Why the Terminology Shifted from Failure to Thrive to Growth Faltering
The medical community has moved away from "failure to thrive" (FTT) to "growth faltering" primarily because the term is more precise, less stigmatizing to families, and avoids ambiguity in populations where short stature is part of the clinical phenotype.
Primary Reasons for the Terminology Change
Lack of Standardized Definition
The term "failure to thrive" has suffered from a fundamental problem of inconsistent definition for decades:
- No consensus exists on specific anthropometric criteria to define FTT, despite widespread use of the term for over 50 years 1
- Reviews of medical literature show that only 9 of 22 pediatric textbooks and 9 of 13 journal articles provided quantitative definitions, and even these lacked consensus on which anthropometric indices to use 1
- Different studies use varying parameters including weight alone, weight-for-height, BMI, or combinations of multiple measurements, with cutoffs ranging around the 5th to 10th percentiles 2
- This absence of a standard, scientifically credible definition has produced an ambiguous body of literature that hampers clinical care and research 1
Ambiguity in Specific Populations
The term "growth faltering" addresses a critical limitation when applied to certain patient populations:
- In skeletal dysplasia conditions where short stature is the clinical phenotype, the term "failure to thrive" becomes ambiguous because low height growth is expected 3
- The preferred updated terminology "growth faltering" is more specific, though it still requires clear definitions of what is being measured (underweight vs. malnutrition) and which growth standards are being used 3
- Condition-specific growth charts are now available for various skeletal dysplasias, making precise terminology even more important for accurate diagnosis 3
Reduced Stigma and Blame
The shift reflects a more family-centered approach to care:
- "Failure to thrive" implies blame and can increase parental anxiety, whereas "growth faltering" is a more neutral, descriptive term 4
- The newer terminology focuses on the growth pattern itself rather than suggesting failure on the part of the child or caregivers 5, 6
- This is particularly important since inadequate caloric intake—the most common cause—often results from complex feeding dynamics rather than neglect 5, 6
Evolution Toward Precision Medicine
Modern pediatric nutrition has moved toward more precise terminology:
- "Growth faltering" is now used interchangeably with "pediatric malnutrition" and "weight faltering", reflecting a broader understanding of nutritional status 5
- The term integrates better with the redefinition of pediatric malnutrition as a disequilibrium between requirements and intakes of energy and nutrients 7
- Anthropometric z-scores are now recommended over traditional criteria because they can be calculated with a single set of measurements and better track severity over time 6
Clinical Implications
Better Diagnostic Clarity
The terminology change supports more accurate assessment:
- Growth faltering describes children who do not reach expected weight, length, or BMI for age using standardized WHO charts (under 2 years) or CDC charts (2 years and older) 6
- Serial measurements over time are more informative than single evaluations, with a sharp decline or flattening of the growth curve indicating growth faltering 8
- Clear definitions must include the specific terminology used (underweight, malnutrition, growth faltering) and the growth standards applied for classification 3
Common Pitfall to Avoid
Despite the terminology change, clinicians must remember that the underlying clinical entity remains the same—inadequate growth requiring evaluation and intervention 5, 6. The shift in terminology should not delay recognition or treatment, as failure to address growth faltering in the first two years of life may result in decreased adult height and cognitive potential 6.