Failure to Thrive (FTT): Organic & Non-Organic Causes — Comprehensive List

Failure to Thrive (FTT) = weight/length <5th %ile or crossing ≥2 major percentile lines downward. Etiology is multifactorial — **always consider both organic and psychosocial**.

Organic (Medical) Causes

System	Conditions
GI	GERD, pyloric stenosis, malrotation, celiac, IBD (Crohn's/UC), cystic fibrosis, eosinophilic esophagitis, short bowel, food protein-induced enterocolitis (FPIES)
Infectious	TB, HIV, chronic viral (CMV), recurrent UTI, parasitic (Giardia), congenital infections
Cardiac	Congenital heart disease (VSD, TOF, coarctation), heart failure
Pulmonary	Cystic fibrosis, BPD, severe asthma, TB, interstitial lung disease
Renal	Renal tubular acidosis, chronic kidney disease, obstructive uropathy
Hepatic	Biliary atresia, metabolic liver disease, hepatitis
Endocrine	Hypothyroidism, GH deficiency, cortisol excess/deficiency, diabetes insipidus, type 1 DM
Neurologic	Cerebral palsy, hypoxic-ischemic encephalopathy, neurodegenerative, dysphagia
Metabolic/Genetic	PKU, MSUD, mitochondrial disorders, chromosomal (Down, Turner, Prader-Willi), imprinting disorders
Immunologic	SCID, CVID, IgA deficiency, chronic granulomatous disease

Non-Organic (Psychosocial/Environmental) Causes

Diagnostic Approach

1. Detailed history (dietary recall, feeding observation, psychosocial screen).
2. Growth chart analysis (trajectory, proportionality).
3. Physical exam (dysmorphia, organomegaly, neuro, skin).
4. Targeted labs: CBC, metabolic panel, TSH, celiac, urinalysis, stool studies, sweat chloride, HIV.
5. Multidisciplinary: Nutrition, social work, psychology, genetics.

Management Principle

**Treat the cause, not just the weight.** Caloric supplementation alone fails if psychosocial driver persists. Hospitalization for observation (caloric intake, behavior, weight gain) sometimes needed for diagnosis.

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Category	Examples
Nutritional Neglect	Inadequate calories, improper formula prep, food insecurity, poverty, parental ignorance
Feeding Dynamics	Force-feeding, distraction, inappropriate textures, bottle propping, nocturnal feeding avoidance
Caregiver Factors	Maternal depression, substance abuse, intellectual disability, young age, isolation, domestic violence
Attachment Disorder	Reactive attachment disorder (RAD) — inhibited/ disinhibited types
Factitious / Munchausen by Proxy	Caregiver fabricates/induces illness