Failure to Thrive: How to Spot it, Treat it, and Overcome it

Much like I’m sure you are, I was so anxious and terrified with my first baby as to whether he was getting enough milk. I had an emergency c-section and as we were leaving the hospital my doctor reiterated to me “he’s lost 7% of his birth weight and we can’t have him lose anymore” and then discharged me home. Those words really sunk in and that is all my mind could think about. I needed to feed my baby and make sure he was getting enough. I remember being so nervous that whole drive home.

Once home, I got settled in and was finally ready to tackle our first breastfeeding session on my own without the help of my hospital nurses. As I finished our first session, I was feeling pretty good that things went pretty well, but then sure enough as I went to burp him, what felt like the entire feed came right back up and landed all over the floor. I was so scared my baby wasn’t going to be getting enough milk and now an entire feed is wasted and I burst into tears! I thought my baby was not going to gain the weight he needed.

As a nurse, my worst fear was my baby would have “failure to thrive” and have to be re-admitted to the hospital for feeding. As a Pediatric ICU nurse, I had seen many extreme cases where babies struggle with getting adequate calories and need specialized help. Luckily, my son went on to do really well. So what is this “failure to thrive” I speak of? Let’s break it down so that you can know what it is, how to spot it, treat it, and overcome it!

Failure to Thrive

Failure to Thrive, also known as FTT, is basically an abnormal pattern of weight gain. It can be caused by several different factors like undernutrition, malabsorption of nutrients, increased energy requirements, or any combination of these. The most common cause of FTT is inadequate caloric intake and so I really want to focus on that particular component as I think this is what most parents are also concerned about as well. Is my baby getting enough?

In the United States, FTT may occur in up to 10% of children in primary care settings. At each health care provider appointment, your baby will get weighed and their weight will get plotted on what we call a growth chart. The growth chart helps your healthcare provider see the trend of your baby’s weight and how they compare to the other children of the same age and height. 

The term failure to thrive is often used when a child’s weight drops below the 5th percentile for gender and corrected age or has a sustained drop in weight that falls by two major percentiles (percentile markers: 95, 90, 75, 50, 25, 10, and 5) over time. 

So for example a baby who at 1 week old is in the 50th percentile for weight drops to the 5th percentile at 1 month of age. This sort of drop by more than 2 percentile marker would require investigation and could possibly have failure to thrive. 

Treat It

Failure to thrive can be confirmed after your healthcare provider looks at your baby’s growth over time, takes a detailed history, and does a physical examination. The goal of treatment from there depends on the underlying cause. Often the reason for poor weight gain is that the baby is not receiving enough calories. Possible causes can be gastroesophageal reflux, inadequate breast milk supply, ineffective latching, incorrect formula preparation, feeding difficulties, or neglect. If the suspicion is that a baby has an underlying medical condition that is attributing to the poor weight gain that will need to be assessed.

Helping Increase Your Baby’s Calories

Your baby will need to be closely monitored by your healthcare provider with increased visits and weight checks. Luckily hospitalization is rarely indicated and most cases can be managed as an outpatient. Getting extra support though is so crucial for the success of your baby. Reach out to your local Mama Coach here if your baby is struggling with feeding and/or weight gain. We have several options to help provide you with the support you need like lactation consultations, mother/baby postpartum visits, and even bottle feeding/formula support. As Registered Nurses taking care of you and your little one is our specialty. Every baby is different and we are skilled at helping you find what works for you and your baby so you can reach your goals! 


One of the best ways to prevent potential problems with feeding is to get in the know before your baby even comes! Check out our live Mama Coach Prenatal Feeding Workshops here. Looking for a self-paced course you can do anytime and anywhere? Then our Antenatal Hand Expression Course will be the perfect fit for you! There is so much to learn and know. Set yourself up for success by getting the tools and support you need! 

Have more questions? Contact us and we will be more than happy to reach out to you! 


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