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The term failure to thrive (FTT) can imply very different conditions, depending on the context. To a general paediatrician, it might conjure up a respectably clad child, sitting on an anxious mother's lap as you study growth charts and test results in the hope of inspiration. To a social worker it might imply a wasted, miserable child found in a cold, dirty house. These differing images reflect not just the wide range of children who might receive the label “failure to thrive”, but also a diversity of ideas about what FTT is and how it should be managed. The term was first coined to describe a syndrome of delayed growth and development also called the “maternal deprivation syndrome”.1 Although it is now accepted that FTT has a predominantly nutritional cause,2the implication of an association with emotional and physical deprivation persists. However, all the early studies were of highly selected children, referred to hospital, and it is only in the past 15 years that population based studies have been conducted. What light have these studies shed on the subject and what implications do they have for practice?
Definition
FTT has been defined as “a failure of expected growth (usually weight) and well being”.3 Therefore, does this make it a problem of growth alone, or something more? A previous consensus concluded pragmatically that definitions should be growth based, because growth can be measured objectively, whereas well being cannot.4 However, even growth based definitions present problems. Many reference texts and research papers provide no objective definition, and the remainder offer a wide range of differing criteria.5 The most common definitions require cases to drop below a low centile, a method that identifies many children with poor weight gain. However, such approaches will …
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