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Failure to thrive (undernutrition) in children younger than two years: Management

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


Failure to thrive (FTT), also called "weight faltering" or "faltering growth," 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 'Prognosis' below and "Secondary immunodeficiency due to underlying disease states, environmental exposures, and miscellaneous causes", section on 'Malnutrition'.)

The management of FTT in infants and children younger than two years will be discussed here. The etiology and evaluation 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: Etiology and evaluation" and "Poor weight gain in children older than two years of age".)


A consensus definition for FTT is lacking. 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) [3]. Weight below the 2nd percentile is approximately equivalent to a Z-score of -2; the Z-scores is a value that represent the number of standard deviations from the mean value. (See "Measurement of growth in children", section on 'Z-scores'.)

Other definitions for FTT are discussed separately. (See "Failure to thrive (undernutrition) in children younger than two years: Etiology and evaluation", section on 'Failure to thrive'.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 02, 2017.
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