Reasons for failure to thrive in under fives

Reasons for failure to thrive in under fives

Failure to thrive may be the result of environmental, emotional, physical and medical factors that prevent a child from growing normally.  Many environmental and social factors can interact to keep the child from getting the nutrition he needs. Parental neglect or abuse, parental mental health disorder and chaotic family situations in which routine, nutritious meals are insufficiently provided may all blunt a child’s growth, appetite and intake of food.

The amount of money a family has to spend on food and the nutritional value of the food they buy also affect children’s growth. Inadequate intake of food may reflect inadequate parenting and environmental stimulation.  Sometimes failure to thrive is caused by a medical disorder in the child; sometimes the disorder is as minor as difficulty in chewing or swallowing. Medical disorders such as gastroesophageal reflux (food being thrown upwards-instead of going down to small intestines), narrowing of the food pipe, or intestinal malabsorption, may also affect child’s ability to retain, absorb, or process food.

Infection, tumour, hormonal or metabolic disorders, heart disease, kidney disease, genetic disorders and Human Immuno-deficiency Virus (HIV) infection are other physical reasons for failure to thrive. Please note, in our own local environment Tuberculosis (TB) is also one of the commonest causes of failure to thrive in the under-fives.  

Diagnosis Doctors diagnose failure to thrive when a child’s weight or rate of growth is well below what it should be when compared with past measurements or standard height-weight charts. If the rate of growth is inadequate, the child may be small for his or her age but still growing normally.  

To determine why a child may be failing to thrive, doctors ask parents specific questions about feeding, bowel habits, social and financial stability of the family; which might affect the child’s access to food; and illnesses that the child has had or that run in the family. Diseases like sickle cell (ugonjwa wa seli mundu) in African societies are not uncommon, and children who suffer from the disease have typical facies with bossing of the skull and failure to thrive.  

The doctor examines the child, looking for signs of conditions that could explain the child’s growth delay. In my clinical practice, I have seen children with foul smelling stools, with undigested food particles; the stools have a characteristic pungent smell like that of rotten eggs. These children usually suffer from Giardia lamblia  (intestinal protozoa infection) and present with fail to thrive because of malabsorption.

No cause for alarm, the disease is treatable, but the house girl and mother of the child with other siblings will need to be treated because of cross contamination (faecal-oral contamination). Adults may also suffer from Giardia-lamblia but will not present with failure to thrive, but chronic recurrent diarrhoeas with feelings of distended abdomen and passing foul smelling wind like rotten eggs. 

On failure to thrive in children, the doctor makes decisions about blood and urine tests and x-rays based on diagnostic evaluation. More extensive testing is performed only if the doctor suspects an underlying disease. Sometimes if HIV screening needs to be done, parents will need to be counselled and if possible, after positive results the parents may be screened as well.  

I did not like the comment made by one person, who did not want to under go an HIV screening test, but he was ready to get married and make sure that his wife is pregnant to deliver a baby whom he will be watching, if the child was born poorly and fails to thrive, ending in death, then he will know that he has contracted the virus. I went into dialogue with the person to know the facts about what it is to bring up a child whom you do not wish him or her well.

I won the debate and the person was convinced to undergo HIV test. His wife to be would have to be tested for HIV screening, in the Prevention of Mother to Child Transmission clinics free-of-charge.  Treatment and Prognosis Treatment depends on the underlying cause. If a physical cause is found, specific treatment is given. Otherwise, treatment depends on how far below normal child’s weight is. Mild to moderate failure to thrive is treated with nutritious, high-calorie feedings given on regular schedule.

Parents may be counselled for family interactions that are damaging to the child and about financial and social implications if regulated may assist the child’s welfare. Give priority to children’s food and invest on them. Severe failure to thrive like marasmic (nyongea) children and Kwashiorkor (Unyafuzi) children usually need initial hospitalisation for rehabilitation of their nutrition.  First year of life is important for brain development; children who become undernourished during this period may fall permanently behind their peers, even if their physical growth improves.

About half of these children, mental development, especially verbal skills, remains below normal and these children often have social and emotional problems in adulthood.  How many parents, especially fathers discuss about their children’s growth during the first two years of life when they go to the under-fives clinic? There is need to involve men before conception, during pregnancy and childbirth and subsequent clinics.

If you want your child to perform well in school as you did follow and monitor the growth chart known as “Road to Health Cards Reproductive Child Health card number 1” for progress.  A quick way to determine the expected weight for age for your child up to the age of five years is to calculate age in years times two plus eight gives the expected weight for age. A one year old should weigh ten kilogrammes, a two year old should weigh 12 kilogrammes, three year old 14 kilogrammes, four year old 16 kilogrammes and a five year old 18 kilogrammes. 


Author: Dr Ali A. Mzige

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