Failure to Thrive

by T. Berry Brazelton, M.D., author of Feeding: The Brazelton Way

What Is Failure to Thrive?

Failure to thrive is a serious but not uncommon medical condition that usually begins during the first year of life. Affected children are below the fifth percentile in weight for age or have a slowed rate of weight gain. If the condition is not treated early and effectively, growth can be retarded, and poor nutrition can interfere with brain development.

What Causes Failure to Thrive?

Failure to thrive is a very general term that refers to babies and young children who are not eating or growing adequately. There are many reasons why this can happen. Some babies may appear to eat normally, but don't grow as they should. They may have a medical condition that interferes with the absorption of nutrients in their digestive system. Sometimes infections are the cause. There are many rarer medical conditions that can interfere with growth, including cystic fibrosis, sickle cell anemia, hypothyroidism, heart disease, kidney disease, and others.

Some babies with failure to thrive are not eating enough. They may have a hypersensitivity to taste or to touch in their mouths, a hypersensitive gag reflex that causes them to choke on food and make them afraid to eat, poor coordination of the tongue and throat muscles needed for swallowing, or gastroesophageal reflux .

There may also be psychological reasons underlying a baby's poor eating. Parent-infant interactions can affect and be affected by the infant's difficulties with eating. Though parents are bound to blame themselves, this is not likely to be anyone's fault. Eating problems may arise from a medical condition that a parent may not at first be aware of. For example, a baby with gastroesophageal reflux may come to connect feeding with the pain of acid reflux and the fear of gagging. She may start to refuse the bottle in order to avoid the pain. Parents, anxious to feed her, may add their tension to hers, or even try to force-feed her out of desperation. A vicious cycle is set up—and the baby will only fight off food all the more. When this occurs, the parents and the baby's physician need to work together as a team to defuse the struggle and help the child grow normally.

Because failure to thrive can be due to medical reasons, such as poor absorption or reflux of foods, reflux of food, a medical evaluation is necessary. Your pediatrician will check for infections, malabsorption syndromes, and other causes. She or he may even have the child spend a few days in the hospital. If none of these tests reveal any reason for poor nutrition and growth, you and your doctor will want to be sure that rarer possibilities are considered, such as those mentioned above.

Treatment of failure to thrive depends on the cause that is identified. Sometimes swallowing problems and oral hypersensitivity are subtle. Sometimes the child's fears, and the parents', have taken on a life of their own—causing serious interference with feeding. Often a team of professionals is needed—a pediatrician (sometimes a pediatric gastroenterologist), a nutritionist, even a speech specialist knowledgeable about the role of throat and mouth muscles in this disorder, and a mental health professional (social worker, psychologist, child psychiatrist) who can help the child and family overcome the patterns that have taken hold of feeding interactions. Parents will need to search for specially adapted ways of feeding their baby and to look to the baby to show them that these feeding interactions have become more comfortable.

Excerpted from:

Excerpted from Feeding: The Brazelton Way © 2004 by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Perseus.

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