Failure To Thrive

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Failure to thrive is a term that describes children whose current weight, or rate of weight gain, is much lower than other children of similar age and gender. Failure to thrive (FTT) is considered a medical condition rather than a 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. Many factors, including race and genetics, may influence that growth.

Infants normally lose around 10% of their weight in the first few days of life; but gain it back within two weeks. The average full-term baby doubles its weight by 6 months and triples its weight by one year. Children with failure to thrive will lose weight, or do not gain weight as expected.

Failure to thrive may have several underlying causes: organic, caused by a medical disorder, or inorganic, cause by a caregiver’s actions. Both often appear together.

Organic causes of FTT may include:

  • Premature birth.
  • Maternal smoking, alcohol use, or illicit drugs during pregnancy.
  • Mechanical problems resulting from a poor ability to suck or swallow.
  • Poor appetite:
    • Inadequate intake.
    • Excessive vomiting cause by obstruction of gastroesophageal reflux (GERD)
    • Poor absorption of food such as milk allergies.
    • Inability of the body to use absorbed nutrients (cystic fibrosis, diarrhea, liver disease, celiac).
    • Increased loss of nutrients.
    • Infections.

Examples of inorganic causes of FTT include:

  • Poor feeding skills of the parent such as insufficient age-appropriate solid foods for babies and toddlers.
  • Inability to produce enough breast milk.
  • Dysfunctional family interactions (neglect, abuse, emotional deprivation).
  • Lack of social support.
  • Lack of parenting preparation.


Symptoms to failure to thrive include:

  • Height, weight, and head circumference in a infant or young child not progressing as expected on growth charts.
  • Weight lower than 3rd percentile (outlined in growth charts) or 20% below the ideal weight for their height.
  • Growth slowed or stopped after a previously established growth curve.
  • Developmental milestones such as rolling over, sitting, standing and walking not reached.
  • Delayed social and mental skills.
  • Constipation.
  • Excessive crying or sleepiness.
  • Irritability.
  • Delayed development of secondary sexual traits in adolescents.


If a baby doesn’t gain weight for 3 consecutive months during the first year of life, doctors usually become concerned. Doctors diagnose failure to thrive by using standard growth charts to plot weight, length, and head circumference. Children who fall below a certain weight range for their age, or who are failing to gain weight, will be further examined.

The following tests may be done:

  • complete blood count (CBC)
  • Electrolyte tests
  • Urinalysis
  • Additional tests if a particular disease or disorder is suspect.

To determine if a child is receiving enough food, the doctor may have a dietitian do a calorie count by asking the parents what the child eats every day. Talking to the parents may also help identify any problems at home such as feeding difficulties, neglect, poverty, household stress, etc.


Children with failure to thrive need the help of their parents and doctor. Other medical professionals may be included in the child’s treatment. A nutritionist may evaluate the child’s dietary needs. An occupational or speech therapist may be needed to help with the child’s feeding behaviors and address any sucking or swallowing problems. If there is a disease or disorder causing the problem, specialists such as a cardiologist, neurologist, or gastroenterologist may also be part of the child’s treatment plan.

Proper eating will help the child grow at the same rate as other children around the same age. Some of the dietary changes that can be made include:

  • Learning to mix formula properly
  • Learning to eat several small meals per day
  • Boosting the calories of healthy foods
  • Limiting sweetened beverages
  • Establishing feeding/meal schedule
  • Addressing behavioral issues such as refusal to eat certain foods

Our registered and licensed dietitians have experience in helping with this diagnosis. Please call (865) 546-3998.