Failure to Thrive (FTT)

What is Failure to Thrive (FTT)?

Failure to thrive (FTT) is a term that is traditionally used for children who have failed to develop and grow normally. In general practice, FTT is commonly used for any child who fails to gain weight or height according to standard medical growth charts. FTT occurs when a child is either not receiving adequate calories or is unable to properly use the calories that are given, resulting in failure to grow or gain weight over a period of time.

Using standard growth charts, a child’s weight or height below the 3rd percentile for age or a progressive decrease in the rate of gain of height or weight would be considered as FTT. Copy adapted with permission from NASPGHAN, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

About 1% of all children admitted to any hospital and 3 to 5% of all children admitted to a Children’s Hospital have failure to thrive.

What Causes FTT?

Some children develop failure to thrive because of an underlying medical condition. This is referred to as Organic FTT. Organic FTT refers to growth failure that is due to an acute or chronic medical condition that interferes with normal food intake, absorption or digestion of food, or is due to increased calorie need to keep up or help growth.

Most babies with FTT do not have a specific underlying disease or medical condition to account for their growth failure. This is referred to as Non-organic FTT. Up to 80% of all children with FTT have Non-organic type FTT. Non-organic FTT most commonly occurs when there is inadequate food intake or there is a lack of environmental stimuli.

Examples of non-organic FTT include lack of food intake due to an inability to afford an appropriate formula, problems with feeding techniques, improperly prepared formula (over-diluting the formula), or an inadequate supply of breast milk (due to the mother being exhausted, under stress or in a poor nutritional state).

How Is FTT Diagnosed?

Weight is the best indicator of nutritional status and you child’s weight should be monitored at each clinic visit. Obtaining your child’s height is also important; however a single measurement of height is less valuable for the diagnosis of FTT than several height measurements over time (linear growth). Linear growth may be affected in children with malnutrition, but this usually indicates a prolonged period of poor nutrition.

Most children with non-organic FTT present with growth failure in the first year of life and usually come to medical attention by 6 months of age. In children with organic FTT, the time of presentation is more variable and is dependent on the child’s underlying medical condition.

When FTT is recognized, your doctor will talk with you about your child’s symptoms, obtain a dietary history and perform a physical examination.

Your child's doctor may request that you provide food records for your child and will likely involve a dietician to assess your child’s food and nutrition needs. Often, as a first step, an appropriate diet will be instituted with the help of a dietician to make certain that adequate calories are provided to allow for “catch-up” growth for your child. In the event of difficulties with breast feeding, a lactation specialist may be asked to help. It may be necessary to involve other specialists to assess the developmental stage of your child and/or your child’s feeding skills.

If your child continues to have FTT, your physician may proceed with further investigation. Your physician will often tailor any blood tests or other laboratory studies according to your child’s symptoms, physical findings and response to initial therapy. Sometimes an infant or child with failure to thrive will be hospitalized for observation to help determine the nature of the problem and to begin dietary therapy.

How Is FTT Treated?

Treatment of failure to thrive depends upon the age of the child, the associated symptoms and the underlying reason for the poor growth. The overall goal of treatment is to provide adequate calories and any other support necessary to promote the growth of your child.

In the event of your child having organic failure to thrive, additional therapy may be needed to treate the underlying medical condition. For example, intestinal disorders may cause poor absorption (malabsorption) of the diet and lead to failure to thrive. In this instance, a special diet may be necessary.

Failure to thrive may also develop in twins or triplets, simply because multiple births are more difficult to care for and more demanding to feed. A baby born prematurely is more likely to have failure to thrive because many of the body functions necessary for the proper ingestion and digestion of the diet are immature at birth. Lung problems or heart disease, especially in very young infants, can make feedings more difficult and lead to poor calorie intake and failure to thrive.

You should call your child's health care provider if any of the following occur:

  • Increased amounts of vomiting or persistent projectile (forceful) vomiting.

  • Vomiting of fluid that is green in color, or looks like coffee grounds or blood.

  • If your child experiences any difficulty breathing associated with the vomiting or spitting.

  • Pain related to eating, or food refusal causing weight loss or poor weight gain.

  • If your child develops trouble swallowing or painful swallowing.