Failure to Thrive (FTT)

May 3, 2022

Failure to thrive (FTT) or poor weight gain refers to a condition in which an infant or child does not gain weight at the expected standard of growth. Failure to thrive is not a disease, but rather a sign that a child is undernourished. Failure to thrive is usually the result of one of three main categories:

Failure To Thrive (FTT), or poor weight gain

  • Inadequate nutritional intake
  • Inadequate caloric absorption
  • Excessive caloric expenditure

Because failure to thrive typically occurs in infants and toddlers, it is important to address quickly, as this is a crucial time in brain development. Poor or inadequate nutrition can have permanent negative effects if not corrected. Regularly scheduled well-check appointments with your doctor are the first line of defense against failure to thrive.

Inadequate Caloric Absorption

Failure to thrive can occur if a child is unable to utilize the nutrition being given. Health conditions that can prevent a child from gaining weight include:

  • Vomiting from acid reflux or food allergies
  • Food intolerance
  • Celiac disease
  • Inflammatory bowel disease
  • Cystic Fibrosis
  • Intestinal infection
  • Chronic diarrhea
  • Metabolic disorders
  • Protein-losing enteropathy
  • Gastrointestinal malformation
  • Chronic liver disease
  • If a child has a condition that causes the malabsorption of calories, the result can be failure to thrive. In some cases, a combination of medical problems and environmental factors, such as a reluctance to eat due to anxiety, causes failure to thrive.

Inadequate Nutritional Intake

Inadequate nutritional intake is the most common reason for failure to thrive. Parents can sometimes mistakenly give too little food if concerned with weight or if the baby is a fussy eater. Depending on the age of the child, failure to thrive can be a result of:

  • Breastfeeding difficulties (low milk supply or latching problems)
  • Improper preparation of formula
  • Difficulty transitioning to solid foods
  • Restricted diet
  • Behavioral feeding issues
  • Gastroesophageal reflux
  • Physical abnormalities of the mouth
  • Poor economic conditions (lack of food availability)
  • In older children, mood or eating disorders and irritable bowel syndrome can be contributors, as well.
failure to thrive growth chart

Excessive Caloric Expenditure

Excessive caloric expenditure is generally a concern for children who have a history of:

  • Chronic infections
  • Congenital heart disease
  • Chronic lung disease
  • Hyperthyroidism
  • Prematurity

Some infections force the body to use nutrients more quickly while decreasing appetite. Other conditions cause a natural excessive expenditure of calories, making it difficult for the child to keep up with the required calorie intake. Most cases of failure to thrive caused by excessive caloric expenditure develop within the first 2 months after birth.

Diagnosing Failure to Thrive

In order to diagnose failure to thrive, a parent should keep a log of measurements of their child’s body. This log should include accurate information about the child’s:

  • weight
  • height (length)
  • head circumference

over a period of time. This account may aid your doctor in diagnosing failure to thrive in a child.

While some children may have other factors contributing to low weight, such as small parents, or premature birth, any child who meets the failure to thrive criteria should be monitored closely. If an underlying medical problem is suspected, your doctor may order other diagnostic tests.

Treatment for Failure to Thrive

Treating failure to thrive may vary from case to case. Treatment may involve a regiment of nutritional counseling for catch-up growth. Some treatment possibilities may include:

  • More frequent breastfeeding
  • Lactation support
  • Formula supplementation
  • Adjusting formula concentration
  • Consumption of higher-calorie foods
  • Nutritional supplements

In severe cases, a child may require a nighttime feeding tube to administer liquid nutrients, or sometimes, hospitalization. The large goal of treatment is to provide nutrition for the child to promote long-term growth and development while providing parental support in any forms necessary.