Dr. Jacqueline Gerhart: What Does 'Failure To Thrive' Mean?
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: What does “failure to thrive” mean? My 2-month-old son is small for his age, but my doctor also said he has “failure to thrive.”
Dear Reader: “Failure to thrive” describes a child whose weight is not increasing at the expected rate. This is different than being “small for one’s age” and is usually not related to whether the parents are “short” or “small.”
To clarify if you need to be concerned, you should first understand what a growth chart is and how your doctor uses it. Growth charts first became standardized in the late 1970s. Clinicians use them because healthy children come in all shapes and sizes — so it was necessary to create standard values for “average” or “expected” growth patterns that also allowed for genetic (and ethnic) variations.
There are two main growth charts used in America today: the Center for Disease Control (CDC) chart, and the World Health Organization (WHO) chart. The WHO growth chart is a graph of how healthy children should grow under optimal environmental and health conditions. You could say it is a “growth standard” in ideal conditions.
The CDC chart, on the other hand, is more of a “growth prediction.” This chart is based on 30 years of children’s height and weight data (from 1963 to 1994), so instead of looking at international children in ideal conditions, it looks at U.S. children in real conditions.
The Institute of Medicine and the American Academy of Pediatrics got together to determine which chart better models our diverse American population. They determined that for ages 0-2 years, the WHO chart should be used, and from 2-19 years, the CDC chart should be used. So, assuming that all clinicians are using the same growth chart, we should all be “talking the same language” — and hopefully giving the same advice — about your child’s growth.
The diagnosis of “failure to thrive” is best seen on these growth charts. The diagnosis indicates that a child is not gaining weight or height at the rate that is expected for his or her age and gender.
This means that instead of following a line on the expected growth curve, they have a flatter curve or line of growth. Premature, low birth weight, or “short stature” children might look smaller than their peers, but if they follow the same “slope” of the growth charts, then they likely do not have “failure to thrive.”
This distinction is important. A shorter child born to shorter parents may simply have “short stature” and may be at the fifth percentile of other U.S. peers. But the key is that this child continues to grow along the fifth percentile. If he doesn’t, then other causes such as malnutrition, a genetic disorder or a hormone imbalance should be considered.
Family physicians and pediatricians should be giving you age-appropriate guidance on recommended nutrition, exercise, immunizations and safety guidelines for your child at each well-child visit. They also should be asking you detailed questions about your child’s development and assisting you in the joyous and complex process of raising a healthy child.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 01/15/2013