Additionally, the child with this syndrome displays withdrawing behavior, avoidance of eye contact, and stiffness or flaccid posture when held. The syndrome was first noticed when European psychiatrists studied the development of babies who had spent the first five years of their lives in institutions where they were deprived of the emotional warmth of a mother, father, or other primary caregiver.Ĭharacteristics of the failure to thrive syndrome include lack of physical growth (for example, weight and height below the third percentile for age) and below normal achievement in fine and gross motor, social-adaptive, and language skills as assessed by psychometric testing using a tool such as the Denver Developmental Screening Test. The syndrome can be seen in children with a physical illness, but the term is most often taken to mean failure to thrive due to psychosocial effects such as maternal deprivation. 23 Patients also should be assessed for oral pathology, ill-fitting dentures, problems with speech or swallowing, medication use that might cause anorexia or dysgeusia, and financial and social problems that may be contributors to malnutrition.Failure to thrive ( failure to thrive syndrome) physical and developmental retardation in infants and small children. 22 The Mini Nutritional Assessment, a validated tool for measuring nutritional risk in elderly persons that combines anthropometric measures and dietary history, is easy to use in the office setting. Body weight, weight trend, and muscle wasting that is found on physical examination and confirmed by laboratory data (such as serum albumin and total cholesterol levels, and lymphocyte count) should be included. 9, 21 Assessment of malnutrition involves a dietary history that includes daily caloric intake, the availability of food, the use of nutritional or herbal supplements, and the adequacy of the patient’s diet as quantified through the amount of food intake, the number of meals, and the balance of nutrients. The most accurate evidence of malnutrition in an elderly patient is hypocholesterolemia and hypo-albuminemia. Malnutrition is an independent predictor of mortality in older adults. Rheumatologic disease (e.g., temporal arteritis, rheumatoid arthritis, lupus erythematosus)ĭysphagia, depression, cognitive loss, functional impairment Recurrent urinary infections or pneumonia Myocardial infarction, congestive heart failure Malabsorption, poor glucose homeostasis, end-organ damage Major depression, psychosis, poor functional status, cognitive loss
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Steroid myopathy, diabetes, osteoporosis, vison loss Metastases, malnutrition, cancer cachexia The diagnosis should prompt discussion of end-of-life care options to prevent needless interventions that may prolong suffering. Physicians should recognize the diagnosis of failure to thrive as a key decision point in the care of an elderly person. Interventions should be directed toward easily treatable causes of failure to thrive, with the goal of maintaining or improving overall functional status. The impact of existing chronic diseases should be assessed. A medication review should ensure that side effects or drug interactions are not a contributing factor to failure to thrive. Laboratory and radiologic evaluations initially are limited to a complete blood count, chemistry panel, thyroid-stimulating hormone level, urinalysis, and other studies that are appropriate for an individual patient. Initial assessments should include information on physical and psychologic health, functional ability, socioenvironmental factors, and nutrition. Four syndromes are prevalent and predictive of adverse outcomes in patients with failure to thrive: impaired physical function, malnutrition, depression, and cognitive impairment.
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Manifestations of this condition include weight loss, decreased appetite, poor nutrition, and inactivity. In elderly patients, failure to thrive describes a state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments.