Joyee Goswami Vachani (editor) - Failure to Thrive and Malnutrition: A Practical, Evidence-Based Clinical Guide

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As a pediatrician who strives to continually integrate evidence-based medicine into practice, I have always been intrigued with failure to thrive (FTT). FTT is often a multifactorial diagnosis requiring multidisciplinary treatment, making a precise definition difficult. Historical definitions (organic vs. nonorganic, crossing percentiles) often do not capture the complex interaction among a childs medical, nutritional, and social/environmental needs. While some studies are shifting towards using the term growth faltering to describe forms of undernutrition, we use the term failure to thrive for this book.

One of the challenges in writing this book is the constantly changing landscape and impact of both the pandemic and local/national policies. Food insecurity is a well-described factor which continues to increase and directly impacts children with FTT and their families. I appreciate the hard work of all the authors in this dynamic environment and would like to thank each of them for their dedication and expertise in contributing to this book and field of work. I would also like to thank my family, friends, and the children/families we have the privilege and honor to care forthey are truly our continuous source of inspiration.

Healthy infancy and childhood are marked by growth and development. Newborns require specific environmental conditions to grow and develop. The connection between growth and nutrition occupies a large portion of parent and provider attention. Parents may find themselves confused or frustrated by the processes involved in breastfeeding a newborn. Latching, positioning, and nursing do not always come naturally. Mixing formula and assembling bottles can be a difficult task. Each family must learn to respond to their individual childs needs and cues. As every child has a unique growth trajectory and potential, it is standard of care for pediatric providers to plot each child on a standardized growth chart and monitor for deviations. Because growth and development involve a complex process of biology, environment, and society, it is important to investigate further when evaluating and treating children for concerns of failure to thrive.

Historically many different terms have been used to describe the specific syndrome referred to as failure to thrive (FTT). Some of the first descriptions in the medical literature were in the 1960s when FTT was referred to as a syndrome of maternal deprivation [].

These historical language choices are outdated but did help characterize the clinical presentation of FTT as encompassing a spectrum of clinical findings, with unclear or complex etiology and not simply malnutrition. Failure to thrive as a clinical syndrome distinct from malnutrition is predicated predominantly on access to food. The definition of FTT required language developed to describe a child who, without obvious or overt starvation, was not growing adequately or in some cases was actually losing weight. As such, further descriptions attempted to divide this syndrome into subcategories. Much of the subsequent language in medical literature distinguished organic as opposed to non-organic or psychosocial failure to thrive []. This distinction in terminology pointed clinicians toward the task of identifying differences in etiology and thus the need for different therapeutic approaches. Given a specific clinical presentationhistory taking, physical examination, and laboratory testing were guided by a desire to uncover medical pathology or familial/social factors as key drivers of a childs faltering growth.

Merriam Websters Collegiate dictionary defines the word thrive as to grow vigorously with flourish as a synonym. More eloquently, to progress toward or realize a goal despite or because of circumstances []. In this understanding, thriving encompasses more than just mere weight gain or objective growth, but also points to a broad type of progress encompassing the environment of the child. In this context, a child who fails to thrive lacks vigor in growth and fails to progress to a goal.