Failure to Thrive

What is failure to thrive?

Failure to thrive is defined as decelerated or arrested physical growth (height and weight measurements fall below the third or fifth percentile, or a downward change in growth across two major growth percentiles) and is associated with abnormal growth and development. The reason for failure to thrive is inadequate nutrition. Previously, failure to thrive was categorized  as either organic (underlying medical condition) or non-organic (no known medical condition). However, this categorization is considered outdated as the causes and effects of malnutrition are usually intertwined in most children.

What causes failure to thrive?

Failure to thrive has many different causes, and sometimes more than one cause may contribute to the condition at the same time. If an infant is not offered enough food or is not willing to eat enough food, or vomits repeatedly (such as with severe gastroesophageal reflux), there will not be enough calories to support growth. A child who is unable to absorb enough calories (such as with severe allergies or a medical condition like cystic fibrosis) will also not grow as expected. Any condition that causes a child to need more calories than normally expected may also lead to failure to thrive.

Who is affected by failure to thrive?

Infants born into families with inadequate support or understanding of infant needs may not provide the right kinds or amounts of food. For example, too much fruit juice, problems breastfeeding, or failure to introduce solids at an appropriate age may lead to too little calories being consumed. Babies and children with developmental delay or problems swallowing may consume too few calories. Conditions such as cystic fibrosis, celiac disease, or severe allergy or intolerance may consume enough food but not be able to absorb it properly. A child with a chronic medical condition, such as congenital heart disease or a genetic syndrome, may need more calories than expected. In severe cases, neglect or abuse may be associated with failure to thrive if food is purposely withheld from a baby. 

What are the symptoms of failure to thrive?

The following are the most common symptoms of failure to thrive. However, each child may experience symptoms differently. Symptoms may include:

  • Lack of appropriate weight gain

  • Irritability

  • Easily fatigued

  • Excessive sleepiness

  • Lack of age-appropriate social response (i.e., smile)

  • Does not make vocal sounds

  • Delayed motor development

  • Learning and behavior difficulties later in childhood

The symptoms of failure to thrive may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is failure to thrive diagnosed?

Failure to thrive is usually discovered and diagnosed by the infant's physician. Infants are always weighed and measured when seen by their physicians for well-baby check-ups. The physician initiates a more complete evaluation when the infant's growth, development, and functioning are found to be delayed.

Treatment for failure to thrive

Specific treatment for failure to thrive will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history

  • Extent of your child's symptoms

  • Cause of the condition

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

The individual issues involved in causing failure to thrive are almost always complex. Treatment depends on the cause of the condition and may involve a team of healthcare providers, including social workers, nutritionists, physical therapists, geneticists, and other specialists.

Next Steps