• FTT is best defined as inadequate physical growth diagnosed by

observation of growth over time using a standard growth chart.

• Failure to thrive is diagnosed when a child’s weight for age is below

the fifth percentile or crosses two major percentile lines.
• Inadequate caloric intake

• Inadequate caloric absorption

• Increased metabolic expenditure

 If weight faltering is confirmed, a dietary history should be taken to
include:
• history of milk feeding,
• age at weaning,
• range and type of foods now taken,
• mealtime routine and eating and feeding behaviours,
• a 3-day food diary will provide a more detailed and accurate
picture of intake,
• if possible, observe a meal being taken.
• was the child born preterm or had intrauterine growth
restriction?
• is the child well with lots of energy or does the child have other
symptoms such as diarrhoea, vomiting, cough, or lethargy?
• the growth of other family members and any illnesses in the
family.
• is the child’s development normal?
• are there psychosocial problems at home?
• If organic disease is the cause, suggestive symptoms and signs are
usually present.
• Examination should focus on identifying signs of organic disease,
such as:
• dysmorphic features, (e.g. Downs’ syndrome)
• signs suggestive of malabsorption (distended abdomen, thin
buttocks, misery),
• signs suggestive of chronic respiratory disease,
• signs of heart failure
• evidence of nutritional deficiencies (koilonychia, angular
stomatitis).
No routine laboratory tests are ordered in the initial work-up of failure
to thrive unless suggested by the history or physical examination.
Children diagnosed with failure to thrive need to receive 150 percent of
the recommended daily caloric intake for their expected, not actual,
weight for age.
• Weight Faltering (Failure to Thrive) Is a description, not a diagnosis.

• Weights of infants are only helpful if measured accurately and plotted

on an appropriate centile growth chart.

• Is present if an infant’s weight falls across two centile spaces.

• Is more likely to be present the further the weight is below the

second centile.
• Although complex in origin and multifactorial, the final common
pathway is inadequate food intake.
• If there is underlying pathology, it is almost always accompanied by
abnormal symptoms or signs.
• Most affected infants and toddlers do not require any investigations
and are managed in primary care by dietary and behavioural
modification designed to increase energy intake and monitoring
growth.