Education And Debate

Fortnightly Reviews: Failure to thrive

BMJ 1994; 308 doi: (Published 01 January 1994) Cite this as: BMJ 1994;308:35
  1. H Marcovitch
  1. The Horton General Hospital NHS Trust, Banbury, Oxfordshire OX169AL.
  • Accepted 16 September 1993

“Failure to thrive” is a descriptive term, not a diagnosis. There is no clear agreement on definition; one commonly used is, “when his or her rate of growth fails to meet the potential expected for a child of that age.” 1 As it is difficult to predict potential, such a definition might initially include many normal children of short stature. Illingworth added to the definition evidence of lassitude, loss of energy and joie de vivre.2

A major paediatric textbook includes “signs of developmental retardation and of physical and emotional deprivation such as apathy, poor hygiene, intense eye contact with people and withdrawing behaviour as well as disorders of oral intake which may be manifested as anorexia, voracious appetite or pica.” 3 This description attempts to combine some of the characteristics of psychosocial deprivation with those of eating disorder and poor growth. Any combination may be present in an individual child.


General practitioners and health visitors have a key role in detecting infants who may be failing to thrive. Such infants might be screened from a population if their weight falls below an arbitrary point, perhaps three standard deviations below the mean or possibly the third4 or 10th 5 centile for the population concerned. Referral by the health visitor to the general practitioner or by the general practitioner to a paediatric clinic is initiated more commonly when early growth velocity appears to be poor as evidenced by “falling through the centiles.”6


Reference to box 1 lists the differential diagnoses in children who may be failing to thrive.

Box 1 - Differential diagnoses in children who may be failing to thrive

  • Normal child of short stature

  • Idiosyncratic growth pattern

  • Breast feeding failure

  • Formula feed errors

  • Non-organic failure to thrive

  • Severe developmental delay

  • Chronic infection (urinary tract, lung)

  • Gastrointestinal disorders

  • Metabolic disease

  • Congenital heart disease


Normal Children Of Short Stature

Pointers in the case of a normal child …

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