Nutrition Interventions for Children with Special Health Care Needs

Chapter 14
Section 3 - Condition-Specific Nutrition Interventions
Nutrition Interventions for Failure to
thrive
Barbara York, MS, RD and Gail Watts, MSW
Updated by Sharon Feucht, MA, RD, CD and
Betty Lucas, MPH, RD, CD
“It seems to me that our three basic needs for food, security, and love, are
so mixed, mingled, and intertwined that we can not think of one without the
other.”- M.F.K. Fisher
Introduction
Children with special health care needs are at risk for failure to thrive for a number
of reasons. Poor or delayed growth is associated with some diagnoses, and conditions
may have developmental problems that can interfere with an adequate intake or can
increase energy needs. The stress of a serious medical condition can put a strain on
the parent-child feeding relationship, further placing the child with special needs at
risk for problems with growth.
Definition of Failure to Thrive
Failure to thrive (FTT) is a medical term frequently used to describe children,
generally up to 3 years of age, who demonstrate a downward deviation in growth
when compared to expectations from the Centers for Disease Control (CDC) growth
charts (1,2). There are no universally accepted diagnostic criteria for FTT, and
there remains confusion about definitions currently used to describe this condition.
Definitions range from vague descriptions of children whose weight is delayed in
comparison to stature, to specific criteria such as weight moving downward across
two standard deviations for age. While these descriptions may help identify a
slow rate of growth, it is important to recognize that they depict anthropometric
parameters only and offer little understanding to the overall complexity of the issues
which have contributed to the diagnosis of failure to thrive (1,2).
Often pediatric undernutrition and growth failure originate from multiple physical and
psychosocial factors that change over time and are most effectively treated by an
interdisciplinary team. Growth experts warn against a broad use of anthropometric
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