Failure to Thrive

Failure to thrive is a term used to describe infants and young children who are not growing or are losing weight due to malnutrition, neglect, abuse, or medical conditions. In failure to thrive, the child may have a low body weight (below the third percentile for the child's age), a low height for age, or a small head circumference. A child with failure to thrive is not eating or being offered enough calories to meet his or her nutritional needs. Besides impaired growth, other symptoms include tiredness, sleeplessness, irritability, lethargy, resistance to eating, vomiting, and problems with elimination. The child may be suffering from an illness, medical condition, or recurring infections; taking medications; or come from a poor, distressed, or socially isolated family. To attain normal growth levels, a child with this condition requires from 1.5 to 2 times the normal amount of calories.

SEE ALSO INFANT NUTRITION.

Heidi J. Silver

Bibliography

Bithoney, W. G.; Dubowitz, H.; and Egan, H. (1992). "Failure to Thrive/Growth Deficiency." Pediatrics in Review 13:453–460.

Schwartz, D. (2000). "Failure to Thrive: An Old Nemesis in the New Millennium." Pediatrics in Review 21:257–264.

Internet Resource

American Academy of Pediatrics. "Failure To Thrive." <http://www.medem.com>

Nutrition and Well-Being A to Z
Copyright © 1999 by The Gale Group.
Published by The Gale Group. All rights reserved, including the right of reproduction in whole or in part in any form.

Failure to Thrive

Definition

Failure to thrive (FTT) is a term used to describe children whose physical growth over time is inadequate when compared to a standard growth chart.

Description

There is no universally accepted definition of failure to thrive, though it has been recognized as a medical condition since the early 1900s. It describes a condition rather than a specific disease. Children are considered as failing to thrive when their rate of growth does not meet the expected growth rate for a child their age. The difficulty lies in knowing what rate of growth is expected for any individual child, since many factors, including race and genetics, may influence growth.

Recognizing abnormal growth requires an understanding of normal infant growth. Infants normally lose up to 10 percent of their weight in the first few days of life. However, this weight should be regained within two weeks. The average full-term baby doubles its birth weight by six months and has tripled it by one year. Children with failure to thrive are often not meeting those milestones. If a baby continues to lose weight or does not gain weight as expected, he or she is probably not thriving.

Children who fail to thrive are either not receiving or have an inability to take in or retain adequate nutrition in order to gain weight and grow. If the condition progresses, the undernourished child may become irritable and/or apathetic and may not reach typical developmental markers such as sitting up, walking, and talking at the usual ages.

Demographics

The incidence of growth failure of American children is difficult to assess. Failure to thrive is believed to affect up to 5 percent of the population but is most common in the first six months of a child's life. It is commonly seen in babies born prematurely. Most diagnoses of failure to thrive are made in infants and toddlers in the first few years of life. An estimated 10 percent of children seen in primary care settings have symptoms of failure to thrive. The condition can appear in all socioeconomic groups, although it is seen more frequently in those families experiencing poverty. There is an increased incidence among children receiving Medicaid, those living in rural areas, and in children who are homeless.

Causes and symptoms

Failure to thrive may have several underlying causes. The causes of failure to thrive are typically differentiated into organic and non-organic. Organic causes are those caused by an underlying medical disorder. Inorganic causes are those caused by a caregiver's actions. However, these definitions are simplified, as both medical and behavioral causes often appear together.

Organic causes of failure to thrive may include:

• premature birth, especially if the fetus had intrauterine growth retardation
• maternal smoking, alcohol use, or illicit drugs during pregnancy
• mechanical problems present, resulting from a poor ability to suck or swallow, for example, presence of cleft lip and cleft palate
• unexplained poor appetites that are unrelated to mechanical problems or structural abnormalities, for example, breathing difficulties that can result from congestive heart failure (Any difficulty in breathing makes eating more difficult and can result in FTT. Inadequate intake also can result from metabolic abnormalities, excessive vomiting caused by obstruction of the gastrointestinal tract, or kidney dysfunction. In addition, gastroesophageal reflux causing regurgitation of formula or refusal of feeding.)
• poor absorption of food, inability of the body to use absorbed nutrients, or increased loss of nutrients

Some examples of non-organic causes of failure to thrive are:

• poor feeding skills on the part of the parent
• dysfunctional family interactions
• difficult parent-child interactions
• lack of social support
• lack of parenting preparation
• family dysfunction, such as abuse or divorce
• child neglect
• emotional deprivation

Studies show that only between 5 percent and 26 percent of FTT cases are due to a purely organic cause. Children in abusive or neglectful families are at higher risk of FTT, but these cases make up only a small proportion of the total. The most common cause of failure to thrive is malnutrition, either as part of an organic problem or simply because of an energy imbalance.

The following symptoms are possible indications of failure to thrive:

• delayed social and mental skills
• delayed development of secondary sexual traits in adolescents
• height, weight, and head circumference in an infant or young child not progressing as expected on growth charts
• edema (swelling)
• wasting
• enlarged liver
• rashes or changes in the skin
• changes in hair texture

When to call the doctor

Parents should notify their physician if their child does not seem to be developing at a normal pace. If parents notice a drop in weight or if the baby does not want to eat, the doctor should be notified. A major change in eating patterns also warrants contact.

Diagnosis

If a child fails to gain weight for three months in a row during the first year of life, physicians normally become concerned. The most important part of a physician's evaluation is taking a detailed history. Prenatal history is important, and the doctor will want to know if the pregnant mother smoked, consumed alcohol, used any medications, or had any illness during the pregnancy. The doctor will also want a dietary history, to determine if there have been any feeding problems. A history of how formula is mixed is important, because improperly prepared formula can result in failure to thrive. Parents will also be asked about whether the child had any illnesses, as some can cause a problem with the growth potential of children. A family and social history will also be done.

Doctors diagnose failure to thrive by plotting the child's weight, length, and head circumference on standard growth charts. Children who fall below a particular weight range for their age or who dip below two or more percentile curves on the chart over a short period of time will likely have a more thorough evaluation to find out if there is a problem. A complete blood count, various serum chemical and electrolyte tests, and a urinalysis may be helpful in discovering any underlying medical disorders. The doctor will want to determine if the child is receiving enough nourishment. To do this, the parents will be asked to record what the child eats each day, and a subsequent calorie count will be done. The doctor may also talk to the parents to help identify any home problems like financial difficulties, household stress, or neglect.

It is important to remember that some children will normally fall below the standards on growth charts. If children are full of energy, interacting normally with their parents, and show no signs of illness, then they are probably not failing to thrive and are just smaller children.

Once the diagnosis of failure to thrive has been made, the physician will attempt to determine if it is from an organic or non-organic cause.

Treatment

Because there are numerous factors that may contribute to a failure to thrive diagnosis, children diagnosed with the disorder sometimes have an entire medical team working on the case. If there is an underlying physical cause, correcting that problem may reverse the condition. The doctor will recommend high-calorie foods and place the child on a high-density formula like Pediasure. More severe cases may involve tube feedings, which can take place at home. A child with extreme failure to thrive may need hospitalization, during which he or she can be fed and monitored continuously. This will give the treatment team an opportunity to also observe the caregiver's interactions with the child.

The duration of treatment will vary from child to child. Weight gain takes time, so several months may go by before a child returns to his normal weight range. Children requiring hospitalization usually stay for approximately two weeks or more to get them out of danger, but many months can pass before the symptoms of malnutrition disappear.

Nutritional concerns

The long-term goal for every child with FTT is to provide adequate energy intake for growth. Therefore, even if no causative factor is uncovered for a child with FTT, aggressive dietary management is the key to successful treatment. Proper feeding can be achieved through infant formulas that are adjusted to meet the child's specific nutrient needs. Infants may be given concentrated formulas, assuming their kidney function is normal. In cases of kidney disorders, increasing the fat content of the formula may be useful as a way of delivering additional calories. Older children with FTT may benefit from adding cheese, sour cream, butter, margarine, or peanut butter to meals. Also, high-calorie shakes can be used to supplement meals. Multivitamin and mineral supplements, including iron and zinc, usually are recommended to all undernourished children. Tube feeding is usually not indicated except for severe cases of malnutrition.

Prognosis

Whether FTT results from organic or non-organic reasons, children with this condition require aggressive calorie supplementation. Some cases may lead to significant developmental delays in children. The cognitive outcome of children who have had FTT is not clear, and this may lead to emotional and behavioral problems later. However, carefully looking for the causes of failure to thrive and implementing calorie supplementation is important for obtaining a positive outcome in these children.

Prevention

Initial failure to thrive caused by physical defects cannot be prevented but can often be corrected before they become a danger to the child. Maternal education as well as emotional and economic support systems may help to prevent failure to thrive in those cases where is no physical deformity.

Parental concerns

Parents who note any of the symptoms of failure to thrive should report them to their child's physician so that treatment can begin.

Resources

BOOKS

Bremmer, J. Gavin, et al. The Blackwell Handbook of Infant Development. Oxford, UK: Blackwell Publishing, 2004.

Slater, Alan, et al. Introduction to Infant Development. Oxford, UK: Oxford University Press, 2002.

PERIODICALS

"Failure to Thrive." Update (June 17, 2004): 567.

Krugman, Scott D., and Howard Dubowitz. "Failure to Thrive." American Family Physician 68 (September 1, 2003): 5, 879–84.

WEB SITES

Bassali, Reda W., and John Benjamin. "Failure to Thrive." Emedicine, August 11, 2004. Available online at <www.emedicine.com/ped/topic738.htm> (accessed January 11, 2005).

"Failure to Thrive." Kidshealth.org, February 2001. Available online at <www.kidshealth.org/parent/growth/growth/failure_thrive.html> (accessed January 11, 2005).

"Failure to Thrive." MedlinePlus, November 3, 2002. Available online at <www.nlm.nih.gov/medlineplus/ency/article/000991.htm> (accessed January 11, 2005).

Deanna M. Swartout-Corbeil, RN

The Gale Encyclopedia of Children's Health: Infancy Through Adolescence
Copyright © 1999 by The Gale Group.
Published by The Gale Group. All rights reserved, including the right of reproduction in whole or in part in any form.

Business Failure and Dissolution

Business failure is defined as the closing of a business that results in financial loss for at least one of the business's creditors. An associated term, business dissolution, refers to the formal termination or closure of a business as well, but with dissolution, financial loss (for the business owners or for the business's creditors) is not necessarily a part of the equation.

All entrepreneurs who decide to establish their own business face the possibility of failure, and a good deal of "popular wisdom" holds that failure is not only possible but probable for the small business owner seeking to launch his or her own enterprise (it has long been said that four out of five new businesses fail within five years of their establishment, for instance). But current studies indicate that such gloomy forecasts often present a false picture of entrepreneurial realities. Indeed, many business experts that the majority of small business owners are actually successful with their ventures. "Outright failures of small businesses are in fact remarkably rare," contended Nation's Business, "if failure is defined, reasonably enough, as a business closing that results in losses to creditors because the firm files for bankruptcy or because it simply closes its doors without paying its debts."

Business experts who study the gap between actual rates of business failure and the popular perception of those rates often blame it on a general misunderstanding of the nature of business dissolutions. "The confusion comes in mixing up business failures with business dissolutions," Nation's Business flatly stated. "Lots of small companies go out of business for reasons that probably shouldn't be called 'failure'—the owner may have gotten bored, for instance, may be disappointed with the returns, or may simply want to try a greener pasture. If an entrepreneur closes one business and starts another one that is more successful, that's more reason for celebration than concern." Bruce D. Phillips, a director with the Small Business Administration's office of economic research, even told Nation's Business that studies indicate that there may be four to eight times as many dissolutions as there are outright business failures.

REASONS FOR BUSINESS FAILURE

Nonetheless, thousands of small business ventures do fail every year in America. "Companies stumble for many reasons," observed Clyton Christensen in Across the Board, "among them bureaucracy, arrogance, tired executive blood, poor planning, short-term investment horizons, inadequate skills and resources, and just plain bad luck." These factors—as well as myriad others—can have a debilitating impact on an operation, as many small business surveys will attest. Chief reasons for business failure cited within such surveys include the following:

POOR PLANNING Ultimately, many small businesses fail because of fundamental shortcomings in their business planning. Planning begins with finding the right business and is integral to every aspect of business operations, including selecting a site, deciding on financing, anticipating work force needs, budgeting, and managing company growth. Planning that is grounded in realistic expectations and accurate, current information is an invaluable asset. Conversely, planning that is based on hopes and hearsay can cripple or destroy even a good business idea in fairly short order.

POORLY CONCEIVED EXPANSION "Every business owner wants to grow his or her business, but expanding with no infrastructure in place makes a business ripe for failure," wrote Tonia Shakespeare in Black Enterprise. "You can incur tremendous losses when you expand outside your core market. Not only is the physical aspect of expansion costly but there are different buying habits in different geographical locations. If you venture into an area outside your home turf, you had better prepare by doing a lot of research."

CASH FLOW DIFFICULTIES Poor cash flow kills thousands of small businesses every year. "Most business owners don't realize how much money it takes to run a business," wrote Shakespeare. "Understand what it takes to get a revolving line of credit before you start your business. It's always easier to get money when you don't need it, so don't wait until you're desperate. Develop your business plan using conservative projections and don't be overly optimistic." Shakespeare warned that profitable, fast-growing businesses can also run into cash crunches that can ultimately lead to bankruptcy. "That's why ongoing cash-flow analysis—tracking the money coming in and going out of the business—is a must."

INABILITY TO REIN IN FLAWED BUSINESS STRATEGIES Some business owners simply refuse to admit when they are wrong. Many small businesses can recover from ill-conceived business initiatives if they are recognized and halted before too much damage is done. But all too often, business owners and managers stubbornly stick with strategies that are doomed to failure, rationalizing that the initiative will begin paying off next month or next quarter. And before they know it, their business is gone, dragged down by poor planning and inordinate pride. Writing in Management Today, Robert Heller characterized this tendency thusly: "Top management sets its sights on some grand but imperfectly conceived objective, launches an incompetent plan of action, pours in cash rather than control when the action misfires, and ignores all the adverse evidence until the disaster strikes."

DETERIORATION IN CUSTOMER BASE This can happen for any number of reasons, including poor service, high prices, and new competitors. Making improvements in products/services offered, marketing, inventory, customer service, and work force personnel can all do a great deal to halt deterioration in customer relations.

INATTENTION TO WARNING SIGNS Most small business failures do not come out of the blue. Certainly, business failures that result from catastrophic natural disasters or the sudden death of a key business member can not be anticipated, but most businesses expire as a result of more mundane factors. New customer complaints and surges in returns are often early warning signs of operational problems. Basic financial tools such as balance sheets and financial statements, meanwhile, can be very helpful tools in helping business owners diagnose what is ailing their company. The numbers contained in those documents often provide ample warning of poor cash-flow management, inventory problems, excessive debt, undercapitalization, or untrustworthy customers, but the business owner has to take the time to look (or take the time to hire an accountant to look) or the warning signs may go unheeded until it is too late.

Other reasons often given for small business failures include the following:

Inattentive and/or indecisive management

• Micromanagement
• Poor control of production costs
• Poor control of product or service quality
• Underpricing of goods or services sold
• Inadequate staff training
• Loss of key employees or business partners, either to extended absence or another company
• Unhealthy company culture
• Overreliance on one customer
• Overinvestment in new technologies of untested value
• Inadequate financing
• Inadequate insurance
• Inadequate tax planning
• Failure to promote and maintain a good public image in the community and/or marketplace
• Poor control of inventory
• Poor relationships with suppliers/vendors
• Poor/unmotivated employees
• Inadequate or subpar professional assistance
• (accountants, attorneys, etc.)
• Competition
• Failure to anticipate marketplace trends and developments
• Undue emphasis on products or services of limited popularity
• Poor budgeting decisions
• Extending too much credit
• Inattention to financial indications of company health
• Flawed or discarded business plan
• Excessive reliance on credit

BANKRUPTCY

Bankruptcy is a legal proceeding, guided by federal law, designed to address situations wherein a debtor—either an individual or a business—has accumulated debts so great that the individual or business is unable to pay them off. It is designed to distribute those assets held by the debtor as equitably as possible among creditors. Bankruptcy proceedings may be initiated either by the debtor—a voluntary process—or by creditors—an involuntary process.

Chapter 7 Bankruptcy. Individuals are allowed to file for bankruptcy under either Chapter 7 or Chapter 13 law. Under Chapter 7 bankruptcy law, all of the debtor's assets—including any unincorporated businesses that he or she owns—are totally liquidated, and the assets are divided by a bankruptcy court among the individual's creditors.

Chapter 13 Bankruptcy. This is a less severe bankruptcy option for individuals. Under the laws of Chapter 13 bankruptcy, debtors turn over their finances to the court, which distributes funds and payment plans at its discretion.

Chapter 11 Bankruptcy. Chapter 11 bankruptcy law is designed to provide businesses with the opportunity to restructure their finances and debt obligations so that they can continue to operate. Companies usually turn to Chapter 11 protection after they are no longer able to pay their creditors, but in some instances, businesses have been known to act proactively in anticipation of future liabilities.

RECOVERING FROM BUSINESS FAILURE

Business failure is usually a demoralizing event in a person's life because it impacts both professional and personal self-esteem. Indeed, many experts believe that the entrepreneur who experiences a business failure goes through many of the same stages as individuals who suffer from the loss of a friend or loved one—shock, denial, anger, depression, and acceptance. But observers are quick to point out that people who experience business failure can still go on to lead rewarding professional lives, either as part of another company or—down the line—in another entrepreneurial venture.

Many analysts believe that chances of subsequent success in the business world often hinge on the entrepreneur's activities in the first year or two after the failure has occurred. "[After a business failure,] you need a period of decompression to rethink and recharge," one executive told Entrepreneur. "People are too quick to rush into the next thing just to prove they can do it." Instead, victims of business failure are often urged to take the time to honestly examine the reasons for the failure, even as they return to the work world in their old capacity as employee. Was your marketing plan flawed? Did you underestimate the amount of time it would take to become profitable? Did your manufacturing processes compromise product quality? Was your family fully committed to supporting the endeavor? Did you pay enough attention to work force training issues? Small business consultants strongly encourage entrepreneurs to seek out the opinion of others—industry experts, area businesspeople, loan officers, investors, family members, etc.—when taking on this task, for their perspectives can be invaluable in helping you to establish a successful business on your next attempt.

FURTHER READING:

Axelton, Karen. "Bouncing Back." Entrepreneur. March 1998.

Barrier, Michael. "Back From the Brink." Nation's Business. September 1995.

Bowles, Erskine. "Good News." Entrepreneur. February 1994.

Christensen, Clayton M. "Why Great Companies Lose Their Way." Across the Board. October 1998.

Delaney, Kevin J. Strategic Bankruptcy: How Corporations and Creditors Use Chapter 11 to Their Advantage. University of California Press, 1992.

Heller, Robert. "Managements That Lost Control." Management Today. October 1995.

"The Most Dangerous Game?" Nation's Business. September 1995.

Schuchman, Matthew L., and Jerry S. White. The Art of the Turnaround: How to Rescue Your Troubled Business from Creditors, Predators, and Competitors. AMACOM, 1995.

Shakespeare, Tonia. "Warning Signs That Your Business is Failing." Black Enterprise. November 1996.

Scott, Jonathan T. "Raising the Dead." Entrepreneur. February 2001.

Tuller, Lawrence W. Getting Out: A Step-by-Step Guide to Selling a Business or Professional Practice. Liberty Hall, 1990.

SEE ALSO: Bankruptcy; Liquidation

Encyclopedia of Small Business
Copyright © 1999 by The Gale Group.
Published by The Gale Group. All rights reserved, including the right of reproduction in whole or in part in any form.

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