Children's Hospital Colorado

Failure to Thrive

What is failure to thrive? A close-up of a girl with reddish-brown curly hair, wearing a white blouse.

Normal growth is the foundation of childhood health. When growth slows or stops, it is critical that the cause be understood and treated. Failure to thrive specifically refers to a child who is not gaining weight appropriately.

What causes failure to thrive?

The causes of failure to thrive can be organized into three general categories. First, a child may not be taking in enough nutrition to support normal weight gain. Secondly, some children may have increased needs for calories. For example, children with certain types of congenital heart disease may require a higher-calorie diet in order to gain weight. Third, some children may be unable to properly digest and absorb food, thereby limiting their ability to properly utilize nutrition for growth.

Who gets failure to thrive?

Failure to thrive is most commonly encountered in the first years of life, when a child’s growth and rate of weight gain is the fastest. Failure to thrive is seen frequently in children with existing chronic medical problems.

Helpful resources about failure to thrive

What are the signs and symptoms of failure to thrive?

Growth is carefully monitored by your primary care provider when your child has a regular checkup. Weight and height are tracked alongside established growth curves. While there are many shapes and sizes of people, all children should demonstrate consistent growth.

Normal growth is particularly important in the first year of life, when growth rates are rapid. In order to fuel the growth of bones and muscles, a child must be taking in an appropriate number of calories and a balance of fats, proteins, carbohydrates, vitamins, and minerals.

The classic early sign of failure to thrive is a child who has normal skeletal and head growth but whose weight gain is faltering. It is critical to evaluate a child at this point, because decreased or slow weight gain or weight loss can ultimately affect how tall a child is able to grow. Children with failure to thrive may also show decreased energy and enthusiasm for play.

What tests are used to diagnose failure to thrive? 

There are many approaches to the diagnosis and management of failure to thrive. If there is a specific symptom that is impacting weight gain, such as persistent vomiting or diarrhea, our doctors will focus on that symptom to help make a diagnosis.

Many children, however, do not have obvious symptoms when they present with poor weight gain. A frequent starting point is to ask families to complete a diary of all food and drink a child takes in for three days, to get a “calorie count.”

Why choose Children’s Hospital Colorado for failure to thrive?

Our registered dietitians are skilled in estimating how many calories a child is receiving in a day and deciding whether or not this amount is adequate to support weight gain and growth. If a child is not consuming enough calories, our diagnostic approach is focused on understanding why – is there a feeding or swallowing problem, for instance? Additionally, a nutritional program may be developed to supplement the child’s current diet with additional calories.

If it appears from the initial calorie count that the child is consuming enough, our diagnostic approach will then focus on making sure that the gastrointestinal tract performs an adequate job of digesting and absorbing food. Our doctors will also focus on ensuring that your child does not have an underlying, undiagnosed illness that leads him or her to require more calories than normal.

What to expect from failure to thrive tests?

There is no one-size-fits-all test for a child with failure to thrive. Children may require extensive testing or very limited testing. Our Digestive Health Institute staff will ensure that the appropriate amount of testing is performed for your child.

How do doctors at Children’s Colorado make a diagnosis?

Depending on the symptoms and clinical history, the diagnostic approach may include laboratory testing with blood and stool samples, radiological evaluations like x-rays, endoscopic evaluation using a camera to look at the intestines, and consultation with registered dietitians, feeding therapists, and other pediatric specialists.

How is failure to thrive treated?

The most important treatment for failure to thrive is to quickly re-establish normal weight gain. Providers in the Digestive Health Institute work hand-in-hand with experienced registered dietitians, who create nutritional plans that provide the energy a child requires. There are a variety of available nutritional supplements that can complement a normal diet and provide a concentrated source of calories.

In a child who struggles to eat, feeding therapists may be very helpful to establish normal behaviors for feeding. If there is an underlying disease that impacts feeding, digestion, or absorption, treatment of that problem can help restore normal weight gain. In some children, particularly those with chronic medical problems, supplemental tube feedings are required.

Why choose Children’s Hospital Colorado for your child’s failure to thrive?

The pediatric gastroenterologists and advanced practice providers in the Digestive Health Institute are focused on the importance of normal growth for children. At Children’s Colorado, there is an emphasis on collaboration; your child will benefit from the breadth of available knowledge and expertise, including nutritional support, feeding support, and a full range of laboratory, radiologic and endoscopic techniques.

Children’s Colorado takes pride in working closely with our referring primary care providers to ensure that children receive exemplary care here and in your medical home.


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