[4] The term failure to thrive has been used in different ways,[5] as there is no single objective standard or universally accepted definition for when to diagnose FTT.
[12] Caretakers may express concern about poor weight gain or smaller size compared to peers of a similar age.
[13][16] FTT caused by malnutrition could also yield physical findings that indicate potential vitamin and mineral deficiencies, such as scaling skin, spoon-shaped nails, cheilosis, or neuropathy.
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.
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.
This state causes greater difficulty taking in enough nutrition to meet the body's energy needs and allow for normal growth.
[56] Additionally, retrospective studies done in the United States suggest that males are slightly more likely than females to be admitted to the hospital for failure to thrive.
Globally, approximately 32.7 million children under 5 years are found to have visible and clinical signs of acute malnutrition.
[61] In comparison, chronic malnutrition is a condition that develops over time and results in growth inadequacy with subsequent developmental, physical and cognitive delays.
[20] The child's feeding and diet history, including overall caloric intake and eating habits, is also assessed to help identify potential causes of FTT.
[65] Based on the information gained from the history and physical examination, a workup can then be conducted, in which possible sources of FTT can be further probed through blood work, x-rays, or other tests.
Medical providers should take care not to order unnecessary tests, especially given estimates that the usefulness of laboratory investigations for children with failure to thrive is 1.4%.
[20] Initial bloodwork may include a complete blood count (CBC) with differential to see if there are abnormalities in the number of blood cells, a complete metabolic panel to look for electrolyte derangements, a thyroid function test to assess thyroid hormone activity, and a urinalysis to test for infections or diseases related to the kidneys or urinary tract.
[67] C-reactive protein and erythrocyte sedimentation rate (ESR) can also be used look for signs of inflammation, which may indicate an infection or inflammatory disorder.
[70] Incidence of refeeding syndrome is high, with one prospective cohort study showing 34% of ICU experienced hypophosphatemia soon after feeding was restarted.
In terms of efficacy, clinical experience and systemic reviews have shown higher recovery rates using CMAM than previous methods, such as milk-based formulas.
[citation needed] Children with failure to thrive are at an increased risk for long-term growth, cognitive, and behavioral complications.
[56][73] Longitudinal studies have also demonstrated slightly lower IQs (3–5 points) and poorer arithmetic performance in children with a history failure to thrive, compared to peers receiving adequate nutrition as infants and toddlers.
[56] FTT was first introduced in the early 20th century to describe poor growth in orphan children but became associated with negative implications (such as maternal deprivation) that often incorrectly explained the underlying issues.
[75] Throughout the 20th century, FTT was expanded to include many different issues related to poor growth, which made it broadly applicable but non-specific.
[64] The current conceptualization of FTT acknowledges the complexity of faltering growth in children and has shed many of the negative stereotypes that plagued previous definitions.
[76] They may struggle with instrumental activities of daily living (e.g., preparing meals for themselves), be at high risk for hospital admission, and need significant discharge planning to support a safe and healthy return home.