Alternative names 
Growth failure; Failure to thrive

Failure to thrive is a description applied to children whose current weight or rate of weight gain is significantly below that of other children of similar age and sex.

Causes, incidence, and risk factors

Failure to thrive in infants and children is usually noticed when they seem to be dramatically smaller or shorter than other children the same age. Teenagers, for example, may have short stature or appear to lack the usual changes that occur at puberty. However, there is a wide variation in normal growth and development. In general, the rate of change in weight and height may be a better indicator of a problem than the actual measurements.

It is important to determine whether the failure to thrive results from medical problems with the child or from psychosocial factors in the environment, such as abuse or neglect.

There are multiple medical causes of failure to thrive that may disturb the body’s metabolism enough to result in delayed growth. These include:

  • Chromosome abnormalities such as Down syndrome and Turner syndrome  
  • Defects in major organ systems  
  • Abnormalities of the endocrine system, such as thyroid hormone deficiency, growth hormone deficiency, or other hormone deficiencies  
  • Damage to the brain or central nervous system, which may cause feeding difficulties in an infant that result in delayed growth  
  • Abnormalities in the cardiac and respiratory systems, which can disrupt deliverly of oxygen and nutrients to the body  
  • Anemia or other blood disorders  
  • Abnormalities in the gastrointestinal system, which may result in malabsorption or absence of digestive enzymes, resulting in inadequate nutrition  
  • Some diseases, such as cerebral palsy, chronic gastroenteritis, and gastroesophageal reflux (usually temporary)

Psychological and social causes may include emotional deprivation as a result of parental withdrawal, rejection, or hostility.

Economic factors can affect nutrition, living conditions, and parental attitudes. Environmental factors may include exposure to infections, parasites, or toxins. Sometimes the cause of failure to thrive is simply poor eating habits, such as eating in front of the television and not having formal meal times. Many times the cause cannot be determined.

Risk factors for failure to thrive are related to the causes and may include underlying undiagnosed diseases, poverty, negative emotional environments, and crowded or unsanitary living conditions.


  • Height, weight, and head circumference in an infant or young child do not progress normally according to standard growth charts - weight less than 3rd percentile, weight 20% below ideal weight for height, or a falloff from a previously established growth curve  
  • Physical skills such as rolling over, sitting, standing and walking are slow to develop  
  • Mental and social skills are delayed  
  • Development of secondary sexual characteristics are delayed in adolescents

Signs and tests
A physical examination is done, including height, weight, and body proportions. A detailed history is taken, including prenatal, birth, neonatal, psychosocial, and family information. A Denver Developmental Screening Test reveals delayed development. A growth chart including all growth parameters and trends since birth is plotted.

The following laboratory tests may be performed:

  • CBC (complete blood count) to detect anemia  
  • Electrolytes (basic chemistries)  
  • Urinalysis  
  • Thyroid function tests  
  • Other hormone studies  
  • Hemoglobin electrophoresis to determine the presence of conditions such as sickle cell disease  
  • X-rays to determine bone age


The treatment depends on the cause of the delayed growth and development. Delayed growth due to nutritional factors can be resolved by educating the parents to provide a well-balanced diet.

If psychosocial factors are involved, treatment should include improving the family dynamics and living conditions. Parental attitudes and behavior may contribute to a child’s problems and need to be examined. In many cases, a child may need to be hospitalized initially to focus on implementation of a comprehensive medical, behavioral, and psychosocial treatment plan.

Do not give your child dietary supplements like Boost or Ensure without consulting your physician first.

Expectations (prognosis)
If the period of failure to thrive has been short, and the cause is determined and can be corrected, normal growth and development will resume. If failure to thrive is prolonged, the effects may be long lasting, and normal growth and development may not be achieved.

Permanent mental, emotional or physical delays can occur.

Calling your health care provider
Call for an appointment with your health care provider if your child does not seem to be developing normally.

The best means of prevention is by early detection at routine well-baby examinations and periodic follow-up with school-age and adolescent children.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.