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  3. Failure to Thrive

Failure to Thrive

  1. What is failure to thrive?
  2. Causes
  3. Symptoms
  4. Diagnosis
  5. Treatment
  6. Prevention
  7. Prognosis
  8. Other names for failure to thrive

What is 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 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 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. 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.

Causes of failure to thrive

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

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

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

Social and environmental factors

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]

Symptoms of failure to thrive

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.

Failure to thrive diagnosis

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.

Failure to thrive treatment

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 counselling 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.

Prevention of failure to thrive

Regular check ups 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.

Failure to thrive prognosis

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]

Other names for failure to thrive

  • Poor infant growth

  1. MSD Manual. “Failure to Thrive.” Accessed May 14, 2018.

  2. MedlinePlus. “Failure to thrive.” May 9, 2017. Accessed May 14, 2018.

  3. Stanford Children’s Health. “Failure to Thrive.” Accessed May 15, 2018.