Failure to Thrive

Failure to thrive (FTT) is defined as a delay in physical growth and weight gain in babies and children. As children mature, they are normally carefully monitored by doctors to ensure that they are growing at a healthy rate.

Percentiles are used to compare children of the same age and sex. If a child is said to be in the tenth percentile, for example, it means that out of 100 children, 90 children weigh more and 10 weigh less than or the same as the child of interest.

A diagnosis of failure to thrive is generally given to children who consistently register as being below the third to fifth percentiles, though this can differ from country to country. If a child dramatically falls from one percentile to another, from the 70th percentile to the 30th, for example, this may also be diagnosed as failure to thrive, even if their weight is not significantly low. 1

The causes of failure to thrive are often complex, with medical disorders, as well as environmental and social factors, all playing a role. There is no specific treatment for the condition. Instead, the underlying causes will be considered and doctors and other medical professionals will outline a management plan based on this.

Although failure to thrive is most common in babies and children, it can also occur in elderly people, with symptoms including weight loss, frailty and loss of appetite. Management, as with children, typically involves addressing the underlying set of causes.

The basic cause of failure to thrive is a child not receiving, or being unable to retain and absorb, the necessary amount of calories and nutrients needed to support healthy growth. The reasons behind this failure are numerous, and more than one factor may play a role simultaneously. There are, however, two broad reasons why failure to thrive occurs: medical disorders and social/environmental factors.

Medical disorders that may contribute to a failure to thrive include: 1 2

• Problems chewing or swallowing caused by a cleft palate for example
• Gastrointestinal problems
• Brain or nervous system damage
• Heart or lung problems
• Genetic problems, such as Down syndrome
• Hormone problems
• Metabolic disorders, such as diabetes or cystic fibrosis
• Blood disorders, such as anemia
• Chronic infections, such as HIV

Social and environmental factors as to why a child does not receive sufficient nutrition can include poverty, parental neglect or abuse, and parental mental health issues. Parents may also feed their child food lacking in sufficient nutrients or not be aware of how to properly prepare food and formula. Social and environmental factors are the most common cause of failure to thrive. 1

The symptoms experienced as a result of failure to thrive depend on the severity and the underlying cause or causes of the condition. However, the key symptom of the condition is a child not developing and growing normally as compared to children of the same age and sex.

Symptoms of failure to thrive include: 2 3

• Height, weight and head circumference which do not match with standard growth charts
• Weight which consistently falls below the third to fifth percentile
• Growth which has stopped or slowed significantly
• Physical skills which do not develop as expected, such as standing and walking
• Mental and social skills which do not develop as expected
• Constipation
• Excessive crying
• Excessive sleepiness
• Irritability

Children may not experience all the possible symptoms of failure to thrive.

Diagnosis is usually made by a child health nurse or pediatrician following routine check-ups, during which weight, height and head circumference measurements are taken. The parents may also be asked about feeding routines and any issues that may be affecting the child’s access to proper nutrition, as well as about the family’s medical history. If there are signs that a child is failing to thrive, further tests may be undertaken to investigate and diagnose the underlying causes.

The treatment of failure to thrive depends on the underlying cause. If the condition is the result of an underlying medical disorder, treatment will be aimed at remedying or managing this condition.

If social and environmental factors are the cause, parental counseling and support may be recommended. The aim of this is to educate the parents about proper nutrition and to help find solutions to any financial and/or emotional issues that may be present. A meal plan may also be devised for the child to ensure that they receive the calories and nutrition needed.

In cases of severe failure to thrive, a child may be admitted to hospital where a team of doctors, pediatricians, nutritionists and social workers, among other professionals, will work together to formulate an appropriate treatment plan.

Regular checkups with a child health nurse can help to diagnose failure to thrive early on. Parenting classes or support groups are also a good way to develop ways and habits of improving a child’s nutrition.

If failure to thrive is diagnosed early and appropriate steps are taken to remedy the condition then long-term health problems are unlikely. However, if this does not happen, especially if the child is in their first year of life – a period critical to development – they may experience long-term mental developmental difficulties affecting their verbal and mathematical skills, as well as their behavioral, social and emotional abilities. 1

Although failure to thrive is most commonly associated with infants and children, the condition can also be diagnosed in elderly people. 4 There is no widely agreed definition of FTT in elderly people, but it is generally described as a syndrome involving: ref4

• Weight loss
• Loss of appetite
• Poor nutrition
• Frailty
• Inactivity
• Dehydration
• Depression
• Immune dysfunction
• Low cholesterol

Failure to thrive in elderly people is caused by a combination of factors, including the process of aging, as well as social circumstances, such as social isolation, lack of support and low socioeconomic status.

Treatment generally involves managing the underlying set of causes. If you or a loved one is displaying symptoms that may be linked to failure to thrive, try using the free Ada app for a symptom assessment.

• Poor infant growth
• FTT

Q: Can failure to thrive be fatal?
A: Yes, in severe cases, when treatment is not received, failure to thrive can be fatal. This is true of failure to thrive in babies and children, as well as elderly people. Mortality as a result of the condition, however, is unlikely if prompt and appropriate treatment is received.

Q: What is the relationship between failure to thrive and autism?
A: The link between failure to thrive and autism has yet to be fully explored, but there does seem to be a relationship between childhood autism and feeding problems, a common feature of failure to thrive. Babies and infants with autism will not necessarily have FTT and vice versa, but severe feeding problems in very young children should alert doctors to the possibility of autism.

Q: Can failure to thrive cause microcephaly?
A: Yes, failure to thrive can cause microcephaly or a smaller head circumference than normal. Microcephaly may be an indicator to doctors that a baby or child is experiencing failure to thrive. However, some babies or children with microcephaly may experience no other symptoms of failure to thrive.