saudigastro.com/patients/failure-to-thrive
Category
Serious
Red flags
6
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Children grow at different rates, and doctors follow growth on charts that compare a child with others of the same age and sex. "Failure to thrive" or "faltering growth" describes a child whose weight (and sometimes height) is below expected or is falling across the chart lines over time. It is a sign, not a diagnosis; the doctor looks for the reason. A single low reading is not a cause for panic, and some small children are healthy and following their own family pattern.
How common is it?
Concerns about growth are a common reason for visits to child health services, especially in the first years of life. Most children are found to be getting too little food energy for their needs, often because of feeding difficulties, rather than having a serious disease.
Why does it happen?
Growth can slow when a child takes in too little energy (poor appetite, feeding difficulties, limited food, difficulty sucking or swallowing), absorbs too little (coeliac disease, cow's milk protein allergy, cystic fibrosis, liver and bile problems, chronic diarrhoea), or needs more energy than usual (chronic infections, heart or lung disease, inflammatory bowel disease). Hormonal, kidney, genetic and emotional or social factors also play a role. Often more than one factor is present.
Symptoms
- Weight (and sometimes height) lower than expected or falling across growth chart lines
- Poor appetite, picky eating, or taking a very long time to feed
- Frequent vomiting, diarrhoea, or bulky, greasy, foul-smelling stools
- Tiredness, low energy, or being less active than other children
- Frequent infections or delayed milestones
- Thin arms and legs with a round belly, or looking pale
Red flags — seek urgent medical care
A baby who is feeding poorly, is very sleepy or floppy, or has signs of dehydration (dry mouth, no tears, few wet nappies, sunken soft spot)
Needs urgent medical assessment. A baby who needs urgent care should be seen immediately.
Green vomit, persistent forceful vomiting, or a swollen belly
May be a bowel blockage. Go to the emergency department now.
Yellow skin or eyes, pale stools or dark urine
Could be a liver or bile duct problem. See a doctor urgently.
Blood in the stool, chronic diarrhoea, or fever that keeps returning
Suggests an infection, allergy or bowel inflammation that needs assessment.
Fast breathing, breathlessness when feeding, or blue lips
May indicate a heart or lung problem. Seek emergency care.
Weight loss, or no weight gain over several weeks, in a baby or toddler
See your doctor soon rather than waiting for the next routine check.
How is it diagnosed?
The doctor plots your child's weight, length or height and head size on growth charts, compares with earlier measurements and with the parents' sizes, and asks about pregnancy, birth, feeding, stools, development, family and home. A feeding history or a diary of what your child eats over a few days is very helpful. Tests are chosen according to the story and examination, and are not done for every child. They may include blood, urine and stool tests, and sometimes tests for coeliac disease, infections or other conditions. A dietitian is often involved.
Outlook — what to expect
Many children catch up once the cause is found and treated, especially when the problem is identified early. Long-standing undernutrition in the first years of life can affect growth and development, so early assessment matters. Your doctor will monitor progress closely.
Treatment
Habits & Lifestyle
Calm, regular mealtimes help most children eat better.
- Offer meals and snacks at regular times, about 3 meals and 2 to 3 snacks, with no grazing or constant milk or juice in between.
- Eat together at the table without screens, and let your child feed themselves when old enough.
- Keep mealtimes relaxed and under about 30 minutes. Do not force, bribe or punish; pressure often makes eating worse.
- Weigh your child only as often as your clinic advises; very frequent weighing can cause worry.
- Keep a simple food diary to share with the doctor and dietitian.
Diet
The aim is to increase healthy energy intake without harming the child's appetite. A dietitian can tailor a plan.
- Offer energy-dense foods such as full-fat dairy (if allowed), eggs, avocado, nut butters (where age-appropriate), olive oil and well-cooked meat and fish.
- Do not make a young child's diet low-fat or high-fibre unless advised, since this fills them up without giving enough energy.
- Limit large amounts of milk, juice and sweet drinks that fill the stomach before meals.
- Do not start special formulas, supplements, appetite stimulants, or restrictive diets without medical advice; if supplements are needed, the doctor or dietitian will choose them.
- For breastfed babies, a feeding assessment by a trained professional can identify latch or supply problems.
Medications
There is no medicine that simply "makes a child grow"; treatment targets the cause.
- If a medical cause is found, such as reflux, allergy, coeliac disease, infection or anaemia, it will be treated specifically.
- Vitamin or iron supplements are given only after assessment.
- Appetite stimulants and herbal "weight gain" products are not recommended for children without medical supervision and can be unsafe.
- The doctor decides every medicine and dose.
Procedures & Surgery
Most children never need a procedure.
- If tests suggest a gut cause, the specialist may recommend an endoscopy with biopsies, ultrasound or other imaging.
- A short hospital stay is sometimes used to observe feeding and growth and to test responses to a feeding plan.
- Children who cannot take enough by mouth may be offered tube feeding for a time, planned and supervised by a specialist team.
Living with the condition
- Feeding worries are stressful. Seek support from your health visitor, dietitian or paediatrician.
- Celebrate small improvements and avoid comparing your child with others.
- Keep all follow-up appointments so that growth can be tracked and the plan adjusted.
In the Saudi context
Family and relatives often encourage extra feeding or offer traditional remedies and tonics. Please check with your doctor before giving herbal products or "weight gain" supplements to a child, and avoid pressuring a child to eat.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Is my child's growth really a concern, or are they following their own pattern?
- What tests, if any, does my child need?
- How many calories or what kind of feeding plan is right for my child?
- How often should my child be weighed and measured?
- Which signs mean we should return sooner?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide