Possible Causes of Failure to Thrive

What are some possible causes of the very general diagnosis of “failure to thrive”? At 7 weeks, our daughter is still 7.5 ozs below her birth weight and none of the “experiments” our doctor has tried have helped her to gain any weight consistently. We were advised to try eliminating all dairy products from my diet, then supplementing formula after each breastfeed, and now give up nursing entirely and formula feed, but none of these is making a difference. I might also note that she began life with very loose, mucousey stools while nursing, and now has quite firm, round, rubbery stools with the formula..neither of which seems normal in my experience. Further, she is more fussy since we switched to the formula only routine; she is not as contented as she was previously and cries out in her sleep.
Angela Quinn – Tipp City, Ohio

Possible Causes of Failure to Thrive

Dr. Greene’s Answer:

When I see a new baby in my office for her first visit, her parents often get more excited about finding out their child’s weight than just about anything else. The scale becomes the focus of the visit. “Is my baby growing okay?” is an urgent question for parents until they are sure of the answer. This deeply rooted concern makes sense.

Growth is central to childhood. In fact, an organism is considered “a child” during that period of its life in which it is growing.

Growth is particularly noticeable and rapid during the beginnings of life. In the first four to six months, a baby typically doubles her birth weight. She will triple her birth weight by the time she is a year old. Maximal brain growth also occurs during the first six months of life. The brain grows as much during a child’s first year as it will during the entire rest of her life.

A child is failing to thrive when she is not growing at the expected rate for her age, or if her weight is disproportionately low compared to her height and head circumference.

A simplistic but very useful way to look at growth failure is to consider that in order to grow, a child must take in adequate calories, absorb those calories, and use them for growth.

If a child is not growing well, first consider whether she is actually taking in an adequate number of calories (and other nutrients). What is she being fed? How much is offered and how often? How much does she actually take? Is she able to suck and swallow adequately? Most cases of failure to thrive in infants can be solved by carefully addressing these questions. It sounds as if this is what your pediatrician is focusing on.

If caloric and other nutrient intake is adequate, consider whether the calories are continuing down the gastrointestinal tract, being digested, and being absorbed into the body. Sometimes the food is vomited back up either due to a blockage in the gastrointestinal tract or a condition called gastroesophageal reflux, in which food travels backwards from the stomach to the esophagus. Sometimes the calories make it through the stomach, but are not absorbed — they are lost out the other end — either because of diarrhea or because of an inability to absorb the nutrients. Possible underlying causes for this include viral, bacterial, or parasitic infection, a digestive enzyme deficiency, a genetic disease (such as cystic fibrosis), or a milk protein intolerance.

When adequate calories are consumed and absorbed into the body, the calories could be spilling out in the urine, if the kidneys are not effective at holding in the protein. If the fuel remains safely in the body, the body could still be burning it at a faster-than-normal rate, leaving insufficient calories for growth. Possible causes of this hyper-metabolic state include hyperthyroidism, chronic infection, congenital heart disease, or malignancy.

Some children will even fail to thrive in the face of adequate calorie absorption simply from extreme neglect. Kids who are not hugged, held, and cared for don’t grow. This has been clearly demonstrated in orphanages where the adult-child ratio is very low. Even if these children are being well nourished, they often fail to thrive, simply because they lack personal care.

So, as you can see, growth requires the smooth working together of many systems throughout the body. The specific causes of failure to thrive are quite numerous, with problems in every major organ system represented. The most common causes for failure to thrive vary with age. In the first three months of life feeding difficulties, infections, gastroesophageal reflux, inborn errors of metabolism, cystic fibrosis, and milk-protein intolerance top the list. Simply switching to formula is not a sufficient solution if your child doesn’t respond with steady growth.

Many infants regain their birth weights by one week of age. Most regain their birth weights by two weeks of age and have a steady weight gain thereafter. A child who has gone seven weeks without regaining her birth weight deserves a thorough work-up to determine the cause. This work-up should begin with a detailed feeding history and a careful physical examination. If the cause for failure to thrive is not apparent, the next step would be to run some simple screening lab tests including a Complete Blood Count (CBC) with differential, urinalysis, and a measurement of serum electrolytes, BUN and creatinine.

Given your child’s unusual stools, it might be useful to have the stool examined for evidence of a malabsorption syndrome. If all of these studies come back normal, and your daughter is still not growing, then a further round of tests, possibly including thyroid function tests, liver enzymes, ammonia, lactate, pyruvate, a sweat chloride test, urine organic acids and serum amino acids, and perhaps x-ray studies, would be indicated.

If a cause is still not found, your doctor will be able to direct you to an appropriate specialist for further testing based on your daughter’s symptoms, test results, and physical exam findings.

Every mom wants to make sure that her child is growing. This instinct runs strong and deep and is there for good reason. When growth is not proceeding apace, take steps to correct the problem or to discover its cause.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Ashley

    Hi my daughter is 8 weeks old and is only drinking 2 Oz every 2.5 to 3 hours. I don’t feel as if she is gaining any weight and it’s a struggle to get her to suckling properly. Also she’s on nutramigen formula because Similac was so hard on her tummy. She was 6lbs 9oz at birth and I believe she is 8lbs now. Is that enough weight gain??

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  2. Kamrul Hassan regan

    Dr
    My daughter is now 5 weeks old. She was born @ 35 weeks with d weight of 2.170 kgs. After a heavy water breaking, my wife had to go a premature emergency c-section cause. However my little one didn’t cry much after birth and they had to provide emergency oxygen aid. After 2 days of NICU care she was released with proper health. Now she is only 2.30 kgs. She is fed on breast, pees and poos are normal and at 10 to 12 times in a day. Everything seems normal. As she grew underweight and not grown much I wonder if the weight @ this age is okay. Plz response.

    Regan.

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  3. kelly siwecki

    My daughter is 7 months old noe and weights just now 12 lbs. At burth she was only 6 lbs 11 oz. We had he diagnois with milk protien allergy but she only eats about 20 oz of formula a day. She is on a high calorie mix but she still isnt gaining weight. She is in the 0.6 percentile on growth and i dont know what to do. She acta normal and is hitting all her milestones at good times. She has 2 teeth so far and is about to crawl. She is very active but the growth is just worrying me.

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  4. Dancun

    My baby is now 8 weeks and only weighs 3kg….she was born normally with 2.9kg…then she dropped to 2.5kg….then started adding on to2.7kg…..now at 8 weeks she is 3.1kg…..she feeds quite often daily, but cries alot during the day….is there a reason to be worried….she does not seem to be sick though…!

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    • Levon Tilbian

      Hi Dr. Greene,

      I want you to share me about a case with F.T.T. My patient is 16 mo. old his B.W was 3 kg. now his wt. 7.4 kg. length 70 .cm. H.C 45 cm. According to parents he was doing well till 12 mo. he was taking formula and other foods , at 12 mo. they changed the formula after which frequent episodes of vomiting occurred.

      Now he has severe anorexia takes 90-120 Ml formula milk (Nido) 2-3 times per day refuses other foods, there is no diarrhea or vomiting, no fever, his developmental milestones are within normal, has 5 teeth in his mouth, moderately wasting, no focal infections, no signs of rickets, no history of recurrent RTI, good sleep.

      The family history, the father has 2 male siblings from first marriage , the 2 boys had history of chronic diarrhea and F.T.T, and diagnosed celiac disease and put on gluten-free diet , they are doing well now without diet??? according to parents. There is no consanguinity between parents.

      I want to read your comment and your experience in managing such cases.

      Thank you in advance.

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  5. elsa

    Dear Doc,

    My son weighted 2.2kg when he was born, he is now 6 months and weight 6,2kg we are worried because he eats very well and not gaining much weight, is the any test we should do to check if he’s getting enough nutrients.

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  6. Anam

    My son is now 17 months exact and he is 11.4 kg. Is that an ideal weight for his age?

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  7. Mits

    Dear Dr,

    My son is 2.5 yrs old and is currently 85 cm tall and weighs 8.9kg.

    We have diagnosed him having adenoids which is causing him to snore when he sleeps.

    He is still not talking except a few words but understands pretty much everything.

    Hes very active and eats reasonably well.

    What could be the reason for the low growth.

    Do let me know

    Thanks in advance

    Mits

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  8. swami

    Hi Dr, My son turned 4 and since last 1 year he is in the 27 to 28 pound range. he drinks milks and eats raw vegetables and fruits. Why is he not putting weight? he is active and loves running around.

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    • KrissieW

      I would like to follow this if you don’t mind my Daughter is the same and we were referred to a nutritionist but my daughter eats really well so I don’t know what they will be able to tell us.

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  9. nazish

    Hi. My son is 11month old and weight 6•5kg.in early 4month he gaind weight but after 6month of age his weight is not increases properly tell me the reason.

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  10. saleem

    MY DAUGHTER IS 4 YEARS OLD NOW. SHE IS ONLY 10 KG. HER DIET IS GOOD SHE EAT EVERYTHING AND DRING MILK AND SHE IS ACTIVE AND PLAYFUL BUT SHE DOESN’T GAIN MUCH WEIGHT IM WORRIED ABOUT HER PLEASE GIVE ME SOME ADVICE I WILL THANKFUL TO YOU.

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  11. Thangadurai

    Hi Dr,

    My daughter is 13 months old and she was born with birth weight of 2.89kg and we did the current weight and found that she is just 8.1 kg and that makes more concern about my baby growth ,we are feeding her properly but she is not going weight.

    Can you please advice us what could be the reason?

    Thanks

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    • beryle mondo

      hii doc my baby girl is 9 months now and she is just 7.4 kgs. she eats well. is there anything wrong with her because her mates are now 9-10 kgs.

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  12. Rosanna

    Hello Dr I just wanna say Im glad you brought up this topic when my daughter was born she failed to thrive she was 8lbs and dropped to 6lbs the first month of her life she got diarrhea it seemed the 2nd or 3rd week of life she had began to vomit as well we later learned after she got really sick she was diagnosed with wolmans disease a really rare genetic disorder known as LAL though there is not alot of new information on this disease because its so rare Drs were able to put us on a special formula and help us help her thrive she gets synthetic enzyme to help and thankfully now she is slowly but surely gaining weight she is 7 almost 8 months but she reached 14lbs. I hope people in the comments find the answer they are searching for! I just wanted to share my story if it might help. I know its hard not really knowing and my prayers are with all of you!

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    • Sims

      Hi doctor,
      My baby boy is 1 yr and 3 months old. He was born at 2.1kg and weighs only 6.5kg currently. Am so worried about him not gain enough weight. Moreover, he hasn’t been reaching his milestones on time. He keeps throwing up every 3-4times a week. Am worried he might have wolmans disease as he also has problem with his digestion. I am not sure what step to take next. I have had him tested for a CBC and stool test for malabsorbtion which shows normal. Can you please help me further. Thanks simis

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    • Dianna

      This sounds like our Skyler, she was born July17,2015 and weighing in at 5 pounds & 4 oz. She was born a few weeks early. But now we are into Feb and she isn’t growing. She weighs less than 9lbs. She has seen a Specialist, they put her on Similac Sensitive, she still throws that up. They have ran blood tests on her her red & white blood cells are low. Her overall health is good they say, but they are very concerned with her not being able to poop without suppositories and many times she bleeds while passing stools. It’s so heartbreaking. She goes to see a Gastoroligist in a few more weeks. I am really shocked she hasn’t been to see 1 before now.

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  13. eddie

    I have a 4 year old who was born with cleft lip and cleft palate and has already 13 surgeries because of complications one being a punctured colon because of a G tube placement she has had every exam to find out why she cant hold no more then 2 ounces of milk via G tube and was even removed a hital hernia. We are lost and hopeless we have to feed our 4 year old 16 times a day in order for her to survive.

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  14. Sandra

    Hi Doctor

    My daughter is 9 weeks old and she’s not gaining any weight, she’s only 7lb 4oz, she takes 1 oz or 1 1/2 oz every 2-3 hrs, her pediatrician referred me with a gastroenterologist… I’m already seeing a nutritionist and switched to different kind of formula and still trying to breastfeed but she doesn’t take much… Please help…

    A very concern mom

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    • Natalyn's Mom

      Hi,
      How is your daughter doing right now? What was her birth weight? Did the doctor find out why she was not gaining? I am king of in a somewhat similar situation. My baby girl was born full term at 6lb 8oz and gained weight rapidly the first 2 months. She then decreased her milk intake around 2.5 months and is now refusing bottle altogether. I am breastfeeding and bottle feeding breastmilk, but I have to work so cannot breastfeed her during the day. She will typically take 1-2 oz max if we use the bait and switch with a soothie. She is gaining very slowly and I am just worried. She is on medication for reflux and that seems to help a little. Does your daughter have reflux or allergies? These can lead to slow weight gain. Don’t know if your daughter sleeps through the night but mine does and I have to wake her up to nurse her just to get more calories in. Please let me know if you had made any progress with your daughter.

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    • artina

      Hi dr
      My son weight was 7lbs 7oz at bitrth i tried brestfeeding for the first couple of days and he lost a few oz .hes now 6 weeks and today he had his 1 month check up well now hes only 7 lbs 12 oz they yook a ultrasound and there was m o blockage what can be the problem please help im so stressed out.

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  15. Meenah

    Hello doc,
    My son son was born through an emergency CS at GA 36 weeks 5days weighing 2.4kg and he’s breastfeeding well but not growing as expected he’s now 1month 3days pls advice on what to do

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  16. Clency

    Hi
    My daughter will be completing 7 months after two days. She is 6.110 kg.her birthweight was 3.2kg.she is having grade 2 to 3 gastroesophageal reflux.she was totally fine till 3 and half months. And then started to vomit after every feed. My paed gave domeperidome.but she continued to vomit.at that time she was 4.8 kg.after one month there was no weight gain so we started her on PPI.She was fine vomiting stopped .was on thickened feeds.after one and half month PPI were stopped. After one month she was irritable and again no weight gain. She is now 6.110kg.she is only on breastmilk and now am not lactating well.not taking bottle feed.takes formula with spoon but only 2 oz.if more than thin she brings it up.can you please tell me how much solid food can I give her and her milk.as she has a poor appetite.she has attained her milestones bt stit sits with support n keeps her back straight. Teething has not yet began.can you please help .even solid food she brings up if given more than 60ml.her barium swallow shows grade 2 to 3 ger.no anatomical problem involved and Normal gastric emptying.
    Thanks
    Clency
    Thanks

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  17. Nero

    My daughter is going to 6 month now and is not gaining weight, is unable to feed through the mouth.she was diagnosed of microcephy at birth and miconuim.my doctor seems not to tell me any thing about inability to feed if its a thyroid problems or not and what is the way out.

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  18. Ellie Cooper

    My Granddaughter is almost 2 weeks old . She weighted at birth 5 lbs 12oz. She has lost 11oz. The doctors are worried because she is losing weight. She was born 3 weeks early.Any helpful answers. Pls help. Ty

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  19. Lee

    Please help. Baby not gaining weight. Born c-section at 38 weeks. 4.07kg. Drinking badly from start. Tried breast feeding. Would not latch cried a lot. Week 2 started crying 14 hours a day. Called pediatric went to hospital fed him nan ha. Then neocate, no difference tube fed, cried less gained 200 grams in 4 days left hospital, no weight gain. They cut under his tongue, made drinking better use to drink only 10-20 ml now on 60 ml if we are lucky back on nan ha. Drinks every 3 hours. Dr says its sensory I don’t believe it. Tested all organs/ reflux drank barium no luck. Went to see chirp/ occupation therapist and speech therapist. Still no weight gain 6 weeks old now 4.9 kg since birth. Tried different bottles and teets. What am I missing. Going out of my mind. In South Africa. Hope you can help. Who do I see next. A dietician??? Help. When you give Colin drops or panado makes no difference sounds like person who is hungry the way it drops into the stomach. Nexium no difference spits up slimy milk no just milk.

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  20. Jada

    Hi doctor,

    I have an 11 1/2 month old son who currently weighs 18 lbs; birth weight was 7 lbs 14 oz. Should I be concerned about his weight? He is tiny but his Pediatrician seems like it’s not a concern even though he’s dropped on his growth chart. Not sure if maybe we need a second opinion.

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  21. naz

    Dear doctor,

    my daughter weighed 5lb 1oz when she was born and failed to grow adequately due to a vsd…

    she had a vsd repair done at 3.5months…however she is still not growing well enough…she is now 5.5months and weighs 9lb 7oz…HV has referred to dietician and I have been advised to start o solids and higher calorie milk….

    what could be the cause of her failure to thrive…

    a very worried mum

    thanks

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    • kathy

      Hiprobiotimy daughter was also diagnosed with failure to thrive . But after I changed her diet with all organic and GMO free my.daughter has gained weight. Also, I give her raw probiotics.

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  22. Jolie

    My son was born with normal weight of 3.3kgs however at week 4 he has lost to 3.1kgs. Doctor said it was failure to thrive and advised me to feed the baby. I am feeding the baby but he’s not gaining weight.

    What can I do to make sure he gains weight?

    Jolie

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  23. Adam

    I have a 3 month old son. He eats every 3 hours. Sometimes, actually often, he fights eating. He is breastfeeding. He weighs 9 pounds and 10 ounces. He was delivered via an emergency c section do to meconium. At birth, he weighed 6 pounds and 4 ounces. He is in the lower 5 percentile for weight, but in the 25 percentile in head circumference. With all that said, he is very alert and engaged. He smiles. He follows sounds. He recognizes voices. He sleeps.

    In out most recent visit to the Ear Nose and Throat specialist, she confirmed (through a scope) our pediatrician’s diagnosis of reflux.

    We have been giving him the reflux medicine, but it’s not working. As I stated before, feeding is a challenge.

    I Google a lot. There are so many ominous things out there. Could this be failure to thrive? Am I missing something?

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    • Lisa

      Has anyone examined your baby’s mouth for a lip or tongue tie?
      This can also be the cause of slow weight gain and symptoms of reflux.

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  24. lacie

    My baby hasn’t gained any weight in a month and she just now turned three months old what should I do.

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  25. Natasha

    MY GRANDSON IS DIAGNOSED WITG FAILURE TO THRIVE AND NOW HAS A HORRIBLE CASE OF RSP MY DAUGHTER HAS BEEN TO SEVERAL DOCTORS YET NO ONE SEEMS TO GIVE HER REASON FOR H I S POOR HEAKTH NOR DO THEY HAVE ANY TRATMENT PLAN
    I WOULD LIKE TO KNOW WHAT WE NEEX TO DO AT THIS . POINT IN ORDER FOR HM TOO HAVE A FUTURE !
    Can you please recommend any advice?
    Thank you,
    Natasha
    A very frustrated and concerned Omie

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  26. Goldie Byerly

    I am working with Early intervention 0 to 3 yrs all and i am interesting in all topics regarding this age range. thank you

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  27. shruti

    Doc,
    i have one concern . my daughter is 1 yr 4 months now. she is underweight with only 7.9 kg.
    though she is quite active and playful .she doesnt gain much in weight like in last 4 months she gained only 200gms. Should we worry about her weight ?

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