Failure-to-thrive should be differentiated from the following conditions:

The evaluation of a child with failure-to-thrive requires several critical steps:

  1. An accurate growth curve (height, weight, head circumference and weight for height) with multiple points over time. (The weight-for-height chart can be found below the head circumference chart on most standardized growth charts.) In general, even children with genetic short stature, constitutional growth delay, or short stature as a result of prematurity or intrauterine growth retardation are height/weight proportionate when plotted on a weight for height chart. Babies who are failing to thrive, are disproportionate. They lose weight percentiles first, followed by height percentiles, with head growth spared except in extreme cases.
  2. Complete past medical history including birth history
  3. Developmental history
  4. Family history, including heights of both parents
  5. A thorough social history to assess sources of parental stress, parent-child interaction, child temperament, and signs of potential physical, mental or sexual abuse or neglect.
  6. A few basic laboratory tests may be important for determining the etiology of failure to thrive.

Hospitalization is usually not required except in children who show evidence of chronic or severe malnutrition, children who continue to show poor weight gain despite aggressive outpatient evaluation and therapy, and children who may be in an environment that suggests maltreatment or danger to the child.