Growth Faltering (Formerly Known as Failure To Thrive)

What is failure to thrive (now known as growth faltering)?

Failure to thrive, now known as growth faltering, means your child is growing more slowly than expected for their age due to malnutrition. This can happen with infants, toddlers and older children. In most cases, growth faltering occurs when a child isn’t taking in enough calories from nutrient-rich sources. Certain medical conditions can also cause a child’s body to require more calories or have trouble absorbing nutrients.

If you hear this called “failure to thrive,” you might feel shocked or upset. You might even feel like you’re at fault. But lots of things can affect your child’s growth, and most of them are out of your control. For this reason, healthcare providers now use the term “growth faltering” instead of failure to thrive. This term emphasizes the medical concern — growth — without suggesting you or your child are somehow failing. “Weight faltering” is another term you might hear.

Your pediatrician will identify what’s causing slower growth and tailor treatment to your child’s needs. Treatment may involve making adjustments to what your child eats — for example, supplementing breastmilk (human milk) with formula, fortifying their milk or adding calorie-dense foods to their plate. Your child’s care team will also manage any underlying conditions affecting your child’s growth.

What is the most common cause of failure to thrive?

Not taking in enough calories is the most common cause of failure to thrive (now known as growth faltering). “Inadequate caloric intake” is a term you might hear a provider use. There are many reasons why your child might not be consuming the calories they need to support their growth. These reasons can vary by age.

Babies might have low caloric intake due to:

• Low milk supply in the nursing parent.
• Latch difficulties that affect how much milk they can remove.
• Formula that’s not prepared right.
• Not taking in enough total milk throughout the day.

Older children might have low caloric intake due to avoidant/restrictive food intake disorder or other eating disorders.

Food insecurity, or limited access to nutritious foods, impacts children of all ages. Food insecurity affects up to 14% of homes in the U.S. This lack of access can lead to a low caloric intake and growth faltering.

What are other causes of growth faltering?

Besides inadequate caloric intake (most common), other causes of growth faltering in children include:

• Inadequate nutrient absorption.
• Increased metabolic demand.

Inadequate nutrient absorption

This means your child’s body doesn’t break down and process nutrients as well as it should. So, it’s not a matter of how many calories they’re taking in — it’s a matter of how their body uses those calories to support their growth.

Many different medical conditions can affect nutrient absorption, including:

• Celiac disease.
• Conditions that affect digestive tract anatomy, including biliary atresia, pyloric stenosis and tracheoesophageal fistula.
• Cystic fibrosis.
• Inflammatory bowel disease.
• Milk protein allergy.

Increased metabolic demand

This means your child’s body needs more calories (energy) than expected in order to function. Examples of medical conditions that can increase your child’s energy needs include:

• Cancer.
• Congenital heart disease.
• Congenital lung disorders.
• HIV.
• Hyperthyroidism.
• Inborn errors of metabolism.
• Kidney disease.
• Tuberculosis.

What are the signs and symptoms of growth faltering (formerly known as failure to thrive) in children?

Signs and symptoms you may notice include your child:

• Not gaining weight as expected.
• Not growing in length or height.
• Crying more than you would expect.
• Sleeping more than you would expect, or even falling asleep during feedings.
• Not interacting with people as they should for their developmental stage (for example, mimicking your facial expression).

You might not know if these are signs of growth faltering, but you may simply feel something isn’t right. If you have concerns about your child, especially if you have problems waking them, call your pediatrician right away.

It’s possible not to notice any changes in your child. Providers sometimes identify growth faltering at a routine checkup when they measure your child’s growth.

What are possible complications of growth faltering in infants?

Growth faltering in infants that goes untreated can cause:

• Infections.
• Changes in brain development that lead to intellectual disability.
• Chronic conditions as an adult, like cardiovascular disease and metabolic syndrome.
• Height that’s shorter than expected as an adult.

Research shows that treating growth faltering during a baby’s first two years of life is crucial for preventing complications.

How is growth faltering (failure to thrive) diagnosed?

Healthcare providers identify growth faltering by measuring your child’s weight and length/height and comparing these numbers to standardized growth charts. These are charts that show expected growth rates for children according to age. Some charts adjust for factors like preterm (premature) birth or certain genetic disorders.

If your child’s growth is slower than expected, your pediatrician will talk with you about possible causes. They’ll need some information from you to understand what factors might be affecting your child’s growth. Keep in mind that their goal is to help your child and support your family, not judge or blame you. The more details you can share, the more your provider can help.

Here are some things you might discuss (some might not be relevant based on your child’s age):

• How breastfeeding (chestfeeding) is going and if you face any challenges.
• The type of formula you’re using and how you prepare it.
• Which solid foods your child is eating and how they respond to them.
• Any signs or symptoms you notice when your child eats, like coughing, gagging or arching of their back.
• Your child’s eating patterns and preferences, including their snacks and any food aversions.
• What mealtimes look like, including who’s with your child when they eat.
• Any cultural practices your family follows related to meals.
• Your family’s ability to access nutritious foods.

Your pediatrician will also review your child’s medical records and ask you about family medical history. This is because some conditions “run in the family” and may affect your child early in life without you even realizing it. Making a list of any diagnoses you’re aware of among your child’s biological family members can help their provider see the bigger picture.

Physical exam

Your pediatrician will do a thorough physical exam to evaluate your child’s growth and check for signs of medical conditions. This exam will provide details about your child’s:

• Vital signs, like pulse and blood pressure.
• Muscle mass and fat distribution.
• Hair health.
• Skin health.
• Head circumference.

Testing

Providers can usually identify the cause of growth faltering without doing any tests. But tests your child might need to diagnose underlying conditions include:

• Blood tests.
• Urine (pee) tests.
• Stool (poop) tests.
• Tests that diagnose specific conditions, like sweat test for cystic fibrosis.

What is the treatment for growth faltering?

Treatment focuses on helping your child get enough nutrients to support their growth. Here are some options your pediatrician might recommend:

• Getting support from a lactation consultant or breastfeeding medicine specialist to help with any breastfeeding issues.
• Supplementing breast milk (human milk) with formula. Your provider will explain which type of formula to use and how to use it.
• Creating an eating plan for your child that has a good balance of all the nutrients they need.

If your child has an underlying condition, their care team will recommend appropriate treatment for that condition. This can vary widely according to the diagnosis. Your child’s care team can tell you more about what you can expect.

Your pediatrician may refer you to other providers — like dietitians, social workers or child psychologists — to support your family’s needs. They may also recommend community resources to help with food insecurity or lack of other resources. If there’s something you need to support your child’s health, don’t hesitate to bring it up to your provider.

For most kids, treatment involves changes you make at home with the support of your child’s providers (and regular follow-up appointments). Some children with growth faltering need care at a hospital so a provider can monitor their caloric intake and identify the exact cause of growth faltering.

Hospitalization for growth faltering

A hospital stay might be helpful for your child if:

• Treatment isn’t working.
• Providers want to measure the exact kinds of nutrition your child is getting.
• Your child has a serious underlying condition.
• Your child has severe malnutrition or dehydration.
• You’re having a difficult time managing your child’s condition at home.
• A hospital is a safer place for your child due to circumstances at home.

Can I prevent growth faltering in my baby?

It’s not always possible to prevent growth faltering. There are many reasons why your child might grow more slowly than their peers. But there’s a lot you can do — even before your child is born — to support their growth and development:

• Go to all your prenatal appointments and follow your provider’s advice on how to care for yourself during pregnancy.
• Take your child to all their routine pediatric well visits.
• Learn about the nutrition your baby needs in their first year and beyond and bring any questions to your pediatrician.
• Tell your pediatrician if you notice unusual symptoms or have any other concerns about your child’s health.
• Let your pediatrician know if your family struggles with food insecurity. They often have community resources to help make sure your children have access to the food they need.

What can I expect if my child has growth faltering?

Your child will likely need repeated follow-up visits to monitor their growth. These may be as often as once a week, but the exact frequency can vary according to your child’s needs.

It may take about four to nine months of steady growth for your child to catch up to where they need to be. Your pediatrician will tell you when your child has reached an appropriate weight and length/height. At that point, your child no longer has growth faltering and can likely continue to grow on schedule.

But every child is different. Some kids have relapses, or periods of time when their growth falls behind schedule again. It depends on the cause of growth faltering and whether treatment successfully addressed that cause. Your pediatrician will keep a close eye on the situation and make sure your child gets further treatment as needed.

When should I seek medical care for my child?

Call your pediatrician if you’re concerned about your child’s growth or any aspect of their development. Growth faltering doesn’t always have obvious signs or symptoms. That’s why it’s important to take your child to all their routine well visits so their pediatrician can monitor their growth.

If your child has growth faltering, your pediatrician will tell you how often to come in for follow-up appointments. These are essential for checking your child’s growth and adjusting their treatment plan as needed.

A note from Cleveland Clinic

You were expecting a typical, routine checkup at the pediatrician’s office. But instead, you were told your child has growth faltering. All sorts of questions swirl around in your mind. How did this happen? Will my child catch up? Did I do something wrong?

Rest assured that in most cases, growth faltering happens for reasons you can’t control. Some children just need a little extra help to grow as expected for their age. And not all families have access to the same resources. Healthcare providers know these things, and they’re prepared to help.

Your pediatrician will identify what you and your family need to support your child’s growth. It may take some months, but your child can catch up and then continue to grow as expected throughout childhood. Don’t hesitate to tell your pediatrician if there’s something you need at any point along the way.