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Failure to thrive (undernutrition) in children younger than two years: Etiology and evaluation

Rebecca T Kirkland, MD, MPH
Kathleen J Motil, MD, PhD
Teresa K Duryea, MD
Section Editors
Jan E Drutz, MD
Craig Jensen, MD
Carolyn Bridgemohan, MD
Deputy Editor
Mary M Torchia, MD


Failure to thrive (FTT), also called "weight faltering," refers to failure to gain weight appropriately; in more severe cases, linear growth and head circumference also may be affected. FTT is a sign that describes a particular problem rather than a diagnosis. The underlying cause of FTT is "always insufficient usable nutrition," although a wide variety of medical and psychosocial stressors can contribute (table 1) [1].

Severe malnutrition can cause persistent short stature, secondary immune deficiency, and permanent damage to the brain and central nervous system [1]. Early identification and expeditious treatment may help to prevent long-term developmental deficits [2]. (See "Failure to thrive (undernutrition) in children younger than two years: Management", section on 'Prognosis' and "Secondary immunodeficiency due to underlying disease states, environmental exposures, and miscellaneous causes", section on 'Malnutrition'.)

The etiology of FTT and the initial evaluation of children younger than two years with FTT will be described here. The management of FTT in children younger than two years and poor weight gain in children older than two years are discussed separately. (See "Failure to thrive (undernutrition) in children younger than two years: Management" and "Poor weight gain in children older than two years of age".)


Failure to thrive — A consensus definition for FTT, including duration of concern about growth, is lacking [3-6]. We use the term FTT to describe children whose weight is less than the 2nd percentile for gestation-corrected age and sex when plotted on an appropriate growth chart (figure 1A-B) (calculator 1) and who have decreased velocity of weight gain that is disproportionate to growth in length (figure 2A-B) (calculator 2) [7]. Weight below the 2nd percentile is approximately equivalent to a Z-score of -2; the Z-score is a value that represents the number of standard deviations from the mean value. (See "Measurement of growth in children", section on 'Z-scores'.)

FTT is not used to describe children growing along a curve with a normal interval growth rate, even if their weight is <2nd percentile [8,9]. FTT is also not used to describe infants and young children with genetic short stature, constitutional growth delay, prematurity, or intrauterine growth restriction who have appropriate weight-for-length and normal growth velocity [10,11]. (See "Normal growth patterns in infants and prepubertal children", section on 'Variants of normal'.)


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Literature review current through: Oct 2015. | This topic last updated: Nov 5, 2015.
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