Delayed growth
Definition
Delayed growth involves poor or abnormally slow gain in weight, height, or both, in a child younger than 5 years old.
Alternative Names
Considerations
Delayed or slower-than-expected growth can be caused by many conditions, most of which can be corrected if the problem is recognized and the remedy is timely. Failure to thrive may be accompanied by withdrawn personality and slow mental, physical, and emotional development. Genetic diseases and chronic illness are less common causes of failure to thrive in the U.S. Social and educational causes for failure to thrive are more common.
Often, problems with infants can be prevented or modified with parental education. Expectant parents should arrange for parenting classes. Also, a child should be taken in to see the health care provider on a regular basis for well-baby checkups.
See the following for more information:
Causes
The term failure to thrive means only that an infant or young child is not growing and developing as expected. Failure to thrive is often divided into 2 main categories: psychosocial and organic.
Psychosocial causes include problems relating to poverty, educational level, malnourishment, and environmental factors (such as abuse or neglect, maternal depression, or a parent's substance abuse). Psychosocial causes for failure to thrive include:
- Parental inexperience or lack of appropriate education, possibly resulting in:
- Inadequate nourishment from a feeding schedule that is rigid or allows little sucking time (in infants less than 1 year being breast-fed)
- Too much water added to powdered formula, or water added to ready-to-feed formula (in infants less than 1 year being bottle-fed)
- Poverty and malnutrition
- Neglect or abuse
- Mental illness in a parent
- Substance abuse by a parent
- Genetic causes with no underlying disorder
- Chronic disease such as sickle cell disease, kidney failure, or chronic infection such as tuberculosis
- Down syndrome or other genetic disorder
- Endocrine diseases, including problems with the thyroid, pituitary (pituitary dwarfism), adrenal, pancreas, or sexual glands
- Celiac disease or lactose intolerance (digestive disorders often accompanied by loose, pale, bulky, and bad-smelling stools)
- Adverse reaction or side effect of a drug (particularly cortisone drugs)
- Fetal alcohol syndrome
- Hydrocephalus
- Gastroesophageal reflux in infants
- Biliary atresia
- Congenital heart disease such as tetralogy of Fallot
Home Care
Follow the health care provider's instructions for care. The necessary treatment and home care is as varied as the number of reasons for delayed growth.
For slow weight gain caused by malnourishment, try feeding the child on demand and increasing the sucking time. Also, prepare formula exactly according to directions. Do not dilute ready-to-feed formula, and try increasing the amount offered to the child.
Provide as much love and support as possible for the child no matter what the diagnosis. Examine feelings and behavior toward the child. If feelings toward the child are not what they should be, arrange for psychological counseling.
When to Contact a Medical Professional
- There is vomiting in an infant (0 - 6 months) after feedings or the weight gain is slow.
- There is any concern about whether the child is growing and gaining weight properly.
A thorough history will be obtained from the parents, and a physical examination of the child will be performed.
Medical history questions documenting delayed growth in detail may include:
- Has the child always been on the low end of the growth charts?
- Was the child growing normally and then the growth slowed down?
- Is the child developing normal social skills and physical skills?
- Does the child eat well?
- What type of feeding schedule is used?
- Is the infant fed by breast or bottle?
- If the baby is breast-fed, what medications does the mother take?
- If bottle-fed:
- What kind of formula is used?
- How is the formula mixed?
- What kinds of food is the child eating (toddlers)?
- What medications does the child take?
- What other symptoms are also present?
There may also be questions about parenting habits, social interaction with the child, and similar questions.
Repeated measurements of height, weight, and head circumference will be performed.
The number of possible tests for failure to thrive is large, but usually only a few are necessary. The tests actually done will be determined by the diagnosis the physician is considering. Some of the more common tests are listed below:
- Blood tests (such as a CBC or blood differential, hemoglobin electrophoresis)
- Hormone studies
- Stool studies (to check for malabsorption)
- X-rays to determine bone age (x-rays of the hands and wrists as a measure of growth)
- X-rays of the long bones to look for new or old fractures
Reviewed By: Thomas A. Owens, M.D., Departments of Internal Medicine and Pediatrics, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.
