Failure+to+Thrive+article - Failure to Thrive SCOTT D...

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Failure to Thrive SCOTT D. KRUGMAN, M.D., Franklin Square Hospital Center, Baltimore, Maryland HOWARD DUBOWITZ, M.D., M.S., University of Maryland School of Medicine, Baltimore, Maryland Failure to thrive is a condition commonly seen by primary care physicians. Prompt diagnosis and intervention are important for preventing malnutrition and developmental sequelae. Medical and social factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hypervigilance) can lead to failure to thrive. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, or premature birth follow different growth patterns than normal infants. Many infants with failure to thrive are not identified unless careful attention is paid to plotting growth parameters at routine checkups. A thorough history is the best guide to establishing the etiology of the failure to thrive and directing further evaluation and management. All children with failure to thrive need additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Few need laboratory evaluation. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe. (Am Fam Physician 2003; 68:879-84,886. Copyright© 2003 American Academy of Family Physicians.) A patient information handout about failure to thrive, written by the authors of this article, is provided on page 886. A PDF version of this document is available. Download PDF now (6 pages /77 KB). More information on using PDF files. The recognition of growth and developmental problems in infants and children is one of the major challenges facing primary care physicians. Failure to thrive (FTT) is a common condition of varying etiologies that has been associated with adverse effects on later
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growth and cognitive development. 1,2 Primary care physicians need to be able to diagnose and manage FTT promptly to reduce the risk of long- term sequelae. Definition FTT is best defined as inadequate physical growth diagnosed by observation of growth over time using a standard growth chart. The National Center for Health Statistics (NCHS) recently released improved growth charts that can be found at While definitions of FTT have varied, most practitioners diagnose FTT when a child's weight for age falls below the fifth percentile of the standard NCHS growth chart or if it crosses two major percentile lines. 3
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Failure+to+Thrive+article - Failure to Thrive SCOTT D...

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