Failure to Thrive: Current Clinical Concepts

Introduction

Failure to thrive (FTT) or growth failure has long been a major focus of attention and critical thought for pediatricians. Over many years, consensus has evolved about its cause, outcome, diagnosis, and management. By the last half of the 20th century, mainstream thinking held that FTT developed by one of two alternative mechanisms. On rare occasions, an underlying medical condition could lead to a failure of growth, which would present as “organic” FTT. In such cases, correct management of this underlying disorder would allow the patient to resume his or her normal growth. However, in most FTT cases, as many as 90% in some series, it was believed that no underlying medical diagnosis could be made. Affected children were said to have “nonorganic” FTT (NOFTT). This term and its synonym, “psychosocial” FTT, were often used as euphemisms to imply that the child was intrinsically normal and healthy and that the observed growth failure was due to environmental issues, most commonly family factors such as neglect, indifference, or other failures of parenting. This construct led to children receiving extensive medical evaluations to rule out diagnosable conditions and to prolonged hospitalizations that …