Failure to Thrive (Growth Faltering)
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
Quick Answer: What is failure to thrive?
Failure to thrive, or growth faltering, is a condition in which a child's weight or height gain is significantly below the expected rate for their age and gender. It typically results from inadequate calorie intake, poor nutrient absorption or increased energy needs [1] [2]. Pediatricians use standardized growth charts to identify it and work with families on nutritional strategies [1] [2].
What the research says
Early growth faltering is linked to small, lasting differences in thinking skills. A meta-analysis of controlled studies in which children were identified in primary care (502 children with failure to thrive and 523 comparison children) found an average IQ about 4.2 points lower (95% CI 2 to 6) in older children (Corbett & Drewett, Journal of Child Psychology and Psychiatry, 2004) [3].
The first weeks of life appear to matter most. Among 5,771 children in the Avon Longitudinal Study of Parents and Children, weight faltering between birth and 9 months was linked to a total IQ 2.71 points lower at age 8 (about 0.17 standard deviations), and the critical period was birth to 8 weeks (Emond et al., Pediatrics, 2007) [4].
Early support can soften some of the effects. In a study of 130 infants with failure to thrive (randomized to clinic care with or without home visits) and 119 with adequate growth, early failure to thrive raised the risk of short stature, poor arithmetic performance and poor work habits at age 8. Children who also received home visits had fewer teacher-reported internalizing problems and better work habits than those who received clinic care only (Black et al., Pediatrics, 2007) [5].
Key Takeaways
Understanding Growth Faltering
Failure to thrive, now widely known in the medical community as "growth faltering," is a term used to describe a child who is not growing at the expected rate [1]. This can affect infants, toddlers, and older children alike. It is important to understand that this term is a clinical observation of growth patterns rather than a judgment on parenting.
The core of the issue is a lack of sufficient nutrients to support the body's energy needs. This imbalance can occur for three primary reasons: not enough calories are consumed, the body cannot absorb the calories it receives, or the body is burning through calories faster than normal due to an underlying illness [1] [2].
Common Causes of Slower Growth
Identifying the root cause of growth faltering is the first step toward recovery. These causes are generally grouped into three categories:
1. Inadequate Caloric Intake
This is the most frequent cause of growth faltering [1] [2]. For infants, it may stem from difficulties with breastfeeding, such as a low milk supply or latch issues [1]. In older children, it might be related to avoidant/restrictive food intake disorder (ARFID) or environmental factors like food insecurity, which affects up to 14% of U.S. households [1].
2. Nutrient Absorption Issues
Sometimes a child consumes enough calories, but their body cannot process them. Conditions that affect the digestive tract, such as Celiac disease, cystic fibrosis, or milk protein allergies, can prevent the body from utilizing the nutrients it receives [1] [2].
3. Increased Metabolic Demand
Certain medical conditions force the body to use energy much faster than expected. Children with congenital heart disease, chronic lung disorders, or hyperthyroidism may require significantly more calories just to maintain basic bodily functions and growth [1] [2].
Recognizing the Signs
Parents may not always notice a change in growth day-to-day, but certain signs may indicate that a child is struggling to thrive:
Weight and Height: A lack of expected weight gain or growth in height over several months [1].
Energy Levels: Unusual sleepiness, lethargy, or falling asleep during feedings [1].
Behavioral Changes: Excessive crying or a lack of typical social interactions, such as mimicking facial expressions [1].
Feeding Struggles: Persistent coughing, gagging, or arching the back during meals [1].
Diagnosis and Professional Evaluation
Pediatricians diagnose growth faltering by plotting a child's measurements on standardized growth charts [1] [2]. These charts provide a baseline for what is considered typical growth for a child's age and gender.
A thorough evaluation includes:
Feeding History: A detailed review of breastfeeding, formula preparation, and solid food intake [1] [2].
Physical Examination: Checking for signs of underlying illness or developmental delays [1] [2].
Social and Family History: Understanding the home environment and any inherited medical conditions that might affect growth [1] [2].
Strategies for Recovery and Support
The goal of treatment is to ensure the child receives the energy they need to thrive. Depending on the cause, strategies may include:
Nutritional Fortification: Adding calorie-dense foods to the diet or fortifying breast milk and formula [1] [2].
Medical Management: Treating any underlying conditions like infections or digestive disorders [1] [2].
Multidisciplinary Care: Working with nutritionists, pediatricians, and specialists to create a tailored growth plan [1] [2].
Early Intervention: Prioritizing treatment during the first two years of life to support critical brain development and prevent long-term complications [1] [2].
Conclusion
Growth faltering is a manageable condition that requires a collaborative approach between parents and healthcare providers. By focusing on nutritional needs and addressing any underlying medical issues, most children can successfully catch up to their growth potential [2] and lead healthy, active lives.
Frequently Asked Questions
What is failure to thrive?
It is when a child grows more slowly than expected for their age.
Is "growth faltering" the same thing?
Yes, it is the preferred modern medical term.
Is it always the parents' fault?
No, most causes are medical or environmental and out of the parents' control.
What is the most common cause?
Not taking in enough calories (inadequate caloric intake).
Can breastfeeding cause this?
Only if there are issues like low supply or a poor latch.
How do I know if my formula is wrong?
Always follow the exact mixing instructions on the label.
What is ARFID?
A restrictive eating disorder where children avoid certain foods.
What is food insecurity?
Limited access to enough nutritious food for an active, healthy life.
Can Celiac disease cause growth issues?
Yes, it prevents the absorption of nutrients.
How does cystic fibrosis affect growth?
It makes it harder for the body to digest fats and proteins.
What is metabolic demand?
The amount of energy the body needs to function.
Can heart disease affect growth?
Yes, the body uses more energy to pump blood, leaving less for growth.
What are the signs of growth faltering?
Slow weight gain, lethargy, and lack of social interaction.
Why is my baby falling asleep during feeds?
This can be a sign of low energy due to malnutrition.
How do doctors diagnose this?
By using standardized growth charts.
What is a growth chart?
A tool that compares a child's growth to others of the same age.
Can a child catch up?
Yes, most children catch up with proper nutritional support.
What are the complications of untreated FTT?
Lower scores on thinking and learning tests, shorter height, and school or behavior difficulties.
Why are the first two years so important?
This is a critical period for brain development.
Can FTT cause infections?
Yes, malnutrition can weaken the immune system.
What is fortifying milk?
Adding extra nutrients or calories to breast milk or formula.
What are calorie-dense foods?
Foods that have a high number of calories per gram.
Do I need to see a specialist?
Your pediatrician may refer you to a nutritionist or gastroenterologist.
Can FTT be caused by lead poisoning?
Yes, environmental toxins can affect growth.
Is crying a symptom?
Excessive crying can sometimes be a sign of hunger or distress.
How often should my child be weighed?
Your doctor will set a schedule for frequent "weight checks."
Can FTT affect adult health?
Yes, it can increase the risk of cardiovascular disease later in life.
What is pyloric stenosis?
A condition that blocks food from entering the small intestine.
Can milk allergies cause this?
Yes, if they lead to chronic inflammation and poor absorption.
Is FTT common?
Yes, it is a frequent reason for pediatric consultation.
Can FTT be diagnosed at birth?
Usually, it is identified as a pattern over time after birth.
What is "weight faltering"?
Another term for slower than expected weight gain.
Does FTT affect milestones?
Yes, it can lead to delays in sitting, walking, or talking.
Can hyperthyroidism cause FTT?
Yes, by significantly increasing the body's metabolism.
What is an inborn error of metabolism?
A genetic condition that affects how the body processes food.
Can kidney disease affect growth?
Yes, by impacting the body's balance of nutrients and energy.
Is hospitalization necessary?
Only in severe cases or to perform extensive testing.
What should I bring to the doctor?
A log of what and how much your child eats.
Can cultural practices affect growth?
Sometimes, if they limit the types of food a child receives.
Is FTT permanent?
No, with intervention, the growth pattern can be corrected.
Can FTT cause seizures?
In rare, severe cases of malnutrition or metabolic issues.
What is the goal of treatment?
To achieve "catch-up growth."
Can FTT affect social skills?
Yes, malnourished children may interact less with others.
What is a nutritionist's role?
To help create a high-calorie, nutrient-dense meal plan.
Can FTT be caused by HIV?
Yes, chronic infections increase energy needs.
Is FTT related to emotional neglect?
In some cases, but most are medical or nutritional.
What if my child is just "naturally small"?
Growth charts help distinguish between small size and slow growth.
Can FTT cause chronic diarrhea?
Yes, if the cause is a malabsorption disorder.
How long does recovery take?
It varies, but progress is usually seen within weeks of intervention.
Where can I get more help?
Your pediatrician is the best primary resource for support.
Helpful External Resources
Related Reading
References
Cleveland Clinic. Growth Faltering (Formerly Known as Failure To Thrive). Cleveland Clinic. Last updated July 1, 2024. https://my.clevelandclinic.org/health/diseases/failure-to-thrive
Smith AE, Shah M, Badireddy M. Failure to Thrive. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; updated November 12, 2023. PMID 29083644. https://www.ncbi.nlm.nih.gov/books/NBK459287/
Corbett SS, Drewett RF. To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and meta-analysis. Journal of Child Psychology and Psychiatry. 2004;45(3):641-654. PMID 15055382. https://doi.org/10.1111/j.1469-7610.2004.00253.x
Emond AM, Blair PS, Emmett PM, et al. Weight faltering in infancy and IQ levels at 8 years in the Avon Longitudinal Study of Parents and Children. Pediatrics. 2007;120(4):e1051-e1058. PMID 17908725. https://doi.org/10.1542/peds.2006-2295
Black MM, Dubowitz H, Krishnakumar A, et al. Early intervention and recovery among children with failure to thrive: follow-up at age 8. Pediatrics. 2007;120(1):59-69. PMID 17606562. https://doi.org/10.1542/peds.2006-1657
Disclaimer
The information provided in this article is for educational purposes only and should not be considered medical advice. Always consult with a qualified pediatrician for concerns regarding your child's growth and development.
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