Failure To Thrive

Failure to thrive (FTT) in infants or faltering growth, is a term used to describe inadequate growth or the inability to maintain growth and is a sign of undernutrition. As there are many biological, psychosocial and environmental processes that can lead to malnutrition, FTT should never be a diagnosis in itself.1

Although healthy infants vary in size, infant growth still tends to follow a predictable path with length and weight gain velocity at its highest during infancy.2 Length/height and weight are used as indicators of an infant’s health, development and nutritional status.3

Weight: In general an infant’s birth weight doubles within the first six months and they gain five to seven ounces (about 140 to 200 grams) a week. An infant’s weight should triple by the end of the first year as they gain three to five ounces (about 85 to 140 grams) a week.4

Height/length: A baby’s height will increase by 50% from birth to 12 months. From birth to age six months, a baby may grow 1/2 to one inch (about 1.5 to 2.5 centimetres). From ages six to 12 months, a baby may grow 3/8 inch (about one centimetre) a month.4

growth disorder

What causes FTT in infants?

The causes of FTT and faltering growth in infants can be both non-organic and organic in nature, however in most cases the cause is multifactorial. Non-organic causes include poverty and an inconsistent feeding routine. Organic causes include a Cow’s Milk Protein Allergy (CMPA) and metabolic disorders, which result in an inadequate caloric absorption for an infant as well as congenital heart disease and infections, which lead to excessive caloric expenditure.1,5

Failure to thrive as a symptom of Cow’s Milk Protein Allergy

When severe CMPA occurs in breastfed infants, failure to thrive has been reported as a symptom, which can have detrimental consequences for a growing infant. Failure to thrive is one of the general symptoms of CMPA and may result as a culmination of several other factors.6,7

Signs and symptoms related to CMPA

The majority of infants affected with CMPA have at least two symptoms affecting at least two different organ systems.8,9


Having an awareness of the most common symptoms of CMPA can help you to make an earlier diagnosis of CMPA in your patients.

CoMiSS® awareness tool

The Cow’s Milk-related Symptom Score (CoMiSS)® is a simple, fast and easy-to-use awareness tool designed to help you more easily recognise the signs and symptoms that can be cow’s milk-related in infants and young children.

CoMiSS® awareness tool is available in print and online version
If you suspect your patient is suffering from symptoms that may be suggestive of CMPA, use the CoMiSS® tool to score and assess the likelihood of CMPA.



1.    Cole SZ. and Lanham JS. Am Fam Physician. 2011:1;83(7):8829–34

2.    Pediatric nutrition in practice. World Review of Nutrition and Dietetics 2015; Vol. 113, pp 1–5

3.    Canadian Paediatric Society. Paediatr Child Health Mar 2004;Vol 9 No 3

4.    Infant and toddler health. Oct 2014. Accessed February 2016

5.    Krugman SC. and Dubowitz H. Am Fam Physician 2003;68:879:884

6.    Koletzko S., et al. J Pediatr Gastroenterol Nutr. 2012;55(2):221–9

7.    Vandenplas Y., et al. Arch Dis Child 2007;92:902–8

8.    Lifschitz C. and Szajewska H. Eur J Pediatr. 2015;174:141–50

9.    Høst A. Pediatr Allergy Immunol. 1994;5:1–36

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cow’s milk protein allergy. This usually requires qualified dietary counseling to completely exclude all sources of cow’s milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.