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What is Failure to Thrive?

By the time your baby is four months old, he/she should double his/her birth weight. By the time he/she turns one, body weight should be triple that of birth weight. If your baby or child hasn't gained weight for three months in a row and is having behavioral, developmental or feeding issues, he or she may be suffering from "failure to thrive".

There is no concrete definition for failure to thrive simply because it isn't a disorder or disease. Rather, it is when a child is undernourished and doesn't meet expected standards of age-based weight and height. There are two types of failure to thrive: organic and nonorganic. Organic failure to thrive stems from an underlying medical cause. Nonorganic failure to thrive is also known as psychosocial failure to thrive because there are no known medical issues causing it.

Symptoms of Failure to Thrive

Beyond not reaching weight and height growth standards, children failing to thrive may also:

  • Be irritable
  • Be easily fatigued
  • Exhibit excessive sleepiness
  • Lack age-appropriate social responses
  • Not make vocal sounds
  • Have poor appetite or feeding aversions

Causes of Failure to Thrive

Failure to thrive typically stems from undernourishment which may be caused by a variety of reasons:

  • Not enough food being offered at mealtimes
  • Your child simply doesn’t eat enough
  • Digestive system issues, such as gastroesophageal reflux (GER), chronic diarrhea, cystic fibrosis, chronic liver disease and celiac disease
  • Food intolerance or sensitivity to certain foods
  • An ongoing illness or disorder
  • Infections or parasites
  • Metabolic disorders, which make it hard for the body to break down, process, or take energy from food

A mixture of medical issues and environmental factors can also lead to failure to thrive. If your child has sensitivity to certain foods or suffers from reflux, mealtimes may become stressful for your family and subsequently lead to your child not eating enough food.

Diagnosis of Failure to Thrive

Should you notice any symptoms of failure to thrive in your child, call your doctor for an appointment. If your doctor determines your child hasn’t been gaining weight or is exhibiting behavioral issues, he or she may ask for a complete health history including feeding history. Your doctor may also order blood and/or urine tests.

Treatment of Failure to Thrive

There is no clear time line for treatment; it may take several months for your child to get back into a healthy weight range. However, treatment can typically be done at home with regular doctor’s visits. A care team may be assembled to help you and your child begin to thrive. Care teams can include:

  • Primary care physician or pediatrician
  • Specialists (such as a cardiologist, neurologist, or gastroenterologist​) to treat underlying health conditions
  • Registered dietician
  • Occupational therapist (to help develop successful feeding and eating habits)
  • Speech therapist (if necessary, to help with sucking or swallowing issues)
  • Psychologist (if necessary, to aid with behavioral issues)
  • Social worker (if there is a struggle to get enough food for the family)

Some more severe cases may require hospitalization and/or temporary tube feedings. All the interventions for failure to thrive are to help your child to have healthy growth and development.

Pediatric Gastroenterology