Health Library

Failure-to-Thrive

Definition

Failure-to-thrive is when a child is not growing as expected. The child's height and weight is often below that of other children their age.

Causes

Failure-to-thrive is caused by a lack of nutrition. This may be from:
  • Not eating enough food
  • Not absorbing the nutrients from food due to problems such as celiac disease or cystic fibrosis
  • Burning more calories than normal due to problems such as insulin resistance or hyperthyroidism

Risk Factors

This problem is more common in babies who are born very early and those who are born with a low birth weight. Other things that may raise a child's risk are:
  • Birth abnormalities, such as laryngomalacia or congenital heart defects
  • Developmental delay
  • Gastroesophageal reflux disease (GERD)
  • Eosinophilic esophagitis—an allergic disease that causes swelling in the tube that connects the mouth to the stomach
  • Poor oral health, such as cavities
Gastroesophageal Reflux Disease
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Family and social risk factors may be:
  • Financial problems that make it hard to buy food
  • Poor use of feeding methods
  • Family stress
  • Poor parenting skills
  • Post-partum depression
  • Lack of social support for the parent(s)
  • Abuse or violence in the family
  • Substance abuse in the parent(s)
  • Unusual ideas about health or nutrition

Symptoms

The main symptom is slowed growth height and weight growth. Other problems may be:
  • Delayed motor skills, such as late rolling, sitting, crawling, standing, walking, or talking
  • Weakness, low energy
  • Irritability
  • Learning and behavior problems

Diagnosis

You will be asked about your child's symptoms and health history. A physical exam will be done. It will include measurements of height, weight, and body mass. This is often enough to make the diagnosis.
More tests may be done to look for what is causing the problem.

Treatment

Any underlying problems causing failure-to-thrive will be treated. The goal of treatment will be to improve nutrition and boost growth. This can be done with:
  • Diet changes to support growth
  • Using a feeding tube in children with severe symptoms
Family and social support may also be needed. This can be done with parent training and family counseling.

Prevention

The risk of failure-to-thrive may be lowered with regular doctor visits to check for growth problems.

RESOURCES

Family Doctor—American Academy of Family Physicians
http://familydoctor.org
Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca
Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References

Failure to thrive. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/growth/growth/failure%5Fthrive.html. Updated November 2014. Accessed January 10, 2020.
Failure to thrive in children. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/failure-to-thrive-in-children. Updated October 23, 2018. Accessed January 10, 2020.
National Institute for Health and Care Excellence (NICE) guideline on recognition and management of faltering growth. NICE 2017 Sep:NG75.

Revision Information

  • Reviewer: EBSCO Medical Review Board Kari Kassir, MD
  • Review Date: 09/2019
  • Update Date: 08/21/2020