Failure to thrive (FTT) in children

What is failure to thrive (FTT) in children?

Failure to thrive (FTT) happens when a child doesn’t get enough nutrients and calories to grow and gain weight in a healthy way. When this happens, babies and kids often experience low energy and don’t get the nourishment they need for their brains, muscles and bones to develop like they should.

Failure to thrive is not a disease or disorder itself. It's a sign that a child is undernourished, and it can be fixed by providing the right diet.

• Babies and children with failure to thrive are often smaller than their peers.

• Teenagers can be short-stature and experience delayed puberty.

• Failure to thrive puts kids at risk of developmental delays, like walking, talking and struggling to learn.

What are the different types of failure to thrive (FTT) in children?

• Inadequate energy intake - When a child does not consume enough calories.

• Inadequate energy absorption - When a child is not able to absorb enough calories.

• Increased metabolic demand - When a child has increased calorie needs.

• Defective utilization - When a child does not intake enough calories.

What are the signs and symptoms of failure to thrive (FTT) in children?

• Weight loss or lack of weight gain

• Slowed height or head growth

• Low energy levels

• Tiring easily and/or sleeping excessively

• Irritability and fussiness

• Delayed milestones

• Dehydration – sunken eyes

• Frequent illness

How is failure to thrive (FTT) in children diagnosed?

Physical exam

Your child’s doctor will start by doing a complete physical exam, and measuring your child's weight, height and head circumference. They’ll review your child’s medical history from your pediatrician’s well-child checkups to understand how they’re progressing compared to other children their age and sex.

Blood and urine test

Your child’s doctor may order some blood and urine tests to check for medical problems that may be affecting your child’s ability to gain weight and grow. We’ll also talk to you about your child’s eating routine, habits, likes and dislikes.

This information, along with a physical exam will help your doctor and dietitian ensure your child gets the nutrition they need.

What causes failure to thrive (FTT) in children?

The most common cause of failure to thrive is a primary medical condition that makes it difficult to eat or retain nutrition.

Some of the medical conditions that cause failure to thrive include:

• Food allergies

• Digestive conditions

• Neurological conditions

• Cystic fibrosis

• Metabolic disorders

• Autism Spectrum Disorder

• Premature birth

• Heart conditions

• Feeding or Eating disorders

• Dysphagia/swallowing difficulties

• Sensory processing disorders

• Behavioral avoidance due to past medical history

Other non-medical reasons a child may not be getting the right amount of nutrition at home include:

• Parents incorrectly mixing formula, so an infant doesn't get enough calories

• Difficulties breastfeeding

• Children having trouble starting solid foods

• Families not being able to afford enough food

• Parents and caregivers misunderstanding a child’s hunger cues

• Parents having a low emotional bond with their child

How is failure to thrive (FTT) in children treated?

Our dietitians are experts in nutrition that promotes the growth and development of children. They can build a nutrition care plan that best meets each child’s needs.

We start by learning about your child’s medical and growth history, type and quantity of food and beverage intake including allergies, GI symptoms and intolerances as well as any barriers your child faces around eating.

If feeding concerns are significant, we may consult with a pediatric psychologist, speech therapist, and/or occupational therapist (OT) to better assess your child’s challenges with eating.

Nutrition treatment plans may include things like:

• Disease-specific diet plans

• Calorie boosting

• Nutrition supplements

• Alternative nutrition treatment, like tube feedings

• Vitamin and mineral supplements

• Nutrition education and counseling

The pediatric feeding team can help to:

• Introducing new foods – expanding variety and textures accepted

• Overcoming challenges with mealtime

• Increasing oral motor and swallowing ability

• Decreasing sensitivity to new foods and food textures

• Decreasing reliance on tube feedings

• Teaching families to prepare foods that are safe for their child.

It’s important to remember that weight gain takes time and it could take several weeks or months before your child meets their ideal weight.