Brewster, D., Nelson, C., and Couzos, S. (2008) Failure to thrive. In: Couzos, Sophia, and Murray, Richard, (eds.) Aboriginal Primary Health Care: an evidence-based approach. Oxford University Press, South Melbourne, VIC, Australia, pp. 265-307.

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Abstract

Failure to thrive (FTT) is a descriptive term referring to the lack of attainment or maintenance of the growth potential expected for a child, and is generally applied when the child's growth crosses 2 or more Z-scores (or centile lines) on a standard growth chart. Reductions in child mortality over recent decades have not translated into improved growth for all Aboriginal children. Many continue to suffer high rates of wasting, stunting, microcephaly, and iron deficiency. The long-term consequences of malnutrition may be substantial, and there is growing evidence implicating low birth weight and poor infant growth patterns in the development of adult chronic disease such as diabetes, chronic kidney disease, and coronary artery disease.

Causes of failure to thrive include: 1) immediate determinants such as a child's food intake (lack of breastfeeding or early cessation of exclusive breastfeeding, suboptimal complementary feeding practices, and factors influencing appetite); and child's health status (birth weight, prematurity, the infection-nutrition cycle, and environmental enteropathy); and 2) underlying determinants such as household income and food access; caregiver education, knowledge and child care practices; and the health environment and services (including safe water supply, adequate sanitation, and health care availability).

Assessment of the child with failure to thrive involves thorough history and examination. Major organic disease is found in <5% of community cases of FTT and can mostly be diagnosed from signs and symptoms accompanying the growth failure. Investigations including urinalysis, stool examination, and assessment of haemoglobin and iron status are warranted in most cases. Routine hospitalisation with an extensive laboratory work-up to exclude rare causes is considered inappropriate. Anthropometric assessment can differentiate wasting and stunting.

Effective primary preventive measures include optimal maternal care and nutrition, breastfeeding promotion, reduction in overcrowding and improved sanitation, community-driven nutrition programs, education, food supplementation for those at risk where food insecurity exists, and integration with primary health care services. Community-based parasite treatment programs may be effective in reducing rates of anaemia in areas of high parasite prevalence.

Secondary prevention is recommended with growth monitoring using World Health Organization (WHO) International Child Growth Standards, provided monitoring is coupled with appropriate intervention when growth faltering is detected. Resources should be directed to screening infants and children between 0-2 years of age, since this represents the critical period for linear growth. Screening for anaemia in high-risk infants at around 9 months and again at 18 months is recommended.

Hospital admission is rarely needed in the management of children with FTI as community-based therapy is at least as effective and Significantly less disruptive for child and carer. Hospitalisation is reserved for children with severe wasting, dehydration and/or infection, and where community-based therapy is failing.

A national monitoring and surveillance system for child health should include quality indicators of childhood nutritional status, and performance indicators which reflect intervention and outcomes.

Item ID:	34132
Item Type:	Book Chapter (Research - B1)
ISBN:	978-0-19-555138-9
Date Deposited:	16 Nov 2014 22:56
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 100%
SEO Codes:	92 HEALTH > 9203 Indigenous Health > 920399 Indigenous Health not elsewhere classified @ 100%
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