Traditionally, causes of FTT have been divided into endogenous and exogenous causes. These causes can also be largely grouped into three categories: inadequate caloric intake, malabsorption/caloric retention defect, and increased metabolic demands. ; Endogenous (or "organic"):Endogenous causes are due to physical or mental issues affecting the child. These causes include various inborn errors of metabolism. Problems with the gastrointestinal system such as excessive gas and acid reflux are painful conditions which may make the child unwilling to take in sufficient nutrition.<unk><unk> , diarrhea, liver disease, anemia or iron deficiency, Crohn's disease, and coeliac disease make it more difficult for the body to absorb nutrition. Other causes include physical deformities such as cleft palate and tongue tie that impede food intake. Additionally, allergies such as milk allergies can cause endogenous FTT. FAS has also been associated with failure to thrive. Additional, medical conditions including parasite infections, urinary tract infections, other fever-inducing infections, asthma, hyperthyroidism and congenital heart disease may raise energy needs of the body and cause greater difficulty taking in sufficient calories to meet the higher caloric demands, leading to FTT. ; Exogenous (or "nonorganic"): Exogenous causes are due to caregiver actions, whether unintentional or intentional. Examples include physical inability to produce enough breastmilk, inappropriate feeding schedules or feeding technique, and mistakes made in formula preparation. In developing countries, conflict settings, and protracted emergencies, exogenous FTT may more commonly be caused by chronic food insecurity, lack of nutritional awareness, and other factors beyond the caregiver's control. As many as 90% of failure to thrive cases are non-organic. ; Mixed: Both endogenous and exogenous factors may co-exist. For instance, a child who is not getting sufficient nutrition for endogenous reasons may act content so that caregivers do not offer feedings of sufficient frequency or volume. Yet, a child with severe acid reflux who appears to be in pain while eating may also make a caregiver hesitant to offer sufficient feedings. Inadequate caloric intake Inadequate caloric intake indicates that an insufficient amount of food and nutrition is entering the body, whether due to lack of food, anatomical differences causing difficulty eating, or psychosocial reasons for decreased food intake. + Cause Description/presentation Mechanism Epidemiology Poverty/inadequate food supply Inadequate food available for child Decreased food intake Most common cause of failure to thrive globally Inadequate breast milk supply/ineffective latching Mother is unable to produce enough breast milk or infant is unable to latch properly during breastfeeding Insufficient breastfeeding Improper preparation of formula Formula is not prepared or mixed properly Insufficient nutrition from formula feeding Postpartum depression/maternal depression Mother experiences low mood, persistent sadness, and/or loss of interest or pleasure in activities Mothers suffering from depression are more likely to have breastfeeding difficulties and may have decreased desire to interact with their children, which may lead to decreased feeding 1 in 10 women in the US experience symptoms of depression 1 in 8 women experience symptoms of postpartum depression, or depression after childbirth Child neglect Caretakers fail to provide adequate care to the child Caretakers do not adequately feed the child Prevalence of neglect in non-organic FTT may be as high as 5-10% Cerebral palsy Disturbance in the developing fetal or infant brain leads to difficulties and delays in cognition, motor movement and coordination, and other aspects of development Decreased motor function and coordination leads to difficulty feeding Affects about 3.6/1000 children Cleft lip/cleft palate During fetal development, parts of the mouth/lips do not fuse properly, causing an anatomical defect Impaired oral motor coordination and poor suck causes difficulty feeding Occurs in about 1 in 600 to 800 live births Gastroesophageal reflux disease Regurgitation of food causes discomfort and irritability Discomfort and pain after eating may cause poor appetite or refusal to feed Occurrence peaks at about 4 months of age Pyloric stenosis Abnormal thickening of the opening between the stomach and small intestine blocks food from flowing through the gastrointestinal tract, causing projectile vomiting Projectile vomiting after eating and inability of food to enter small intestine leads to dehydration and weight loss Infant is usually well at birth, and pyloric stenosis usually presents at 3-6 weeks of age Toxins causing gastrointestinal problems Toxins such as lead can cause decreased appetite, constipation, or abdominal pain Gastrointestinal problems and discomfort can lead to decreased appetite or refusal to eat Avoidant/restrictive food intake disorder (ARFID) Psychiatric condition in which individuals avoid eating certain foods or restrict the amount of food they eat; may be due to sensory sensitivity, a traumatic experience with eating, or another cause Food avoidance or restriction leads to inadequate nutritional intake Malabsorption/caloric retention defect Malabsorption and caloric retention defects cause the body to the unable to absorb and use nutrients from food, despite an adequate amount of food physically entering the body. + Cause Description/presentation Mechanism Epidemiology Inborn errors of metabolism Genetic conditions that interfere with the utilization of nutrients for energy; include conditions such as galactosemia, glycogen storage disease Disruption in the breakdown of nutrients and to utilization of nutrients to produce energy Cow's milk protein allergy Allergy to a protein in cow's milk, causing symptoms such as skin reactions, wheezing, difficulty breathing, diarrhea, or vomiting after ingestion of cow's milk Inability to drink milk leads to poor growth; discomfort after drinking milk may also lead to food refusal Affects 2-6% of children, primarily during the first year of life, though many children outgrow the condition Celiac disease Autoimmune disease in which ingestion of foods containing gluten leads to symptoms including diarrhea, abdominal pain, and bloating Damage to intestinal lining leads to problems with nutrient uptake Prevalence of 0.5-1% among the general population Short bowel syndrome Loss of functioning intestines due to surgery, congenital anatomical differences, or other disease Shortage of functioning intestines leads to malabsorption of nutrients Necrotizing enterocolitis is the most common cause in infancy<unk><unk>  Disorder in production and clearance of mucus leads to problems with lung and gastrointestinal function Problems with mucus clearance leads to issues with the pancreas and other gastrointestinal organs, leading to malabsorption of nutrients Affects 1 in 2500 Caucasian newborns Biliary atresia Failure of development of the bile ducts that help carry enzymes necessary for digestion of fats in food Causes yellowing of the skin (jaundice), pale stools, and dark urine in the infant Underdevelopment of bile ducts leads to malabsorption of fats, difficulties with absorbing vitamins and other nutrients, and poor oral intake of food Pancreatic insufficiency Inability of pancreas to produce sufficient enzymes necessary for digestion and absorption of nutrients, leading to symptoms such as chronic diarrhea and greasy stools Malabsorption of fats and inability to digest nutrients such as fat-soluble vitamins leads to poor weight gain Increased metabolic demand Increased metabolic demand suggests a state of increased energy needs and caloric expenditure. This state causes greater difficulty taking in enough nutrition to meet the body's energy needs and allow for normal growth. + Cause Description/presentation Mechanism Epidemiology Hyperthyroidism Increased levels or activity of thyroid hormone leads to elevated metabolic rate Elevated metabolic rate causes increased energy usage Most common cause among children is Graves' disease, causing about 96% of cases of hyperthyroidism Chronic infections Chronic infections such as HIV, tuberculosis, urinary tract infections Infections result in increased energy expenditure TORCH infections Toxoplasmosis, other (syphilis, varicella zoster, parvovirus B19), rubella, cytomegalovirus, herpes simplex virus Infections result in increased energy expenditure Inflammatory conditions Conditions such as asthma, inflammatory bowel disease Inflammation increases energy utilization Diabetes mellitus Group of disorders in which sugars are unable to be properly taken up into cells and used for energy, leading to high blood sugar levels Failure to thrive may be caused by a type of diabetes mellitus called neonatal diabetes mellitus Inability to utilize sugars for energy leads to growth difficulties Congenital heart defects Abnormalities in heart anatomy and function leads to problems pumping oxygen to the body, difficulties with breathing and feeding, and possible downstream issues with organs that do not receive enough oxygen Breathing problems may make feeding more difficult Lack of oxygen to the intestines may cause malabsorption Overall decreased oxygen delivery to the body and increased energy needs may stunt growth Chronic lung disease Conditions such as bronchopulmonary dysplasia, bronchiectasis, chronic lung disease of prematurity Breathing difficulties may interfere with feeding Chronic disease and low oxygen state causes increased energy expenditure Cancer Presentation varies depending on type of cancer, but include pain, swelling, fatigue, fever, headache, night sweats, loss of appetite Rapid growth of cancer cells requires high energy usage Pediatric cancers are less than 1% of all new cancer diagnoses Most common pediatric cancers are leukemia, brain and spinal cord tumors, and neuroblastoma Chronic kidney disease Dysfunction of the kidneys, the organs that filter blood and produce urine May be caused by anatomical differences in the kidneys and urinary tract, or by diseases (eg, infections, diabetes) that cause damage to the kidneys Damage to the kidneys leads to dysfunctional activity of growth hormone and other necessary hormones, disruptions to metabolism, inflammation causing increased expenditure, and disturbances in retention and utilization
symptom of Cystic fibrosis
symptom of Alpha-1 antitrypsin deficiency
symptom of Tuberculosis
symptom of Tonsillitis
symptom of Croup
symptom of Peritonsillar abscess
symptom of Aspiration pneumonia
symptom of Peanut allergy