Anthropometric Criteria of Failure to Thrive

Anthropometric Criteria of Failure to Thrive

Failure to thrive (FTT) in early childhood is associated with subsequent developmental delay and is recognised to reflect relative undernutrition. Although the concept of FTT is widely used, no consensus exists regarding a specific definition, and it is unclear to what extent different anthropometric definitions concur. The operative definition of “non-organic” FTT  in developed societies is not agreed upon, resulting in difficulty in  establishing a clear diagnosis and in blurring the divide between a normal  extreme and clinical illness; the latter perhaps associated with impaired  development.

However, a suboptimal nutritional state is usually recognized as one of the hallmarks of this entity.2 Olsen et al evaluated growth data from 6090 Danish children examined between 1 to 5 weeks of age, 2 to 6 months of age, and 6 to11 months of age in an effort to establish the prevalence of this growth pattern. Utilizing 7 anthropometric criteria of FTT (Table), they examined the concurrence of these criteria in establishing its presence. In this population of infants, 27% met one or more of the anthropometric criteria at either the earlier (3-6 months) or later (6-11 months) examinations.

Only 1.3% of infants met the criterion “weight <80% of  median weight for length,” and they were a good deal longer than other infants.  Twenty-two percent of infants crossed 2 major weight percentiles downward, but  they were substantially heavier at birth and throughout the study than were  other children with FTT. None of the infants in this study were concordant for  all 7 criteria, and approximately 70% of subjects with FTT met only one  criterion. Significant under-nutrition, defined as BMI <5th   percentile for chronological age, was present in only 2% of children screened.

No single measurement on its own seems to be adequate for identifying nutritional growth delay. Further longitudinal population studies are needed to investigate the discriminating power of different criteria in detecting significant undernutrition and subsequent outcomes.

Anthropometric Criteria  of Failure to Thrive

  • Weight <75% of median weight for chronological age (Gomez criterion)
  • Weight <80% of median weight for length (Waterlow criterion)
  • Body mass index for chronological age <5th centile
  • Weight for chronological age <5th centile
  • Length for chronological age <5th centile
  • Weight deceleration crossing more than two centile lines; centile lines used: 5, 10, 25, 50, 75, 90, 95, from birth until weight within the given age group
  • Conditional weight gain=lowest 5%, adjusted for regression towards the mean from birth until weight within the given age group*
*Conditional weight gain was determined by the “thrive index” – the change in weight z-scores between 2 points, from birth to the later age, adjusted for regression to the mean.
Infant growth chart: How much should my baby grow?
Age Average growth in height Average growth in weight
0-6 months 6-7 inches 7-12 pounds
6-12 months 3-4 inches 5-7 pounds
1-2 years 4-5 inches 5-7 pounds


  • Olsen EM, Petersen J, Skovgaard AM, Weile B, Jørgensen T, Wright CM.
  • Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population. Arch Dis Child. 2007 Feb;92(2):109-14. Epub  2006 Mar 10.
  • Hughes I.  Confusing terminology attempts to define the undefinable. Arch Dis Child. 2007;92:97-8.
  • Spencer NJ.  Failure to think about failure to thrive. Arch Dis Child. 2007;92:95-96.
  • Emond A, Drewett  R, Blair P, Emmett P. Post natal factors associated with failure to thrive in  term infants in the Avon Longitudinal Study of Parents and Children. Arch Dis Child. 2007;92:115-9.
  • Lucas P, Arai L, Baird  J, Kleijnen J, Law C, Roberts H. A systematic review of lay views about infant  size and growth. Arch Dis Child  2007;92:120-7.
  • Blair PS, Drewett RF, Emmett PM, Ness  A, Emond AM. Family, socioeconomic and prenatal factors associated with failure  to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC). Int J Epidemiol. 2004;33:839-47.
  • Wright CM, Weaver  LT. Image or reality: why do infant size and growth matter to parents? Arch Dis Child. 2007;92:98-100.
  • Mei Z, Grummer-Strawn LM, Thompson D,  Dietz WH. Shifts in percentiles of growth during early childhood: Analysis of  longitudinal data from the California Child Health and Development Study. Pediatrics. 2004;113:e617-27.


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