My Child Isn't Gaining Much Weight -- Could It Be Failure to Thrive (FTT)?

child standing on scale

Depending on where your child falls on those ubiquitous growth charts at your pediatrician's office, a standard checkup for your toddler or preschooler can be a nerve-racking experience for a parent. Have they gained the right amount of weight? Is their height on par with their peers? No parent wants to feel like they've somehow failed at providing their child with the essentials to grow healthy and strong.


What is FTT?

For children who fall into the lower percentile brackets for height and weight, parents may have heard the term Failure to Thrive (FTT) thrown around. But what exactly is it, and does it mean you've failed as a parent? (The short answer: absolutely not).

"FTT is a broad term to indicate sub-optimal growth in a child," explains Natasha Burgert, MD, FAAP, a general pediatrician in Kansas City, Missouri, and spokesperson for the American Academy of Pediatrics. "Children with FTT are those who need special attention to their natural growth, and may need additional testing or specialty evaluation to determine what is causing unique growth patterns to occur."

While FTT is typically diagnosed during the infant stage, doctors can dial into a course of action when they see slow growth or weight loss at any age. First and foremost, parents shouldn't blame themselves.

How is FTT diagnosed in toddlers and preschoolers?

Normal lineal growth (height in layman's terms) and weight gain are the best indicators of healthy body functioning and adequate nutrition, which is why your pediatrician asks your child to step on the scale and stand against a growth chart at each checkup.

"In toddlers and preschoolers, the biggest red flag is a change in weight percentile," says Dr. David J. Mathison, MD, MBA, FAAP, Regional Medical Director for PM Pediatrics. "A child that follows along the third percentile for weight for three years isn't necessarily worrisome. But a child who sits at the fiftieth percentile and drops two percentage lines indicates something may be wrong."

If growth and weight gain seem off in preschoolers, doctors may express concern that it will also reflect in a lack of cognitive growth. 

What causes FTT?

"There are so many conditions that can lead to FTT, and many have to do with a child's genetics, his ability to absorb nutrients, and other reasons that are not connected with how much effort parents are putting into feeding," says Dr. Nimali Fernando, MD MPH, author of Raising a Healthy, Happy Eater.

If a toddler is experiencing slow growth or an unexpected weight loss, initially your pediatrician will assess whether their condition falls under one of two categories: physiologic or pathologic.
"Physiologic implies that the child isn't eating enough or perhaps that they are small because parents are small," explains Mathison. "Pathologic implies that there isn't appropriate weight gain or growth despite otherwise normal conditions, such as feeding, or there is a major recent change in rate of weight gain or loss." That means it could be a sign of illness.

How can I help my child gain weight?

"Different underlying causes of failure to thrive may require different approaches, but parents should not lose hope and try not to become too fixated on pushing food on children," says Fernando. "While there may be [the] short-term goal of getting a child with failure to thrive to gain weight, parents should not lose sight of long-term eating habits. Keep meals fun and stress-free and make sure to remember that mealtimes should still be about connection and keeping the joy in eating."

More from CafeMom: 7 Sneaky Tricks for Turning Your Baby into a Foodie

How worried should I be?

"The good news is that kids [with FTT] thrive in homes with stability, adequate basic resources, and love," says Burgert. "Few children require special diets, supplements, or many changes for adequate growth. If parents are concerned about their child's growth, they need to connect and lean into a trusted child health expert. That is the best place to start."

As far as having to make any grandiose lifestyle changes to help your child, Burgert says that typically isn't necessary, and very few ever require hospitalization. Phew!


Image via

Read More >