Failure to Thrive

Hearing the doctor say that your child has “failure to thrive” can be frightening. There are many reasons why an infant, child or adolescent may have failure to thrive. The gastroenterology team at CHOC Children’s includes pediatric gastroenterologists, as well as a dedicated dietitian and psychologist, who work with patients and their families to diagnose the underlying cause of a child’s failure to thrive and get them back on the road to proper nutrition and development.

Failure to thrive is defined as slowed or halted (stopped) physical growth (with height and weight measurements falling below the third or fifth percentile or a downward change in growth across two major growth percentiles). The reason for failure to thrive is not getting enough nutrition. Although failure to thrive is usually thought of as something that happens only to babies, it can also happen to children and adolescents.

What causes failure to thrive?

Failure to thrive has many different causes, and sometimes more than one cause may contribute to the condition at the same time. If an infant is not offered enough food, is not willing to eat enough food, or vomits repeatedly (such as with severe gastroesophageal reflux), there will not be enough calories to support growth. A child who is unable to absorb enough calories (such as with severe allergies or a medical condition like cystic fibrosis) will also not grow as expected. Any condition that causes a child to need more calories than normally expected may also lead to failure to thrive.

Who is at risk for failure to thrive?

There are different reasons an infant, child or adolescent may have failure to thrive:

Infants, children and adolescents who are not provided with the right nutrition. Infants born into families who do not understand the nutritional needs of an infant may not provide the right kinds or amounts of food. For example, too much fruit juice, problems breastfeeding or not introducing solids at the right age may lead to a child not getting enough calories.

Some children and adolescents may suffer from inadequate nutrition due to economic problems that affect their living conditions and access to nutritious or enough food. In extreme cases, poor habits like eating in front of the television, no formal meal times or parents not keeping up on their children’s food intake can also lead to failure to thrive.

Infants and children who are developmentally delayed or have swallowing problems. Some babies and children with developmental delays may struggle with the process of eating and thus not consume enough calories. Swallowing problems (which may be caused by prematurity, being introduced to eating and swallowing late because of health problems early in life, or other medical problems) can make it difficult for babies and children to consume enough calories as well. Learn more about swallowing problems in children.

Infants, children and adolescents with certain medical conditions. Conditions such as cystic fibrosis, celiac disease, inflammatory bowel disease, short bowel disease, or severe food allergy or intolerance may consume enough food but not be able to absorb it properly. A child with a chronic medical condition, such as congenital heart disease or a genetic syndrome, may need more calories than expected.

Children and adolescents exposed to toxins, infections or parasites. These can potentially affect appetite and the absorption of nutrients.

Infants, children or adolescents who are neglected or abused. In severe cases, neglect or abuse may be associated with failure to thrive if food is purposely withheld from a child.

Children and adolescents with certain psychosocial problems. Eating disorders, anxiety problems and depression can all affect a patient’s willingness to eat an appropriate diet.

What are the symptoms of failure to thrive?

The following are the most common symptoms of failure to thrive. However, each child may experience symptoms differently. Symptoms may include:

The symptoms of failure to thrive may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

How is failure to thrive diagnosed?

Failure to thrive is usually discovered and diagnosed by your child’s physician. Infants are always weighed and measured when seen by their physicians for well-baby checkups. Your child’s physician may start a more complete evaluation if your child’s growth, development and functioning seem delayed. Pediatricians also look at the overall growth and development of older children and adolescents at regular appointments in order to make sure they are continuing to grow as they should.

How is failure to thrive treated?

Specific treatment for failure to thrive will be determined by your child’s physician based on:

  • The child’s age, overall health and medical history
  • Extent and severity of the child’s symptoms
  • Cause of the condition
  • The child and family’s opinion or preference.

The individual issues involved in causing failure to thrive are almost always complex. Treatment depends on the cause of the condition. At CHOC Children’s, our pediatric gastroenterologists team with each patient’s family, referring physician, as well as our specially trained dietitians, psychologist, physical therapists, geneticists and other specialists in order to develop a treatment plan that is mindful of each patient’s medical, physical, social and emotional needs.

What is a swallowing disorder (dysphagia)?

Children with swallowing disorders (dysphagia) are unable to easily pass food and/or liquids from the mouth, into the throat and down into the esophagus to the stomach during the process of swallowing. Learn more about swallowing disorders and how they are treated at CHOC Children’s.

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