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Failure to Thrive

Summary

Faltering growth, previously known as failure to thrive, describes a child’s weight, height, or body mass index (BMI) falling below expected levels for their age. It may also refer to a slower-than-expected growth rate.

This condition can occur in children of all socio-economic backgrounds but is more common in families facing multiple challenges, such as food insecurity or limited access to healthcare. Regardless of the cause, growth concerns can be stressful for families and may lead to anxiety and parent-child conflicts.

Diagnosis and When to Seek Help

Doctors diagnose faltering growth by carefully tracking a child’s growth over time, measuring weight, height (or length), and head circumference. They also assess:

  • Nutritional intake – How much and what types of food a child consumes daily.
  • Feeding environment – Family routines, meal consistency, and whether meals are provided in a nurturing setting.
  • Medical history and physical examination – Looking for any underlying medical conditions.

Extensive medical tests are not always needed, but they may be performed if there are concerns about an underlying health issue.

If a child is not meeting growth expectations or shows signs of poor nutrition, early intervention is key. Seek medical advice if you notice:

  • Significant or persistent weight loss or slow growth
  • Feeding difficulties, such as refusal to eat or frequent vomiting
  • Delayed developmental milestones
  • Unusual lethargy, irritability, or persistent digestive issues

Management

Treatment for faltering growth depends on the underlying cause and often requires a team approach, involving medical professionals, nutritionists, psychologists, and social workers. Strategies may include:

  • Nutritional support – Encouraging nutrient-rich meals and snacks tailored to the child’s needs.
  • Parental guidance – Helping caregivers create structured, stress-free mealtime routines.
  • Addressing underlying health conditions – If a medical issue is contributing to poor growth, targeted treatment may be needed.

Hospitalization is reserved for severe cases, such as when a child has significant weight loss, dehydration, or other medical complications.

Follow-Up and Monitoring

Regular check-ups are essential to track progress and adjust the management plan as needed. Families may also receive support from social workers or mental health professionals to address stress and anxiety related to feeding challenges.

Early recognition and intervention can significantly improve outcomes, ensuring a child reaches their full growth and developmental potential. If you have concerns about your child’s growth, consult a healthcare provider for personalized guidance.

History and Exam

Key diagnostic factor

  • presence of risk factors
  • faltering growth
  • signs of malnutrition
  • poor social history

Other diagnostic factors

  • family history of faltering growth
  • increased caloric loss
  • gastrointestinal symptoms
  • comorbid medical history

Risk factor

  • small for gestational age (SGA)
  • gastrointestinal problems (reflux, coeliac disease)
  • poor carer knowledge
  • poor carer-child interaction

Diagnostic Investigations

1st investigations to order

  • according to clinical assessment
  • FBC
  • iron studies
  • chemistry panel

Investigations to consider

  • blood lead level
  • serological testing for coeliac disease
  • stool analysis
  • HIV testing or other infectious screen

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    Other Related Conditions

    coeliac disease

    Inflammatory bowel disease (Crohn’s disease or Ulcerative Colitis)

    Eosinophilic Oesophagitis

    cow’s milk protein intolerance, food allergies

    irritable bowel syndrome (ibs)

    reflux & vomiting

    failure to thrive

    constipation or diarrhoea

    incontinence

    chronic abdominal pain

    gastroparesis

    liver disease

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      Social and emotional functioning refers to a child’s ability to understand, express, and manage their emotions, as well as to interact effectively with others. These skills are fundamental for building positive relationships, developing empathy, and coping with the everyday challenges of growing up.

      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

      In the school environment, social and emotional difficulties can impact a child’s engagement, cooperation, and overall learning experience. Emotional distress may manifest as withdrawal, irritability, or disruptive behaviour, which can further affect academic progress and peer relationships.

      Assessment of social and emotional functioning as part of a neuropsychological evaluation typically includes behavioural observations, standardized rating scales, and information gathered from parents, teachers, and sometimes the child. This comprehensive approach helps identify strengths and areas for support in emotional regulation, social skills, and adaptive behaviours.

      Understanding a child’s social-emotional profile allows for the development of tailored strategies to enhance emotional wellbeing, build resilience, and improve social communication. Early intervention and supportive environments can empower children to navigate their emotions more effectively, fostering confidence and meaningful connections. 

      At Offspring Health, we aim to provide transparent information about the costs involved in neurodevelopmental and educational assessments.

      Neuropsychological assessments typically involve multiple sessions that usually take between 8 and 16 hours in total, depending on the complexity and individual needs. Our hourly rate is $260, so the total cost typically ranges between $2,300 and $4,230.

      Fees generally cover:

      • Initial consultation and history gathering
      • Testing sessions where your child will complete various fun and interactive tasks
      • Liaison with schools or health professionals as needed
      • Comprehensive case analysis and report preparation
      • Feedback sessions with families and, where applicable, educators or other professionals

      Please note that standard neuropsychological assessments are generally not covered by Medicare. However, some assessments and therapy services may be funded through the National Disability Insurance Scheme (NDIS) for eligible participants. We recommend discussing funding options with your NDIS planner or support coordinator prior to booking. Private health insurance may offer partial rebates depending on your level of coverage.

      What’s the next step?

      Please phone reception for a discussion about your needs or email psychology@offspringhealth.com