Intended for healthcare professionals

Clinical Review

Weight faltering and failure to thrive in infancy and early childhood

BMJ 2012; 345 doi: (Published 25 September 2012) Cite this as: BMJ 2012;345:e5931
  1. Brian Shields, paediatric specialty registrar1,
  2. Ian Wacogne, consultant paediatrician1,
  3. Charlotte M Wright, professor of community child health/consultant paediatrician2
  1. 1Department of General Paediatrics, Birmingham Children’s Hospital, Birmingham B4 6NH, UK
  2. 2Paediatric Epidemiology and Community Health Unit, School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to: I Wacogne Ian.wacogne{at}


  • Weight faltering is not a disease, but rather a description of a relatively common growth pattern

  • It is most commonly caused by undernutrition relative to a child’s specific energy requirements

  • Causes tend to be multifactorial and often involve problems with diet and feeding behaviour that usually respond to simple targeted advice

  • More rarely, weight faltering may be associated with neglect or maternal mental health problems or addiction

  • The health visitor (public health nurse) is often best placed to assess and advise in the first instance

  • Organic disease is rare in otherwise asymptomatic children, but it is reasonable to rule out organic disease if dietary and behavioural interventions are unsuccessful

Weight faltering, or failure to thrive, is a childhood condition that provokes concern about possible neglect, deprivation, and organic illness. However, research over the past 20 years has brought the validity of this concern into question, leading to the proposal that management should be less aggressive.1 We summarise the evidence base, discuss new developments, and provide a practical approach to management. Failure to thrive has been defined in a range of ways, with no overall accepted definition2 but an essential element is subnormal growth or weight gain, hence the increasing use in recent years of the term weight faltering.

Sources and selection criteria

We searched Pubmed, Medline, Embase, and the Cochrane Database of Systemic Reviews with key reference terms “failure to thrive,” “growth faltering,” and “weight faltering.” We reviewed citations from key articles. We also used our personal archive of references.

What is normal growth?

Growth charts rank a child’s measurements against children of the same age and sex. If a child gains weight more slowly than their peers, their measurement moves to a lower centile (crosses centiles). The World Health Organization has proposed that its growth standards, based on healthy, relatively affluent, breastfed infants from six …

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