Failure to thrive natural history, complications and prognosis

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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]


The most common presenting complaint is poor growth and failure to gain weight. The patient may have more specific complaints depending on the underlying cause. A few important complications include a diminished final weight and height, vitamin deficiencies and an increase risk of recurrence of failure to thrive. Not much data is available on the prognosis of failure to thrive as it is a multifactorial process. However, the duration of malnutrition is directly proportional to the cognitive and physical decline of the patient.

Natural History

  • Though the scope for differentials and investigations is broad, nothing is more specific and time efficient in diagnosing a patient with failure to thrive than an accurate history.
  • Patients typically present with weight loss, signs of malnutrition and specific manifestations of environmental/psychological/ organic causes. [1]
  • Given the various psychological and environmental influences on failure to thrive, a physician should take a detailed history with a slight degree of skepticism.
  • To obtain a complete picture, history taking should be performed when both parents are present. Hearing what only one parent has to say is analogous to examining a patient without a stethoscope. [1]
  • If the child is hospitalized, then a second history is often more valuable than the first as the physician may ask questions that did not spring to mind the first time along. Keen attention should be paid to the parents’ ability to provide details but also their attitudes to the entire history taking process. "Failure to Thrive: A Practical Guide - American Family Physician".
  • The following are important history taking questions: "Failure To Thrive - StatPearls - NCBI Bookshelf". [2] [3][4]
  • The chief complaints commonly are:
    1. Poor weight gain, poor growth, baby not getting enough milk, crying too often, and refusing feeds
    2. Recurrent respiratory infections, gastroenteritis, fussiness, fatigue, irritability, stomatitis, cheilosis –vitamin deficiency or immunodeficiency syndromes, recurrent exposure to a parent who may be a primary contact.
    3. Urinary symptoms – frequency, urgency, foul smell, dysuria, fever of unknown origin, change in color
    4. Bowel habits – stool frequency, stool consistency, recurrent episodes of vomiting, blood or mucus in stool
    5. Poor development in terms or work habits or performance in school.
    6. Growth pattern -
    • Children with no remarkable history findings and a normal physical/behavioral examination may have a decreased growth of two major percentiles as they begin to match their genetic potential which may be set at a lower growth rate – Catch down growth.
    • Compare bone age and chronological age of the patient to differentiate between constitutional growth delay and familial short stature.

Complications and Prognosis

  • Failure to thrive is a contributing rather than an exclusive cause of the complications seen.
  • Each case of failure to thrive is different as there are psychological, environmental, and pathological components to it. There are very few long-term outcome studies for one to comment with certainty.
  • Complications include: [1][5][2][4]
    1. Poor weight gain
    2. Short stature
    3. Anti-social personality
    4. Highrisk of recurrent infections
    5. Development delay; educational and behavioral problems.
    6. Malnutrition, vitamin deficiencies – pallor, rickets, stomatitis, cheilosis, edema, dermatitis.
    7. Cognitive skill deficits, poor work habits
    8. Future recurrence of failure to thrive
    9. Aggressive nutritional rehabilitation may cause refeeding syndrome; seizures, arrythmias, encephalopathy, circulatory decompensation, etcetera.
    10. Decreased weight, height and head circumference.
  • The prognosis of the child depends on the severity and duration of malnutrition. However, failure to thrive is not associated with a decrease in the intelligent quotient.


  1. 1.0 1.1 1.2 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. 2.0 2.1 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.
  3. Krugman SD, Dubowitz H (2003). "Failure to thrive". Am Fam Physician. 68 (5): 879–84. PMID 13678136.
  4. 4.0 4.1 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.
  5. Goldbloom RB (1982). "Failure to thrive". Pediatr Clin North Am. 29 (1): 151–66. doi:10.1016/s0031-3955(16)34114-1. PMID 6276853.

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