS, Drewett RF, Emmett PM, Ness A, Emond AM. Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC). Int J Epidemiol. 2004;33:839-47.
- Wright CM, Weaver LT. Image or reality: why do infant size and growth matter to parents? Arch Dis Child. 2007;92:98-100.
- Mei Z, Grummer-Strawn LM, Thompson D, Dietz WH. Shifts in percentiles of growth during early childhood: Analysis of longitudinal data from the California Child Health and Development Study. Pediatrics. 2004;113:e617-27.
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