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Very early onset nonorganic failure to thrive in infants
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit.
Insights
Nonorganic failure to thrive (NOFTT) in children is not caused by disease but by inadequate calorie intake. Early, aggressive nutritional intervention is critical for improving growth and development in affected infants.
Area of Science:
- Pediatrics
- Nutrition Science
- Child Development
Background:
- Nonorganic failure to thrive (NOFTT) is characterized by inadequate caloric intake and growth delay, often linked to psychosocial factors rather than underlying medical conditions.
- This condition can occur even without maternal pathology or developmental delays in the child.
Purpose of the Study:
- To investigate the clinical presentation and outcomes of infants and children with NOFTT.
- To emphasize the importance of early and aggressive nutritional intervention for managing NOFTT.
Main Methods:
- Case series of seven infants and children aged 13–30 months presenting with NOFTT.
- Evaluations included assessment of growth parameters, feeding habits, and response to various interventions.
- Nutritional support involved oral supplementation, nasogastric tube feeding, and gastrostomy tubes.
Main Results:
- All patients exhibited decreased oral intake and delayed growth from early infancy.
- Standard interventions like formula changes and psychological support were largely ineffective, except in two cases.
- Aggressive nutritional intervention, including enteral supplements and tube feeding, led to significant improvements in height and weight percentiles for all patients.
- Two patients had persistent head circumference below the 5th percentile despite nutritional rehabilitation.
- Attempts to discontinue supplements resulted in weight loss, highlighting the need for ongoing support.
Conclusions:
- NOFTT requires early and aggressive nutritional intervention to improve growth outcomes.
- Persistent nutritional support is crucial, as weaning from supplements can lead to regression.
- Further research into long-term outcomes and optimal management strategies for NOFTT is warranted.
Abstract:
Nonorganic failure to thrive (NOFTT) occurs in absence of any gastrointestinal, endocrine, or other chronic diseases. It is usually associated with psychosocial deprivation, although behavior problems may also contribute to its occurrence in absence of maternal pathology. We report seven infants and children between the ages of 13 and 30 months at the time of presentation, who failed to consume adequate calories and suffered from delayed growth. All were born at term after normal pregnancies with birth weights and lengths between the 50th and 95th percentiles except in one. None had any history of perinatal problems. Decreased intake was encountered almost immediately after birth, with lack of interest in consuming adequate calories. The evaluations performed did not reveal any specific etiology for the decreased intake. None had any developmental delay nor were there any psychiatric conditions in mothers. Changes in formulas or psychologic intervention were unsuccessful in modifying feeding habits except in two infants. All were supplemented with enteral supplements (Pediasure-five, Ensure-one, and Osmolite-one). Three did not consume enough orally and needed nasogastric tube infusions with eventual placement of gastrostomy tubes in two, and the third one has continued with nasogastric infusions. A significant increase in caloric intake caused improvement in growth percentiles. Height and weight percentiles improved in all and crept into the normal curve in four and five patients, respectively. Head circumference of two stayed at < 5th percentile despite nutritional rehabilitation. Attempts at weaning off the supplements actually resulted in weight loss in all. Our data suggest that there is a critical need for early, aggressive nutritional intervention in such infants.