Definition

Failure-to-thrive is when a child is not growing as expected. It does not include children who are small for their age. Definitions of failure-to-thrive may vary.

Children grow quickly in the first few years of life. A child with failure-to-thrive will usually have a height and weight that is well below other children of their age. Your child may have also had a normal growth pattern that began to slow down. Initially, the child has similar height and weight than their peers but at follow-up appointments the child’s height and weight does not keep up with their peers.

Growth is assessed at health visits by measuring height, weight, and head circumference. This information is entered into a growth chart, which makes a line or curve that follows how your child grows. Standard curve lines on the chart called percentiles show where babies fall in terms of normal growth compared to other babies at specific ages. Failure-to-thrive can occur when a child:

• Is at or below the third to fifth percentile for height and weight.
• Has failed to grow as expected. This is shown by crossing 2 percentile lines on the growth chart.

Failure-to-thrive is split into 3 different types. These types include:

• Organic—caused by some medical condition
• Nonorganic—occurs in children with no known medical condition
• Mixed—occurs when the child has features of both

Causes

Failure-to-thrive is caused by a lack of nutrition. The most common causes of lack of nutrition include:

• Inadequate food intake
• Malabsorption—inability of the intestines to properly absorb nutrients from food
• Loss of nutrients, which may occur from excessive vomiting or diarrhea
• Inability to process nutrients correctly
• Increased energy expenditure

Risk Factors

Failure-to-thrive is more common in boys. Many factors may contribute to an increased chance of developing failure-to-thrive in children, including:

Medical conditions:

• Genetic disorders, such as cystic fibrosis, Down Syndrome, or Turner syndrome
• Physical defects, such as cleft lip or palate which interfere with feeding
• Gastrointestinal diseases, such as:
  • Reflux
  • Hirschsprung’s disease
  • Crohn’s disease
  • Hepatitis or cirrhosis
  • Pancreatic insufficiency, which may be caused by cystic fibrosis
• Chronic or untreated urinary tract infections
• Kidney failure
• Undiagnosed food intolerance
• Heart and lung diseases, such as:
  • Heart failure
  • Severe or uncontrolled asthma
  • Congenital heart or lung defects
• Endocrine diseases, such as diabetes, or thyroid or pituitary gland disorders
• Chronic or congenital infectious diseases such as HIV or toxoplasmosis
• Fetal alcohol syndrome
• Lead poisoning

Family and social factors may include:

• Reduced availability of food
• Giving non-nutritious foods
• Withholding food
• Breastfeeding difficulties
• Depression in the parent
• Lack of knowledge about proper nutrition and typical child growth patterns
• Parent and child interaction or attachment problems
• Lack of social support for the parent(s)
• Severe family stress
• Child abuse or neglect

Symptoms

Failure-to-thrive may cause:

• Slowed growth in a young child, including height and weight
• Slowed development, including late rolling, sitting, crawling, standing, walking, and talking
• Small muscles
• Weakness, low energy
• Hair loss
• Loose folds of skin
• Other symptoms related to an underlying medical condition

Diagnosis

Failure-to-thrive is diagnosed based on following a child’s growth. Your child’s weight, height, and head circumference will be plotted on standard growth charts. If the child falls below a certain weight range or crosses 2 lines on the growth chart, the doctor will evaluate the child further.

Based on your child’s symptoms, additional tests may be ordered.

Rarely, a child must be hospitalized for a period of time to find the cause of failure-to-thrive. During this time, the doctor will:

• Monitor the relationship between parent and child, paying particular attention to their behavior around feeding
• Set up a feeding schedule with an adequate amount of calories
• Make sure that an appropriate feeding technique is used

This will also be done in an outpatient setting and often require referrals to feeding specialists.

If your child can gain weight under these circumstances and no underlying disease is found, this supports the diagnosis of nonorganic failure-to-thrive.

Treatment

Talk with your child’s doctor about the best treatment plan. Treatment will depend on what is causing your child’s failure-to-thrive. Options may include:

Prevention

To help reduce your child’s chance of developing failure-to-thrive:

• Take your children to the doctor regularly to have their growth checked. This helps detect and treat failure-to-thrive before it becomes severe.
• Develop a good relationship with your child’s doctor.
• Ask the doctor about proper parenting and nutrition for early in a baby’s life.

Healthychildren.org—American Academy of Pediatrics http://www.healthychildren.org

Public Health Agency of Canada http://www.phac-aspc.gc.ca

Failure to thrive in children. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated August 5, 2013. Accessed September 14, 2015.

Krugman S, Dubowitz H. Failure to thrive. Am Fam Physician. 2003 Sep 1;68(5):879-884.

Needlman, R. Failure to thrive: parental neglect or well-meaning ignorance? Am Fam Physician. 2001;63(9):1867-1869.

8/7/2013 DynaMed’s Systematic Literature Surveillance.
http://www.ebscohost.com/dynamed:
Bocca-Tjeertes IF, van Buuren S, et al. Growth of preterm and full-term children aged 0-4 years: integrating median growth and variability in growth charts. J Pediatr. 2012 Sep;161(3):460-465.