VERY EARLY-ONSET NONORGANIC FAILURE-TO-THRIVE IN INFANTS

Nonorganic failure to thrive (NOFTT) occurs in absence of any gastroin testinal, endocrine, or other chronic diseases. It is usually associat ed with psychosocial deprivation, although behavior problems may also contribute to its occurrence in absence of maternal pathology. We repo rt 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 pregn ancies with birth weights and lengths between the 50th and 95th percen tiles except in one. None had any history of perinatal problems. Decre ased 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 ha d any developmental delay nor were there any psychiatric conditions in mothers. Changes in formulas or psychologic intervention were unsucce ssful in modifying feeding habits except in two infants. All were supp lemented with enteral supplements (Pediasure-five, Ensure-one, and Osm olite-one). Three did not consume enough orally and needed nasogastric tube infusions with eventual placement of gastrostomy tubes in two, a nd the third one has continued with nasogastric infusions. A significa nt increase in caloric intake caused improvement in growth percentiles . Height and weight percentiles improved in all and crept into the nor mal curve in four and five patients, respectively. Head circumference of two stayed at <5th percentile despite nutritional rehabilitation. A ttempts at weaning off the supplements actually resulted in weight los s in all. Our data suggest that there is a critical need for early, ag gressive nutritional intervention in such infants.