Failure To Thrive

Failure to thrive is a term that describes children whose current weight, or rate of weight gain, is much lower than other children of similar age and gender. Failure to thrive (FTT) is considered a medical condition rather than a disease. Children are considered as failing to thrive when their rate of growth does not meet the expected growth rate for a child their age. Many factors, including race and genetics, may influence that growth.

Infants normally lose around 10% of their weight in the first few days of life; but gain it back within two weeks. The average full-term baby doubles its weight by 6 months and triples its weight by one year. Children with failure to thrive will lose weight, or do not gain weight as expected.

Failure to thrive may have several underlying causes: organic, caused by a medical disorder, or inorganic, cause by a caregiver’s actions. Both often appear together.

Organic causes of FTT may include:

  • Premature birth.
  • Maternal smoking, alcohol use, or illicit drugs during pregnancy.
  • Mechanical problems resulting from a poor ability to suck or swallow.
  • Poor appetite:
    • Inadequate intake.
    • Excessive vomiting cause by obstruction of gastroesophageal reflux (GERD)
    • Poor absorption of food such as milk allergies.
    • Inability of the body to use absorbed nutrients (cystic fibrosis, diarrhea, liver disease, celiac).
    • Increased loss of nutrients.
    • Infections.

Examples of inorganic causes of FTT include:

  • Poor feeding skills of the parent such as insufficient age-appropriate solid foods for babies and toddlers.
  • Inability to produce enough breast milk.
  • Dysfunctional family interactions (neglect, abuse, emotional deprivation).
  • Lack of social support.
  • Lack of parenting preparation.


Symptoms to failure to thrive include:

  • Height, weight, and head circumference in a infant or young child not progressing as expected on growth charts.
  • Weight lower than 3rd percentile (outlined in growth charts) or 20% below the ideal weight for their height.
  • Growth slowed or stopped after a previously established growth curve.
  • Developmental milestones such as rolling over, sitting, standing and walking not reached.
  • Delayed social and mental skills.
  • Constipation.
  • Excessive crying or sleepiness.
  • Irritability.
  • Delayed development of secondary sexual traits in adolescents.


If a baby doesn’t gain weight for 3 consecutive months during the first year of life, doctors usually become concerned. Doctors diagnose failure to thrive by using standard growth charts to plot weight, length, and head circumference. Children who fall below a certain weight range for their age, or who are failing to gain weight, will be further examined.

The following tests may be done:

  • complete blood count (CBC)
  • Electrolyte tests
  • Urinalysis
  • Additional tests if a particular disease or disorder is suspect.

To determine if a child is receiving enough food, the doctor may have a dietitian do a calorie count by asking the parents what the child eats every day. Talking to the parents may also help identify any problems at home such as feeding difficulties, neglect, poverty, household stress, etc.


Children with failure to thrive need the help of their parents and doctor. Other medical professionals may be included in the child’s treatment. A nutritionist may evaluate the child’s dietary needs. An occupational or speech therapist may be needed to help with the child’s feeding behaviors and address any sucking or swallowing problems. If there is a disease or disorder causing the problem, specialists such as a cardiologist, neurologist, or gastroenterologist may also be part of the child’s treatment plan.

Proper eating will help the child grow at the same rate as other children around the same age. Some of the dietary changes that can be made include:

  • Learning to mix formula properly
  • Learning to eat several small meals per day
  • Boosting the calories of healthy foods
  • Limiting sweetened beverages
  • Establishing feeding/meal schedule
  • Addressing behavioral issues such as refusal to eat certain foods

Our registered and licensed dietitians have experience in helping with this diagnosis. Please call (865) 546-3998.

Increasing Calories and Protein for Weight Gain


Whole Milk or Cream

  • Use whole milk as a beverage with meals.
  • Add “instant breakfast” or other flavoring to whole milk (chocolate syrup, strawberry powder, etc).
  • Substitute whole milk or cream for water in soups, cocoa, pudding.
  • Add to milkshakes: fresh, canned, or frozen fruits; cocoa mix, honey, sugar, flavorings, instant breakfast powders, Ovaltine
  • Add cream to cereals, gelatin, and stewed or canned fruits in heavy syrup


  • Eat whole milk cheeses as a snack (Cheddar, Jack, American)
  • Add to sandwiches, eggs, salads, casseroles, vegetables, soups, sauces, pasta, grains, and dip.
  • Mix with meatballs and meatloaf.
  • Melt on sandwiches, hamburgers, hot dogs, vegetables, eggs.
  • Serve cream cheese with breads, crackers, bagels, muffins, raw veggies.
  • Mix cottage cheese with jams, jellies, preserves, and honey. Serve with cooked or canned fruits in heavy syrup.

Ice Cream

  • Use as is or add to beverages (milkshakes, floats, smoothies)
  • Add to desserts like cake, cookies, pie, graham crackers

Plain or Fruit Yogurt

  • Serve for snack or dessert
  • Top with cereal, dried fruits, granola, and nuts
  • Add to milk-based beverages and gelatin dishes



  • Serve with meals or snacks
  • Serve fresh fruits with dip, peanut butter, or cream cheese
  • Serve canned or cooked fruits with whipped cream or ice cream
  • Add dried fruits to cereal, puddings, and in baked goods
  • Serve fruit pies and tarts with sliced cheese, ice cream, whipped topping
  • Freeze fruit juice in Popsicles


  • Add butter or margarine, cheese, cream sauce, eggs, crumbled bacon or bacon bits to canned or fresh veggies
  • Add cheddar cheese soup and other cream soups for cooking vegetables


Meat, Fish, Poultry

  • Serve as an entrée (breaded, fried, sautéed in oil or margarine, or served with gravy or cream sauce)
  • Cold cuts and hot dogs served as meals or snacks with added cheese
  • Add ground meat or cut up pieces to soups, salads, casseroles, sauces, omelets
  • Add cream soups for cooking meat and casseroles

Peanut Butter

  • Spread on breads, muffins, crackers, fruit slices, waffles, pancakes
  • Use as a dip for fresh veggies
  • Blend with milk and/or ice cream to make a beverage


  • Add to salads, vegetables, and casseroles
  • Mix into meatloaf, meatballs, and hamburger prior to cooking
  • Sprinkle cheese on scrambled eggs, fried eggs, egg casseroles

Dried Beans & Peas

  • Use in soups, casseroles, pasta and grain dishes
  • Serve baked beans with franks or top with crisp bacon



  • Serve for breakfast or snack
  • Add butter/margarine, sugar, honey, nuts, raisins to hot cereals cooked in whole milk
  • Add fruits, nuts to cold cereals
  • Cook hot cereals in whole milk, half-and-half, or cream
  • Top biscuits with gravy
  • Try granola-type sweetened cereals with dried fruits and nuts


  • Spread with butter, mayonnaise, sandwich fillings, cheese spreads, jam/jelly, apple butter
  • Top sweet breads with cream cheese or peanut butter

Pasta, Rice, Potatoes, etc.

  • Add butter/margarine, cream, milk, cheese
  • Sprinkle grated or shredded cheese on rice, pasta, casseroles, mashed potatoes
  • Add sour cream, cheese, bacon bits to baked potatoes
  • Serve French fries, tater tots, hash browns, fried rice, egg rolls

A simple rule of thumb:

  • Serve foods from at least 3 food groups at each meal, and at least 2 food groups at each snack
  • Provide your child with regular mealtimes and snacks (2-3 snacks daily)

High-Calorie, High-Protein Diet

  1. Offer a variety of high calories beverages: flavored milk, yogurt drinks, 100% fruit juices and smoothies.
  2. Offer a variety of foods every day.
  3. Offer high-fiber foods such as: whole-grain breads and cereals, fresh fruits and vegetables, popcorn, and nuts.
  4. Off a medical nutritional supplement for additional calories and protein. Consult your physician or Registered Dietitian for one that is most appropriate.
  5. Offer whole milk. Skim and low fat (1%) or reduced fat (2%) do not provide enough calories.
  6. Add seasonings, such as salt to foods that will make the food taste better. Consult your health care professional first.

Sample Menu for a High-Calorie/High-Protein Diet*


½ cup Oatmeal with strawberry preserves (1 tbsp) and margarine (2 tsp) Cheese omelet:
1 egg
2 oz. cheese
½ cup whole milk


1 cup whole milk
1 pkg. powdered instant breakfast
¼ cup 10% fat ice cream


Turkey breast sandwich:
2 slices whole-wheat bread
2 oz. turkey
2 tsp. mayonnaise
1 piece lettuce
1 slice tomato
½ cup raw carrot sticks with sour cream (2 tbsp)
½ cup whole-milk fruit yogurt
2 chocolate chip cookies
1 cup whole milk


½ cup baked custard ½ cup canned peaches in heavy syrup


3 oz. breaded fish sticks with tartar sauce (2 tbsp)
½ cup mashed potatoes with gravy (2 tbsp)
½ cup creamed spinach
1 slice pound cake
¼ cup strawberries in syrup
½ cup apple juice


5 crackers, butter type
1 tbsp. peanut butter
½ cup whole milk

    *Sample menu is designed to meet the requirements of a 4- to 8-year-old child

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