Failure to thrive


These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.


Failure to thrive is a descriptive term for children who have poor weight gain.1, 2, 3, 4 There are many definitions, including crossing two or more centiles over time 1,3,4 and weight persistently below the 3rd percentile.1,2,4

Whilst there are many potential causes to consider, it is common for no specific cause to be found. 1, 2, 3, 4 

If a child looks well, is developmentally normal with a normal clinical examination and initial investigations are normal, parents can be reassured that the long-term outlook is excellent.2,3

Pre-referral investigations 1,2,4

  • FBC, Iron studies, U&E’s, LFT’s, coeliac serology (if consuming gluten in diet) 
  • Urine MC&S
  • Stool MC&S
  • Check amount of food offered
  • If breast fed, how often?
  • Incorrect preparation of formula
  • Limit of 600L milk after 1 year of age

Pre-referral treatment 1,3,4

  • If breast fed-baby, provide advice regarding breast feeding1,3,4
  • Dietetic referral for caloric supplementation and introduction of solids1,4
  • Limit of 600ml milk after 1 year of age1,3,4

When to refer

If receiving adequate calories for growth and failure to thrive is not explained by underlying disease. 

Please include a tracked percentile chart with all previous measurements of weight, length and head circumference with the referral.


  1. Cole SZ, Lanham JS. Failure to thrive: an update. American family physician. 2011 Apr 1;83(7):829-34. 
  2. Kaneshiro NK. Failure to Thrive: A.D.A.M; 2011 [updated February 2011; cited 2013 June 28th]. Available here.
  3. Melbourne RCH. Failure to Thrive - initial management 2012 [cited 2013 June 28th].
  4. Shields B, Wacogne I, Wright CM. Weight faltering and failure to thrive in infancy and early childhood. BMJ (Clinical research ed). 2012.

Reviewer/team:  Dr Andrew Martin, Charlotte Allen DPAM CNS Review date: Apr 2020

Date:  Jul 2018

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