Failure to Thrive (FTT)

Growth failure in infancy and early childhood

Causes and Characteristics:
o Organic (specific physical cause): examples include anemia, insulin
resistance, renal failure, and uncontrolled asthma
o Nonorganic (not a specific physical cause): economics, ignorance,
poor parenting skills, ongoing family stress. Nonorganic causes are
more common. (Howard, Williams, Miller, & Aiken, 2014)
FTT is characterized by: an infant whose rate of weight gain or current
weight is significantly below that expected of similar children of the same
age, sex and ethnicity (Hendaus & Al-Hammadi, 2013, p. 48).
o Age of onset: FTT symptoms are typically seen during infancy (30
days-12 months old). Concern usually arises when the child is around 3
months of age.

Red Flags:

(Hendaus & Al-Hammadi, 2013)

On growth charts
Symmetric drop in height and weight
1. Infant weight below 3rd percentile
suggests chronic medical condition.
2. Infant weight that drops down two Short stature and sparing of weight
major percentiles
suggests endocrine cause.
rd
3. Infant below 3 percentile on the
Small head size
suggests lack of
weight for length curve
brain growth
Ideal weight for age percentiles found at:
http://www.cdc.gov/growthcharts/html_charts/wtage.htm
Plotting the infants weight, height, and head circumference on a growth
chart is crucial because it will give the clinician an objective of the infants
growth status (Hendaus & Al-Hammadi, 2013, p. 48).

Biological Factors
o Child eats too little (because
of prematurity or a
developmental delay)
o Digestive system problems
o Food intolerance
o Ongoing illness/disorder
(heart/ lung/ endocrine
system condition)
o Infections
o Metabolic disorders
(KidsHealth).

Environmental Factors
Poverty
Abuse
Neglect
Not enough food offered
Lack of understanding of
childs dietary needs
o Lack of emotional bond
between parent and child
o Exposure to parasites and
toxins
o
o
o
o
o

(Childrens Health).

Mild Characteristics:

Severe Characteristics:

Weight loss or lack of weight gain,

growth that has stopped or slowed,
delayed physical, mental, and
social skills.
(Childrens Health).

Severe or prolonged cases of FTT

may also lead to delayed mental
development in the child. It could
cause the child to lose the will to
live, and extreme cases may lead
to death (Howard, Williams, Miller, &
Aiken, 2014).

FTT History
In 1897, L. Emmet Holt first referenced an infant who ceased to thrive in
his book The Diseases of Infancy and Childhood. Holt associated this with
malnutrition, although he recognized it could be related to a variety of
clinical circumstances (Schwartz, 2000, p. 257). Fail to thrive was first used
in the 10th edition of this book in 1933.
What has become known: In the 1960s FTT became synonymous with
parental deprivation syndrome & was entered into the DSM-III as reactive
attachment disorder. Here, biological and environmental causes were made
distinct from one another.

Educational Implications:
Studies have found evidence suggesting relationships between FTT and IQ as
well as FTT and developmental delays. Shown by:
o significant association was found within the cases between severity of
FTT and IQ (Corbett, Drewett, & Wright, 1996).
o on developmental testing (Bayley Developmental Scales) 55% were
delayed, 27% severely (Raynor & Rudolph, 1996).
Professional and Parent-Friendly Resources:
1. http://www.connecticutchildrens.org/healthinfo/parents/growth-anddevelopment/growth/failure-to-thrive
2. https://www.healthychildren.org/English/health-issues/conditions/GlandsGrowth-Disorders/Pages/Failure-to-Thrive.aspx
References
1. Corbett S.S., Drewett R.F., & Wright C.M. (1996). Does a fall down a centile chart matter? The growth
and developmental sequelae of mild failure to thrive. Acta Paediatr, 85(11):1278-1283. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/8955452
2. Childrens Health. (2016). Failure to thrive. Retrieved October 24, 2016, from
https://www.childrens.com/specialties-services/specialty-centers-andprograms/gastroenterology/programs-and-services/general-gastroenterology/failure-to-thrive
3. KidsHealth. (n.d.). Failure to thrive. Retrieved October 24, 2016, from
http://kidshealth.org/en/parents/failure-thrive.html
4. Hendaus, M., & Al-Hammadi, A. (2013). Failure to thrive in infants (review). Georgian Medical News,
(214), 48-54. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23388535
5. Howard, V. F., Williams, B. F., Miller, D., & Aiken, E. (2014). Very young children with special needs: A
foundation for educators, families, and service providers (5th Ed.). Upper Saddle River, NJ: Pearson
Education, Inc.
6. Raynor, P. and Rudolf, M. C. J. (1996), What do we know about children who fail to thrive? Child:
Care, Health and Development, 22: 241250. DOI: 10.1111/j.1365-2214.1996.tb00427.x
7. Schwartz, I. D. (2000). Failure to thrive: an old nemesis in the new millennium. Pediatrics in Review /
American Academy of Pediatrics, 21(8), 257-264. Retrieved from
http://medicine.missouri.edu/childhealth/uploads/failure-to-thrive.pdf