Failure to thrive

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Updated by: Dr. Praveen Goday
Updated on: October 2020


Most commonly is due to inadequate calorie intake; Other causes: malabsorption, etc account for <5% of FTT cases


Signs and symptoms:

  • Weight-for-length (or BMI) < 3rd percentile (CDC growth chart) or 2nd percentile (WHO growth chart)
  • Poor or no weight gain
    • Over a period of time that varies according to the age of the child. In general, the younger the child, the shorter the interval where there is little or no weight gain
  • These should be done along with:
    • Assessment of parental size / growth
    • Correction for prematurity (where applicable)

Referring provider's initial evaluation and management:

Diagnosis: Initial interventions in a child with failure to thrive

Establish mealtime routine

  • Add calories
  • Meals and snacks offered every 3 hourly
  • All meals and snacks should be offered in a high chair/at the table
  • Minimize distractions
  • Avoid force feeding
  • Grazing in between meal and snack times should be eliminated
  • Limit meals to 30 minutes

Most children with FTT do not need labs:

Labs are needed if:

  • Significant FTT, FTT not due to inadequate calorie intake

Common labs:

  • CBC, ESR
  • Metabolic panel
  • Anti-TTG IgA, serum IgA level
  • If less than 2 years old: DPG

When to initiate referral/ consider refer to GI Clinic:

  • ↓ weight, ↓ height - Malnutrition
  • Normal weight, ↓ height - Endocrine
  • Normal weight, ↓ height, dysmorphism - Genetics/Endocrine
  • SGA patients without catch-up growth can be referred to endocrine clinic for possible growth hormone treatment
  • Nutrition Clinic: Contact Dr Praveen Goday at for FTT patients who are not progressing according to plan.

What can referring provider send to GI Clinic?

  1. Using Epic referral form, please complete:
    • What is the patient's chief complaint
    • Describe details
    • Pertinent past medical history
    • Abnormal imaging findings
    • What is the key question you want addressed
    • Please ensure we have growth charts
    • If you have obtained labs make sure that we have access to them
  2. Not using Epic referral form:
    • Please fax 414-266-4966 the above information and include:
    • Chief complaint, onset, frequency
    • Recent progress notes
    • Labs and imaging results
    • Other Diagnoses

Office Number: (414) 607-5280

Specialist's workup will likely include:

After referral to GI Clinic:

  • Most children with FTT do not need labs


  • Significant FTT
  • FTT not due to inadequate calorie intake

Common labs

  • CBC, ESR
  • Metabolic panel, electrolytes
  • Anti-TTG IgA, serum IgA level
  • Fecal elastase
  • Urinalysis

Overall algorithm chart for medical guideline Failure to thrive

Guide to high-calorie beverages

Resources for increasing calories:

Provider resources

  • Indications for use of pediatric formulas and oral supplements
  • Recipes for fortifying breast milk
  • Infant and pediatric powder formula recipes
  • Weight velocity charts

Patient resources

3 scoops powder + 5 ounces water (Add water to bottle first, and then add powder)