Failure to Thrive

Failure to thrive describes a child whose weight gain or growth is significantly below expected levels for their age, indicating inadequate nutrition, an underlying medical condition, or both. Early identification and management are important to prevent long-term effects on growth and development.

• Weight gain that is slower than expected, or weight loss, tracked over time using growth charts
• Height or length gain that falls behind expected growth
• Visible thinness or loss of muscle and fat stores in more significant cases
• Delayed developmental milestones can occur alongside poor growth in more prolonged or severe cases
• Often identified through routine growth monitoring rather than a specific presenting complaint

• Most commonly results from inadequate calorie or nutrient intake, which can relate to feeding difficulties, food insecurity, or inappropriate feeding practices.
• Can also result from an underlying medical condition affecting nutrient absorption, increasing nutrient needs, or reducing appetite, such as chronic infection, HIV, or gastrointestinal conditions.
• Psychosocial factors, including difficulties in the caregiving environment, can also contribute and should be considered as part of a full assessment.

• Identified through routine growth monitoring, comparing a child's weight and height against standard growth charts over time, since a single measurement is less informative than a trend.
• A detailed feeding history, including what, how much, and how often the child eats, is a key part of assessment.
• Examination and, where indicated, further investigation help identify any underlying medical cause contributing to poor growth.

Nutritional support and feeding counselling for caregivers form the foundation of management, addressing the type, amount, and frequency of feeds appropriate for the child's age.

Any identified underlying medical condition — such as chronic infection or a gastrointestinal condition — is treated specifically.

Regular follow-up with growth monitoring helps track the child's response to intervention and guides any further steps needed.

Support for the caregiving environment, including addressing food insecurity or feeding difficulties, is an important part of a comprehensive approach.

Children with severe or persistent failure to thrive despite initial intervention are referred for more detailed assessment.

• Attend routine growth monitoring visits so that poor growth can be identified and addressed early.
• Practise exclusive breastfeeding for the first six months, followed by appropriate, nutritious complementary feeding.
• Seek support for feeding difficulties rather than assuming a child will simply catch up on their own.
• Address underlying food insecurity through available community or health system support where needed.