Failure to Thrive (FTT) in Children

What is failure to thrive in children?

Failure to thrive (FTT) is slow physical development in a baby or child. It’s caused by a baby or child not having enough nutrition. FTT is a clinical observation, not a diagnosis. It is used to describe a baby or child who is less than the 5th percentile for weight for their sex and age. Or it means the child continues to grow more slowly than normal over time.

What causes failure to thrive in a child?

FTT has many possible causes. In some cases, more than one thing may cause it.

A baby or child may not be taking in enough nutrients and calories. This can occur if a baby or child:

• Is not given enough breastmilk, formula, or food

• Has breastfeeding problems

• Is not given solid food at an appropriate age

• Is not willing to eat enough food. This is, usually due to an underlying condition such as heart disease, cancer, HIV, liver disease, chronic lung disease, or kidney disease.

• Vomits food repeatedly, such as from severe gastroesophageal reflux

• Has trouble swallowing

• Has developmental delays that cause feeding problems

A baby or child may take in enough food, but not be able to absorb enough nutrients and calories. This can occur if a child has a problem such as:

• Cystic fibrosis

• Celiac disease

• Severe food allergies or intolerance

A baby or child with a chronic health condition may also need more calories and nutrients than normal. This may be the case with congenital heart disease, chronic infections, metabolic disease, or a genetic syndrome.

In some cases, a family may not have enough support or understanding of what a baby needs. Or they may not provide the right kinds or amounts of food. In severe cases, neglect or abuse may lead to FTT if food is kept from a baby on purpose. 

Which children are at risk for failure to thrive?

A child is more at risk for FTT if their family has problems with poverty, high stress, or parental coping skills.

Babies and children with chronic illnesses are also at risk for FTT.

What are the symptoms of failure to thrive in a child?

Symptoms can occur a bit differently in each baby or child. They can include:

• Not enough weight gain for age

• Low height (or length, if a baby) for age

• Irritability

• Tiredness

• More sleepiness than normal

• Lack of age-appropriate social response, such as smiling

• No vocal sounds

• Delayed physical movement changes (motor development)

• Learning and behavior problems in older children

The symptoms of failure to thrive can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is failure to thrive diagnosed in a child?

Failure to thrive is usually diagnosed by a healthcare provider. Babies are weighed and measured by a healthcare provider during routine checkups. These results are compared with standardized charts for sex and age. The provider will give your child a physical exam. The exam will include checking the baby's growth, development, and functioning. Your baby's provider may also order lab tests to help diagnose the cause of your baby's failure to thrive. In extreme cases, your child may need to stay in the hospital. This is so the provider can evaluate your baby, observe their response to appropriate feeding, and involve a feeding team if other efforts have not worked.

How is failure to thrive treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. And it depends on the cause.                                         

Your child may need to see more than 1 healthcare provider, such as:

• Social worker

• Nutritionist

• Physical therapist

• Geneticist

• Gastroenterologist

The healthcare providers will work with the family to find the cause of FTT, and help the child get more nutrition. This may be done by:

• Boosting the amount of calories the child gets

• Prescribing appetite stimulants

• Treating the condition that's causing FTT

In more severe cases, your child may need supplemental feedings through a nasogastric tube. This is a tube that is put into the nose and then into the stomach. Or the feedings can be done through a gastrostomy tube. This is a tube that is put directly into the stomach through surgery.

What are possible complications of failure to thrive in a child?

A child with FTT is at risk for problems such as:

• Short height

• Behavior problems

• Developmental delays

• Thinking problems

• Problems in school

How can I help prevent failure to thrive in my child?

The problem can be prevented by seeking early help with a child’s nutritional needs.

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about failure to thrive in children

• FTT is slow physical development in a baby or child. It’s caused by a baby or child not having enough nutrition.

• A child with FTT is at risk for problems such as short height, behavior problems, and developmental delays.

• FTT has many possible causes. A baby or child may not be getting enough nutrients and calories. Or a baby or child may take in enough food, but not be able to absorb enough nutrients and calories.

• A baby or child with a chronic health condition may also need more calories and nutrients than normal.

• In some cases, a family may not understand what a baby needs. In severe cases, neglect or abuse may lead to FTT if food is kept from a baby on purpose. 

• FTT can be prevented by seeking early help with a child’s nutritional needs.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.