Failure-to-Thrive

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:

  • 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

  • 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 two percentile lines on the growth chart.

    Failure-to-thrive is split into three 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

  • Diagnosis

    Failure-to-thrive is diagnosed based on following a child's growth. The doctor will plot your child's weight, height, and head circumference 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, the doctor will order further tests.

    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.

  • 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.

  • 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 parent
    • 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

  • 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: