Environmental failure to thrive: the need for intervention

Evaluation of the child with failure to thrive consists of a comprehensive history, a thorough physical examination and appropriate laboratory tests. The behavioral characteristics of the infant and mother, as well as the social characteristics of the family, may point to the diagnosis of environmental failure to thrive. Appropriate management strategies are influenced by the psychosocial assessment. The physician must maintain an advocacy role for the child throughout this time, even if community agencies are providing most of the care.

Similarities and differences between nonorganic failure to thrive and deprivation dwarfism

Although the terms, nonorganic failure to thrive and deprivation dwarfism, are sometimes used interchangeably, and while the family pathology is similar in both conditions, the clinical features differ. The majority of children with nonorganic failure to thrive are under 2 years and often 18 months of age. Weight loss is the most marked feature and they are often withdrawn and apathetic. In contrast, the documented ages of children with deprivation dwarfism range from 2 to 15 years although the history may reveal earlier feeding and behavior problems. Short stature is the most striking feature, their weight often being in proportion to their height. They may steal and hoard food and have bizarre eating habits. In some cases reversible hypopituitarism has been documented. It is suggested that deprivation dwarfism constitutes a subgroup within the nonorganic failure to thrive syndrome. Management in both conditions is similar. It should emphasize a practical, supportive approach and be on a long-term basis.