by Rosalyn Carson-DeWitt, MD
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:
Failure-to-thrive is split into three different types. These types include:
Failure-to-thrive is caused by a lack of nutrition. The most common causes of lack of nutrition include:
Risk Factors TOP
Failure-to-thrive is more common in boys. Many factors may contribute to an increased chance of developing failure-to-thrive in children, including:
Family and social factors may include:
Failure-to-thrive may cause:
Failure-to-thrive is diagnosed based on following a child's growth. Your child's weight, height, and head circumference will be potted on standard growth charts. If the child falls below a certain weight range or crosses two 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:
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.
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:
Treating a Medical Condition
Treating the underlying medical condition may correct failure-to-thrive.
Providing Extra Calories
Children who are malnourished may need a dietary supplement. These may include Ensure/PediaSure, milk fortifiers, and other ways to add calories to food. They help improve nutrition and boost growth.
Parent Training TOP
When a child is hospitalized for diagnosis, the hospital staff can also provide treatment. Nurses can teach parents appropriate feeding techniques. They may also show how to best interact with their child. If the child isn't hospitalized, parents can still have training sessions with a nutritionist or a nurse.
Parents and children who are having difficulty with their relationship may benefit from counseling.
To help reduce your child's chance of developing failure-to-thrive:
FamilyDoctor.org—American Academy of Family Physicians
Healthychildren.org—American Academy of Pediatrics
About Kids Health—The Hospital for Sick Children
Public Health Agency of Canada
Failure to thrive. Nemours Kid's Health website. Available at:
...(Click grey area to select URL)
Updated August 2011. Accessed September 24, 2014.
Failure to thrive in children. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated August 5, 2013. Accessed September 24, 2014.
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. https://dynamed.ebscohost.com/about/about-us: 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.
Last reviewed August 2014 by Kari Kassir, MD
Last Updated: 9/24/2014