Failure to thrive causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]


Causes of failure to thrive are mainly organic and non-organic. Organic causes are further divided into inadequate calorie intake, inadequate calories absorption and increased calorie expenditure.


  • The most common cause of failure to thrive is inadequate calorie intake. [1][2]
  • Causes can broadly be divided into organic and non-organic causes. [3]
  1. Non organic causes include[4]:
    1. Social, psychological, and environmental factors
    2. Non accidental trauma – subdural hematoma
    3. Low socioeconomic status
    4. Child neglect, abuse, and poor parent-child interaction
    5. Poverty
    6. Poorly educated parents
  2. Organic causes can further be subdivided into; [5][6][7]
    1. Inadequate caloric intake
    2. Excessive calorie expenditure "Failure To Thrive - StatPearls - NCBI Bookshelf".
    3. Inadequate calorie absorption "Failure to Thrive: A Practical Guide - American Family Physician".
Inadequate calorie intake Excessive calorie expenditure Inadequate calorie absorption
  1. Poverty and inadequate food storage
  2. Feeding difficulties- poor infant feeding technique, improperly reconstituted formula, uninhibited access to high calorie food, behavioral problems related to feeding
  3. Inadequate breast milk production, breastfeeding failure, errors in artificial feeding, poor latch/suck strength
  4. Mechanical or structural problems with swallowing; cleft lip, cleft palate, neuromuscular disease, motor neuron disease
  5. Prenatal insult – worsening of prematurity or intrauterine growth restriction
  6. Erratic diets – unorthodox beliefs, Munchausen syndrome by proxy
  7. Systemic diseases causing decreased appetite, anorexia, and food refusal.
  1. Chromosomal conditions – trisomy 13,trisomy 18, trisomy 21, Turner’s syndrome
  2. Congenital heart disease – cyanotic and non-cyanotic heart diseases.
  3. Teratogenic exposures – anti-epileptics, tetracyclines
  4. Endocrine dysfunction – growth hormone deficiency, type 1 Diabetes mellitus
  5. Cirrhosis of liver
  6. Chronic respiratory illness, intrauterine infections
  7. Malignancy
  8. Thyroid dysfunction
  9. Renal tubular acidosis, Renal failure
  10. Increased Intracranial pressure
  11. Immunodficiency syndrome causing recurrent infections, e.g. HIV
  1. Bowel obstruction - Ladd bands, paralytic ileus, small intestinal bowel obstruction
  2. Necrotizing enterocolitis /Short bowel syndrome
  3. Pyloric stenosis
  4. Gastro-esophagal reflux disease
  5. Cystic fibrosis
  6. Pancreatic insufficiency


  1. Pancreatic insufficiency,
  2. Celiac disease
  3. Giardiasis
  4. Inflammatory bowel disease
  5. Inborn errors of metabolism – amino acid disorders, lysosomal storage diseases
  6. Enzyme deficiencies
  7. Biliary atresia
  8. Cow’s milk protein allergy


  1. Venkateshwar V, Raghu Raman TS (2000). "FAILURE TO THRIVE". Med J Armed Forces India. 56 (3): 219–224. doi:10.1016/S0377-1237(17)30171-5. PMC 5532051. PMID 28790712.
  2. Larson-Nath C, Biank VF (2016). "Clinical Review of Failure to Thrive in Pediatric Patients". Pediatr Ann. 45 (2): e46–9. doi:10.3928/00904481-20160114-01. PMID 26878182.
  3. Marcovitch H (1994). "Failure to thrive". BMJ. 308 (6920): 35–8. doi:10.1136/bmj.308.6920.35. PMC 2539114. PMID 8298353.
  4. Nangia S, Tiwari S (2013). "Failure to thrive". Indian J Pediatr. 80 (7): 585–9. doi:10.1007/s12098-013-1003-1. PMID 23604606.
  5. Goh LH, How CH, Ng KH (2016). "Failure to thrive in babies and toddlers". Singapore Med J. 57 (6): 287–91. doi:10.11622/smedj.2016102. PMC 4971446. PMID 27353148.
  6. Krugman SD, Dubowitz H (2003). "Failure to thrive". Am Fam Physician. 68 (5): 879–84. PMID 13678136.
  7. Jeong SJ (2011). "Nutritional approach to failure to thrive". Korean J Pediatr. 54 (7): 277–81. doi:10.3345/kjp.2011.54.7.277. PMC 3195791. PMID 22025919.

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