Failure to Thrive

A seemingly normal baby who refuses to eat, doesn’t grow and has been tested for everything with no apparent results may have failure to thrive. There are many medical and psychosocial reasons for failure to thrive, but there are also many factors that may not be so obvious.

What Is Failure to Thrive?

Failure to thrive is frequently referred to as the failure to gain weight and/or failure to grow within the first three years of life. Typically, an infant’s or toddler’s weight is much lower than others of the same age and gender.

A more formal definition of failure to thrive is that either:

  • The child’s growth drops below as least two major weight-percentile curves (such as from the 50th percentile to the 5th percentile, and/or
  • The child’s growth drops below the 3rd percentile (known as “falling off the chart”)

Failure to thrive is normally associated with abnormal growth and development. There may be symptoms of coordination problems and developmental delays in reaching developmental milestones such as:

  • Rolling over
  • Sitting up
  • Crawling
  • Standing
  • Walking
  • Cognitive skills
  • Social skills

Other signs of failure to thrive can include:

  • Lack of weight gain
  • Irritability
  • Listlessness
  • Excessive sleepiness
  • Sleep disturbances
  • Lack of eye contact
  • Disinterest in surroundings
  • Fatigue
  • Hair loss (alopecia)

What Your Doctor May Tell You About Failure to Thrive

Your child’s pediatrician will likely do an assessment with a standard growth chart of your infant or toddler’s age, the length, weight and head circumference, overall health and development as well as your baby’s medical history. The pediatrician will observe and question the overall extent of your child’s symptoms to see if your child is undernourished and why, or if there is a genetic disorder or disease.

If your baby is bottle-fed, your pediatrician may want a new formula higher in calories and may increase the number of feedings in a day. If you are breastfeeding, your pediatrician may tell you to supplement your breastfeeding with formula.

If you are breastfeeding your baby, your pediatrician may feel you have an inadequate breastmilk supply or problems with the breastfeeding technique such as with the way your baby latches on to your breast.

Medical tests maybe be required by your pediatrician to rule out any or the possible medical causes of your child’s failure to thrive. If there is a possible medical cause, your pediatrician may give you a referral to a specialist for your child.

Your child’s pediatrician may give your child medications or suggest specific medical procedures depending on the cause of the condition of your child; however, the focus on eating will be to increase calories. Severe cases may require a feeding tube for your child.

Your child’s doctor may suggest any of the following:

  • A dietitian
  • A high-calorie diet
  • A lactation consultant
  • An occupational therapist for a feeding program
  • A speech therapist for sucking or swallowing problems
  • A social worker for lack of food issues
  • A psychologist or other mental health professional if there is a behavioral problem or challenging social situation

Severe cases of failure to thrive may be treated in the hospital, fed and monitored until symptoms of severe malnutrition are gone.

Another Way to Think About Failure to Thrive

Traditionally, once known underlying medical conditions such as central-nervous-system damage, hormone abnormalities, and metabolic disorders were ruled out, failure to thrive was a condition that was believed to occur most frequently in families where the primary caregiver either could not or would not adequately care for (feed) the child (due to social, economic or psychological factors).

However, failure to thrive is now commonly seen in children without other medical diagnoses who are from affluent, stable, and loving homes–homes in which social, economic or psychological factors are less likely to contribute to growth delays. In fact, even children who appear to be consuming adequate daily calories and nutrition are receiving this diagnosis. Why is this happening?

If this condition occurs in an infant/child with adequate care/food intake and who otherwise lacks an established medical condition (like cerebral palsy), there may be other underlying and underrecognized medical problems at play.

A child with failure to thrive is not absorbing/assimilating nutrients. Why?

The gastrointestinal health and environmental exposures of a child with failure to thrive must be considered.


Nutritional deficiencies and malabsorption are two major causation factors that can lead to failure to thrive in babies and young toddlers. When your baby’s weight drops on the growth curve before the length and the head circumference this usually means a nutritional problem.

When the length drops on the growth curve before the weight, it usually means it’s an endocrine problem (hormonal). When the head circumference drops as much or more than the weight or length then that usually means there is a genetic problem or a problem from pregnancy. Remember to take into consideration that some families are just shorter and smaller by genetic inheritance.

Biochemist William Walsh PhD says that southern European Mediterranean countries lacked food with zinc centuries ago and so therefore, the genetics evolved, resulting in people with a shorter stature.

Possible Medical Causes for Failure to Thrive

The following symptoms/diagnoses are commonly seen in children/babies with failure to thrive, and all of these conditions indicate that the child is suffering from gut dysbiosis and/or immune dysregulation and/or mitochondrial dysfunction:

  • Malabsorption: Not absorbing nutrients, caused by factors such as:
    • Damaged gastrointestinal lining
    • Inflammation
    • Food allergy
    • Inadequate probiotic microorganisms
    • Gut dysbiosis
  • Celiac disease, which is caused by an immune response to the consumption of wheat/gluten
  • Inflammatory bowel diseases such as colitis and Crohn’s, which may be due to a variety of causes, including
  • Feeding/swallowing issues, which may be caused by a variety of issues, including:
  • Vomiting/reflux disorder (child is unable to keep food down due to one of the above conditions)
  • Chronic diarrhea, which may be caused by:
    • Celiac disease
    • Food allergies and/or sensitivities
    • Inflammatory bowel disease
    • Gut dysbiosis
    • Immune dysregulation
  • Genetic/chromosome abnormalities such as:
    • Down Syndrome
    • Turner Syndrome
  • Defects in major organ systems
  • Ongoing illnesses or disorders
  • Endocrine imbalances such as:
  • Neurological or central nervous system abnormalities causing feeding issues
  • Heart or lung issues that may affect how nutrients are diffused throughout the body
  • Chronic respiratory conditions
  • Malignancies
  • Renal failures
  • Anemia or other blood disorders such as:
    • Fanconi anemia
    • Bone marrow failure
  • Gastrointestinal abnormalities such as:
    • Malabsorption syndrome
    • Lack of digestive enzymes
    • Pancreatic insufficiency
    • Short-gut syndrome
    • Inflammatory bowel disease
  • GastroEsophageal Reflux (GER)
  • Specific vitamin and mineral deficiencies such as:
    • Iron
    • Vitamin D
  • Chronic liver disease
  • Chronic diarrhea
  • Excessive vomiting
  • Long-term gastroenteritis and gastroesophageal reflux (usually temporary)
  • Long-term chronic infections such as:
    • Parasites
    • Urinary Tract Infections (UTIs)
    • Tuberculosis
    • HIV
  • Infections in the mouth and throat that make sucking/eating painful
  • Cerebral palsy
  • Severe allergies and food intolerances such as cow’s milk protein
  • Developmental delays
  • Swallowing difficulties
  • Inadequate breastmilk production
  • Breastfeeding problems
  • Cystic fibrosis
  • Congenital heart disease such as:
    • Tetralogy of Fallot
    • Multifocal atrial tachycardia (increased heart beat)
  • Metabolic disorders
  • Orofacial defects such as cleft palate and lip
  • Suck-swallow incoordination
  • Neuromuscular disorders
  • Inherited disorders such as:
    • Homocystinuria (inability of the body to process methionine)
    • Abetalipoproteinemia (inability to absorb certain dietary fats)
  • Drugs such as anti-epileptic medications
  • Fetal alcohol syndrome
  • Drugs
  • Cigarettes
  • Complications with pregnancy and low birth weight
  • Premature baby
  • Mother’s stress/postpartum depression

Possible Psychosocial Causes for Failure to Thrive

  • Loss of emotional bond between the child and the parent(s)
  • Financial difficulties and poverty
  • Problems with the child- caregiver relationship
  • Poor social support
  • Lack of caregiver knowledge and understanding the infant’s dietary and well-being needs
  • Unlimited access to juice and snacks
  • Inadequate provision of nutrients and calories
  • Inappropriate mealtime environment
  • Food purposefully withheld or erratic eating schedule with little consistency
  • Baby just might not be feeding for long enough or often enough
  • Mom is having trouble weaning baby on to solid foods


Frequently associated with failure to thrive is pica, a commonly overlooked compulsive-eating disorder of non-food substances caused by nutritional deficiencies and malabsorption issues in the gastrointestinal tract that can lead to failure to thrive very easily among young children.

Pica often precedes diagnoses such as Obsessive Compulsive Disorder (OCD), celiac disease (intolerance to gluten and malabsorption in the gut) and Autism Spectrum Disorders. Pica can also affect children between the ages of two and three, children who have had a brain injury, and children with epilepsy.

Your child may have signs of OCD and severely restricted food intake with the sudden on-set of symptoms from Pediatric Acute-onset Neuropsychiatric Syndromes (PANS) or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The severely restricted food intake and abnormal eating pattern of the PANS diagnosis can lead to failure to thrive.

In some children, pica may be an indicator of OCD. Pica can often result in lead toxicity, anemia (low iron), growth retardation and spoon nail.

Many young children will eat dirt because they are looking for minerals that they are missing in their bodies.

Parasitic infestations, infectious organisms and other heavy metal toxicity such as arsenic and lead can be found in the gastrointestinal tract from eating dirt or feces.

Pica not only leads to failure to thrive, but also negatively affects neurological functioning of a developing brain with the ingestion of toxic items such as:

  • Foam
  • Chalk
  • Clay
  • Crayons
  • Feces
  • Sand
  • Dirt
  • Metal
  • Plaster
  • Cigarette butts
  • Glue
  • Cornstarch
  • Chalk
  • Paint chips
  • Paper
  • Soap
  • Burnt match heads

These toxic foreign particles pass through the gastrointestinal tract and eventually develop holes in the mucosa (gut lining), causing the digestive tract to permeate; also known as leaky gut syndrome. A leaky gut allows toxic waste to leak through the intestinal wall into the bloodstream, causing an immune reaction.

Small children with developing neurological, immune, sensory, and nervous systems are a risk to develop autism spectrum disorders and other devastating autoimmune conditions from pica.

Lead Toxicity

Lead toxicity is known as the silent killer for children and is found in three main items:

  • Paint chips
  • Paper, especially newspaper
  • Dirt

Symptoms of lead toxicity include:

  • Hyperactivity
  • Inattentiveness
  • Distractibility
  • Hand-eye coordination impairment
  • Delayed motor skills
  • Abnormal reflexes

Many children with ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) have lead toxicity. Children with ADD, ADHD, pica or failure to thrive should be tested for lead levels.

Common Nutritional Deficiencies in Pica


Iron is the essential mineral that carries oxygen in the blood; iron deficiency can lead to decreased blood cells and iron-deficiency anemia. Iron-deficiency anemia can cause significant developmental delays because not enough oxygen is getting to the developing brain.

Iron deficiency can also cause:

  • Fatigue
  • Weakness
  • Shortness of breath
  • Stunted growth

Infants are prone to iron deficiency after six months; in the first six months they have enough stored iron from the mother’s pregnancy. Therefore, babies need more iron-rich foods when starting on solids around six months of age; otherwise, they could become iron deficient.


Zinc is a very important mineral that is needed to:

  • Enhance the functioning of the immune system
  • Support the gastrointestinal and hormonal systems
  • Improve physical growth
  • Activate a sense of smell (olfactory)
  • Stimulate taste buds (for picky eaters)

Did you know that without zinc, the stomach does not create enough hydrochloric acid and pepsin to break down foods for digestion? Pepsin is one of the crucial factors in the absorption of vitamin B12. Zinc plays an integral part in failure to thrive.


Calcium is one of the most important minerals necessary for bones and teeth development in children, as are magnesium and phosphorus. Calcium is also important in emotional development.

Potassium is important for the nervous system and muscle function, both of which affect growth and development.

Vitamin D

Vitamin D deficiency can lead to rickets in babies which can cause skeletal deformities. Vitamin D is not only necessary for calcium and phosphate absorption for the bones, but also improves immune and hormonal functioning. Vitamin D deficiency can cause a child’s growth to be slow or delayed.

Supplement from 400 to 1000 IUs daily of D3 for preemies infants three months and older and try to get as much sunshine as possible when available. Please note that vitamin D3 should be taken with vitamin K2 to prevent constipation and other side effects.

Vitamin B12

A vitamin B12 deficiency is a common occurrence with the vegan diet, which Joseph Mercola DO feels can be deadly. Here’s what researcher Michael Donaldson, PhD of Cornell University has to say:

“Based on the published studies and our results, adequate vitamin B12 status of vegans cannot be taken for granted. Pregnant women, nursing mothers, infants, and small children are particularly vulnerable to B12 shortages. Ensuring adequate B12 is critical for normal neurological development and maintenance, with shortages resulting in permanent damage.”

If your child has the genetic mutation variant MTHFR, then processing the methylation of vitamin B12 for important neurological functioning is going to be difficult and will require methylation support.

Other reasons why the gastrointestinal tract is unable to absorb vitamin B12 are:

  • Bacterial dysbiosis
  • Insufficient stomach acid (hydrochloric acid)
  • Insufficient pepsin
  • Parasites, such as Giardia
  • H. pylori bacterial infection
  • Inflammatory conditions such as Crohn’s or celiac disease

Beneficial bacteria in the baby’s gut can help protect their immune system. Certain bacteria can also help baby grow, and the microbiome affects baby’s weight, growth, energy and nutrition.

Trace Minerals

Trace minerals are necessary for:

  • Muscle tone (externally and internally)
  • Proper bone mass
  • Gross and fine motor skills
  • Increased height and weight
  • Decreased sensory meltdowns
  • Improve ability to climb
  • Expanding a limited picky eater’s diet
  • Stopping chronic constipation due to poor internal muscle tone

Other Factors

Toddlers who eat sugar-laden snacks and drink sugar-laden beverages without a consistent reliable mealtime schedule may not acquire or develop the internal cycles of hunger and satiety that is needed for the basis of self-regulation and self-control of eating and healthy growth patterns. It is also crucial for babies and toddlers to get enough sleep at night with intermittent daytime naps to be able to eat during meals without fussing. Acquiring an appetite may be difficult due to appropriate timing, the size of meals and the amount of snacking and grazing all day long.

Studies have been done that show attention, self-regulatory skills for self-control, organizational skills and cognitive functioning and academic abilities all tend to be at risk with the effects of malnutrition.

Failure to Thrive Healing Checklist

It is critical that you work with an experienced integrative healthcare practitioner who can help you get to the bottom of the condition. Ultimately, as a parent, it is up to you to be your child’s “health detective” and get to the root cause of the failure to thrive diagnosis.

Make Lifestyle Changes

  • Get an age-appropriate amount of sleep per night
  • Get outside every day
  • Get an hour of exercise or movement per day
  • Sync circadian rhythm by getting up when the sun does and going to bed after it sets
  • Limit screen time as much as possible
  • Use blue-blocking lightbulbs and glasses at night, especially when looking at screens
  • Put bare feet in wet ground when possible
  • Drink half body weight in ounces of water

Eat a Clean Diet

Use Only High-Quality Fats

  • Coconut oil
  • Olive oil (unheated)
  • Avocados
  • Medium-Chain Triglycerides (MCT) oil
  • Grass-fed ghee
  • Duck fat
  • Grass-fed beef tallow
  • Cod liver oil (unheated)
  • Walnut oil (unheated)

Remove Vegetable Oils and Trans Fats

  • Canola
  • Corn
  • Soy
  • Safflower
  • Sunflower
  • Hydrogenated vegetable oils (Crisco, etc.)
  • Margarine

Include High-Quality Protein with Every Meal

  • Pasture-raised eggs, chicken and other fowl
  • Grass-fed beef, lamb and other red meats
  • Wild-caught fish
  • Legumes
  • Nuts

Add Fermented Foods and Probiotics

These will keep the gastrointestinal system and microbiome healthy and strong which in turn will keep the immune system strong.

  • Eat kefir yogurts, if dairy is tolerated
  • Eat fermented vegetables such as sauerkraut and kim chi
  • Eat umeboshi plums, which are very alkalizing
  • Eat miso soup, if soy is tolerated
  • Take a quality probiotic, such as VSL #3, Gut Pro, Dr. Ohirra’s Live Cultured Probiotics, Garden of Life, Klaire Labs. Work with your practitioner for a more targeted probiotic.

Optimize Blood Sugar

Blood sugar that is too high can lead to excess inflammation and hormonal imbalances.

Blood sugar that is too low can lead to attention and behavioral problems.

We recommend keeping blood sugar optimized so that it's neither too low nor too high.

Do an Elimination Diet

Children with chronic health conditions often have hidden food sensitivities and intolerances that exacerbate their symptoms. With an elimination diet, remove potentially inflammatory foods such as:

  • Casein
  • Gluten
  • Soy
  • Corn
  • Eggs
  • Fish
  • Shellfish
  • Nuts
  • Peanuts

Clean up Your Environment

  • Identify and remove possible environmental triggers, such as mold, dust, pet dander, and electromagnetic fields (EMFs)
  • Identify and remove possible toxic exposures in the home from purchased products, such as detergents, soaps, lotions, and other cleaning and personal care products
  • Remove animals (both live and stuffed!)
  • Remove carpets
  • Use non-toxic cleaners
  • Use non-toxic building materials

Lower Stress Levels

Viruses, bacteria and other pathogens become more active when the body is in a state of stress.

By teaching your child ways to self-regulate with practices such as prayer, reiki, meditation, yoga, qi gong, tai chi and the Emotional Freedom Technique (tapping), they can become good advocates for themselves and become active participants in the recovery process.

Practitioners of techniques such as EMDR (Eye Movement Desensitization Retraining) and jin shin jyutsu can lower stress levels for your child, as well.

See a NAET or BioSET Practitioner

Children with chronic health conditions typically also have food allergies and/or food sensitivities and intolerances.

NAET (Namudripad's Allergy Elimination Technique) and BioSET are two non-invasive methods of allergy elimination.

See a Homeopath, Naturopath or Homotoxicologist

These practitioners can diagnose and treat gastrointestinal disorders naturally so that the child’s immune, sensory, neurological and nervous systems develop without being compromised.

Ask Your Practitioner to Run Some Laboratory Tests

  • Enzyme-Linked Immunosorbent Assay (ELISA) for possible food sensitivities and allergies
  • Nutritional deficiencies in vitamins and minerals, especially vitamin D
  • NutrEval by Genova Diagnostics Labs for malabsorption, gut dysbiosis, cellular energy, mitochondrial metabolism, neurotransmitter metabolism, vitamin deficiencies, toxin exposure and detoxification need
  • Organic Acid Test (OAT) for yeast overgrowth, other microbial infections and oxalates
  • Inflammation markers such as C-Reactive Protein (CRP)
  • Fasting blood sugar and insulin levels
  • Comprehensive Digestive Stool Analysis (CDSA)

Use Digestive Aids with your Practitioner's Guidance

  • Betaine hydrochloric acid
  • Digestive enzymes with DPP-IV for gluten and casein intolerances
  • Proteolytic enzymes
  • BiCarb
  • Bromelain
  • Papaya

Use Supplements with Your Practitioner's Guidance

Always work with your practitioner to determine the brand, type and dosage of supplements. Common supplements include the following:

  • Cod liver oil
  • Probiotics
  • Vitamin D3
  • Methylated B complex vitamins
  • N-acetylcysteine (NAC)
  • Magnesium, zinc, selenium, iodine and other minerals
  • Others

Help Your Child Detoxify

  • Make sure your child is pooping every day. Learn more about how to clear up constipation and diarrhea.
  • Have your child exercise or move every day. Sweating carries toxins out of the body.
  • See a homotoxicologist, naturopath or homeopath for drainage remedies and detoxification aids.
  • Optimize blood sugar to allow the liver to spend more time detoxing rather than processing sugar.
  • Ionic foot baths can help detox unwanted pathogens and are easy to do with children.
  • Infared saunas can detox heavy metals through the skin by sweating. However, this form of detoxification may not be suitable for young children who lack the ability to sweat.
  • Epsom salt baths add sulfur transdermally to help with detox.

See a Chiropractor

A chiropractor can perform spinal cord adjustments, which can improve bodily functions.

Work with a Health Coach

Our Epidemic Answers health coaches are trained to understand the root causes of your child's chronic health condition.

They provide hands-on helping with the practical matters of healing such as cooking healthy foods, removing toxins from the household and helping you work more efficiently with your practitioner.

See an Acupuncturist

Acupuncture can help lower stress and anxiety. It can also help with blood-sugar and hormonal regulation.

Check your breastmilk supply:

Some women use a nipple shield to alleviate the pain of breastfeeding from cracked nipples and sore breasts; however, it can reduce the amount of breastmilk supply to baby if not applied properly. Check with your lactation consultant, pediatrician, midwife or doula to make sure your supply of milk is not limited.

Reduce lead exposure:

Public health agencies have attempted to reduce the risks of lead exposure and poisoning by enforcing a drinking water standard for lead of 15 parts per billion; reduced the lead content of canned foods; eliminated lead additives in gasoline; and banned lead in residential paints in 1977, but lead-based paint remains the primary source of lead exposure for children.

  • Lead-containing paint cans should be removed from the house.
  • Children and pregnant woman should evacuate an old house while undergoing renovation or paint removal.
  • If your tap water contains more than 10-15 parts per billion of lead, run the faucet until the temperature is cold before drinking or cooking.
  • Do not use hot water from the tap to mix infant formula or for cooking because it usually contains lead.
  • Do not use pottery or cans to store food and beverages.
  • Do not use ceramic dishes for heating food unless you know they are lead-free.
  • Check imported, highly decorated, glossy, multicolored ceramic dishes or mugs for lead content, as they typically contain more lead.

See a craniosacral practitioner:

These practitioners use approaches rich in vestibular, proprioceptive and tactile input, which can help alleviate birth trauma and failure to thrive. The New York College of Osteopathic Medicine at St. Barnabus Hospital in the Bronx, New York City discovered that babies who have undergone birth trauma may be able to reverse their failure to thrive with craniosacral therapy.

See a chiropractor:

The spinal cord adjustments, treatment of subluxations and improvement of neurological flow that chiropractors offer can improve nervous-system functioning and calm down the “fight or flight” sympathetic nervous-system overdrive. Digestive problems can be caused by a physical compression of the vagus nerve (also known as the wandering nerve). The vagus nerve exits the upper cervical spine and descends to the heart and the stomach. The vagus nerve controls:

  • Heart rate
  • Blood pressure
  • Gastric motility
  • Gastric acid secretion

If the vagus nerve is compressed, the child may need an upper cervical correction by a chiropractor to restore proper digestive functioning; this correction can help children with failure to thrive.

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