Failure to Thrive 

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 For many parents, the term failure to thrive is a scary one, conjuring images of sickly children who are not growing or meeting milestones as expected.

It is a term that causes fear and sometimes anger towards the person mentioning the term. I once had a parent say to me “No, she’s not! That’s a terrible thing to call a baby!  Look at her, she’s babbling and laughing, she’s thriving beautifully. I think you medical people are horrible, to tell a mother her child is not thriving!” This mother was very upset at the mention of the diagnosis. Nobody had ever explained it’s meaning to her, and after a rocky course in the NICU she was very defensive of how far her baby had come, and didn’t want to hear that her journey was not yet over. 

I realize the term may be scary to hear, but let’s go over what Failure to Thrive really means in the medical world. The Handbook of Pediatric Nutrition, 3rd edition says “Failure to thrive is defined as a serious condition of under nutrition and poor growth usually identified in the first 3 years of life”.This diagnosis by itself does not indicate your child is not meeting developmental milestones, it simply means she is not gaining weight the way we would like them to, and in most cases she is dropping off the child growth chart.

So why wouldn’t a child gain weight adequately? One reason could be due to an underlying medical condition that causes inadequate intake, absorption of utilization of nutrients. In other words, a condition where your child cannot eat enough or is unable to properly use the nutrients she has eaten. This is referred to as Organic failure to thrive (OFTT).

Among other possible conditions, failure to thrive is one of the specific symptoms of non-celiac gluten intolerance and especially of celiac disease. Nonorganic FTT suggests an outside influence, either social or behavioral that leads to inadequate weight gain because they either refuse or are not offered adequate amounts of food. Many children with FTT present with both physiologic and psychosocial conditions that inhibit growth.

Criteria for the diagnosis of Failure to Thrive (FTT) are as follows:

1. Growth below a specified percentile on a child growth chart:

   a. Weight for age plotting less than 5th percentile in the absence of a delay.

    b. Weight for height plotting less than the 5th percentile.

 2. Poor growth velocity

   a. Decreased growth where weight drops greater than 2 percentiles over 3-6 months.

If you are confused or do not know what a growth chart is or how it relates to your child, speak to your doctor or click on the link above.

toddler girl eating

What can you do if your child has been diagnosed with FTT?

Well, first you need to evaluate your child’s diet and make sure they are getting enough calories to promote growth. Now is a good time to make an appointment with us or meet with a pediatric dietitian near you. We can evaluate and analyze your child’s diet and give you suggestions based on the results. If you find your child is not eating enough to gain weight and you do not feel it is organic, you need to begin giving them higher calorie foods. If they are picky eaters and will not change what they eat, you may want to start adding calories to the foods they will currently accept.

If you feel your child’s lack of weight gain has an organic cause and you have evaluated her diet and discovered she is receiving adequate calories and should be gaining weight, you should get your child evaluated to find out what the underlying problem is. Dietary intervention may still be the primary treatment, but different types of diets are recommended for different conditions. Besides this, if your child has a problem you need to know about it to begin other treatments besides dietary modifications.

While you are investigating and testing your child for an underlying cause for her lack of weight gain however, you should start giving her additional calories. Also consider adding a supplement or high calorie supplement. 


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