What is Failure To Thrive (FTT)? | Nutrition

Failure to thrive (FTT)

Overview failure to thrive (FTT)

A child is said to have a failure to thrive when they don’t meet recognized standards of growth. Failure to thrive isn’t a disease or disorder. Rather, it describes a situation in which a child is undernourished. They either don’t receive or are unable to process enough calories.

An example of failure to thrive would be a child who’s persistently below the standard weight range for their age. Typically, a doctor will diagnose failure to thrive during a child’s infant years.

A doctor determines a child’s ideal weight range by comparing their weight, height, age, and sex to national averages. Children who fail to thrive usually fall well below their ideal weight. A child may also receive the diagnosis if their growth rate in terms of weight, often along with height, stalls when it should be on an upward trend.

Symptoms of failure to thrive

Symptoms are slightly different for each baby or child. They include:

  • Not gaining enough weight with age
  • Short stature for age (or length, if a baby)
  • Fatigue
  • Sleep more than usual
  • No vocal sounds
  • Delayed changes in physical movement.
  • Learning and behaviour problems in older children

The symptoms of growth failure are similar to other health problems. Make sure your child sees their healthcare provider for a diagnosis.

Causes of failure to thrive

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).

Risk factors of failure to thrive

Risk factors in a child’s development underlying conditions, including:

  • Down’s Syndrome
  • Cerebral palsy
  • Heart disease
  • Infections
  • Milk allergy
  • Cystic fibrosis
  • Celiac Disease
  • Acid reflux disease

Children with serious medical problems are more likely to develop failure in the first few years of life. Babies who are born prematurely and with low birth weight may also not grow.

The most common cause of stunted growth is not consuming enough calories. Other risk factors for poor nutrition include:

  • Bad eating habits
  • Psychological trauma
  • Mental health conditions such as depression.


Weight is the best indicator of nutritional status and your 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.


 Treatment options vary based on:

  • Severity of symptoms
  • The general health of the child.
  • Parent/Guardian Preferences
  • Family atmosphere
  • The cause of the condition

Once your child’s growth has returned to normal, you may need help to keep track of he/her physical and mental growth. Experts who can help your children:

  • Physiotherapists
  • Speech therapists
  • Occupational therapists
  • Dietitians

Key points about the failure to thrive in children

  • Failure to thrive is slow physical development in a baby or child. It’s caused by a baby or child not having enough nutrition.
  • A child with FTT is at risk for problems such as short height, behaviour problems, and developmental delays.
  • FTT has many possible causes. A baby or child may not be getting enough nutrients and calories. Or a baby or child may take in enough food, but not be able to absorb enough nutrients and calories.
  • A baby or child with an ongoing (chronic) health condition may also need more calories and nutrients than normal.
  • In some cases, a family may not understand what a baby needs. In severe cases, neglect or abuse may lead to FTT if food is kept from a baby on purpose.
  • FTT can be prevented by seeking early help with a child’s nutritional needs
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