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.
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 conditionNonorganic—occurs in children with no known medical conditionMixed—occurs when the child has features of both
Failure-to-thrive is caused by a lack of nutrition. The most common causes of lack of nutrition include: Inadequate food intakeMalabsorption—inability of the intestines to properly absorb nutrients from foodLoss of nutrients, which may occur from excessive vomiting or diarrheaInability to process nutrients correctlyIncreased energy expenditure
Failure-to-thrive is more common in boys. Many factors may contribute to an increased chance of developing failure-to-thrive in children, including:
Genetic disorders, such as
cystic fibrosis, Down Syndrome, or Turner syndrome
Physical defects, such as
palate which interfere with feeding
Gastrointestinal diseases, such as:
RefluxHirschsprung's diseaseCrohn's diseaseHepatitis
Pancreatic insufficiency, which may be caused by
Chronic or untreated
urinary tract infectionsKidney failureUndiagnosed food intolerance
Heart and lung diseases, such as:
Severe or uncontrolled
asthmaCongenital heart or lung defects
Endocrine diseases, such as
diabetes, or thyroid or pituitary gland disorders
Chronic or congenital infectious diseases such as HIV or toxoplasmosisFetal alcohol syndromeLead poisoning
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Family and social factors may include: Reduced availability of foodGiving non-nutritious foodsWithholding foodBreastfeeding difficultiesDepression
in the parent
Lack of knowledge about proper nutrition and typical child growth patternsParent and child interaction or attachment problemsLack of social support for the parent(s)Severe family stressChild abuse or neglect
Failure-to-thrive may cause: Slowed growth in a young child, including height and weightSlowed development, including late rolling, sitting, crawling, standing, walking, and talkingSmall musclesWeakness, low energyHair lossLoose folds of skinOther symptoms related to an underlying medical condition
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 feedingSet up a feeding schedule with an adequate amount of caloriesMake 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.
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 the underlying medical condition may correct failure-to-thrive.
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.
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: 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.
Failure to thrive. Nemours Kid's Health website. Available at:
http://kidshealth.org/parent/growth/growth/failure_thrive.html. Updated November 2014. Accessed September 14, 2015.
Krugman S, Dubowitz H. Failure to thrive.
Am Fam Physician. 2003 Sep 1;68(5):879-884.
Failure to thrive: parental neglect or well-meaning ignorance?
Am Fam Physician. 2001;63(9):1867-1869.
Last reviewed September 2015 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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