When does slow weight gain become 'failure to thrive'?

Comparison of changes in growth percentiles of US children on CDC 2000 growth charts with corresponding changes on WHO 2006 growth charts

Longitudinal data with 37 964 length and weight measurements from 10 844 children who participated in the California Child Health and Development Study was used to compare the proportion of children aged ≤24 months who crossed major percentile lines on the Centers for Disease Control and Prevention (CDC) 2000 growth charts with the percentage who crossed corresponding lines on the World Health Organization (WHO) 2006 growth charts. Percentage of children aged ≤24 months who crossed at least 2 major percentile lines for length-for-age, weight-for-age, and weight-for-length according to CDC 2000 charts were compared with the percentage who did so according to WHO 2006 charts. The results from this analysis suggest that pediatricians who monitor children's growth on the basis of WHO 2006 growth charts may be more likely to refer children aged <6 months and less likely to refer those aged 6 to 12 months for further evaluation for failure to thrive.

Shifts in percentiles of growth during early childhood: analysis of longitudinal data from the California Child Health and Development Study

OBJECTIVE

To document growth-velocity changes across major percentiles during the preschool years.

DESIGN

Analyses of longitudinal data using height-for-age, weight-for-age, weight-for-height, and body mass index (BMI)-for-age percentiles were performed to examine crossing of major percentiles of the Centers for Disease Control and Prevention 2000 growth charts. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were defined as the major percentiles.

SETTING

Data from the California Child Health and Development Study were used.

SUBJECTS

A total of 10,844 children up to 60 months of age, with 44,296 height and weight measurements, were included in our final analysis.

RESULTS

For height-for-age, 32% of children between birth and 6 months of age, 13% to 15% of children between 6 and 24 months of age, and 2% to 10% of children between 24 and 60 months of age crossed 2 major percentiles. For weight-for-age, 39% of children between birth and 6 months of age, 6% to 15% of children between 6 and 24 months of age, and 1% to 5% of children between 24 and 60 months of age crossed 2 major percentiles. In contrast, for weight-for-height, 62% of children between birth and 6 months of age, 20% to 27% of children between 6 and 24 months of age, and 6% to 15% of children between 24 to 60 months of age crossed 2 major percentiles. Similar to the pattern observed for weight-for-height, 8% to 15% of children between 24 and 60 months of age crossed 2 major BMI-for-age percentiles. During the preschool years, weight-for-height had the highest percentages of children who crossed 2 major percentiles, and weight-for-age had the lowest percentages of children who crossed 2 major percentiles among these 3 indices.

CONCLUSIONS

Shifts in growth rates were very common for children from birth to 6 months of age, somewhat less common for children 6 to 24 months of age, and least common for children 24 to 60 months of age. Shifts in weight-for-height occurred more frequently than did other growth changes. Pediatricians must consider the prevalence of growth rate shifts during infancy and early childhood before they counsel parents regarding growth or refer children for additional evaluations of growth.

FAILURE TO THRIVE

Failure to thrive is a commonly encountered problem in Paediatric practice. This essentially generic term refers to children whose attained weight or rate of weight gain is significantly below that of other children of similar age and same sex. Several defining criteria have been proposed and help to differentiate true failure to thrive from other conditions causing apparent growth failure. There are numerous organic causes of failure to thrive, but non-organic failure to thrive is also an important entity and is caused by social, psychological and environmental factors. The clinical features are those of malnutrition, signs of underlying organic cause and specific manifestations of environmental/psychosocial deprivation. Indiscriminate laboratory investigations are usually non-contributory and have no role in evaluation. Management requires a multidisciplinary approach and hospitalization has a specific role. Although nutritional rehabilitation is the cornerstone of therapy, treatment of underlying factors-medical, psychological, social and environmental-should receive equally important attention. Long term physical, developmental and behavioural sequelae are known to occur in children with failure to thrive.

Nutritional management of failure to thrive

Failure to thrive, or failure to grow or gain weight, could have several causes that are reviewed in this article. Infant behaviors are discussed, together with nutritional management, catch-up growth, effects of nutritional rehabilitation on body composition, follow-up, and long-term prognosis.

Failure to thrive

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