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Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population
  1. E M Olsen1,
  2. J Petersen1,
  3. A M Skovgaard2,
  4. B Weile3,
  5. T Jørgensen1,
  6. C M Wright4
  1. 1Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
  2. 2Child and Adolescent Psychiatric Centre, Glostrup University Hospital, Glostrup, Denmark
  3. 3Department of Paediatrics, Gentofte University Hospital, Gentofte, Denmark
  4. 4Unit of Paediatric Epidemiology and Child Health, Glasgow University, Glasgow, UK
  1. Correspondence to:
    Dr E M Olsen
    Research Centre for Prevention and Health, Glostrup University Hospital, 2600 Glostrup, Denmark; emao{at}


Background: 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.

Objective: To compare the prevalence and concurrence of different anthropometric criteria for FTT and test the sensitivity and positive predictive values of these in detecting children with “significant undernutrition”, defined as the combination of slow conditional weight gain and low body mass index (BMI).

Methods: Seven criteria of FTT, including low weight for age, low BMI, low conditional weight gain and Waterlow’s criterion for wasting, were applied to a birth cohort of 6090 Danish infants. The criteria were compared in two age groups: 2–6 and 6–11 months of life.

Results: 27% of infants met one or more criteria in at least one of the two age groups. The concurrence among the criteria was generally poor, with most children identified by only one criterion. Positive predictive values of different criteria ranged from 1% to 58%. Most single criteria identified either less than half the cases of significant undernutrition (found in 3%) or included far too many, thus having a low positive predictive value. Children with low weight for height tended to be relatively tall.

Conclusions: 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.

  • BMI, body mass index
  • CCCC2000, Copenhagen County Child Cohort 2000
  • FTT, failure to thrive
  • PEM, protein energy malnutrition

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  • Published Online First 10 March 2006

  • Funding:This study was funded by the Egmont Foundation, the Danish Health Insurance Foundation, the Foundation of Carl August and Jenny Andersen, the Lundbeck Foundation, the Gangsted Foundation, the Beatrice Surovell Haskell Fund for Child Mental Health Research of Copenhagen, the Rosalie Petersen Foundation, the Foundation of Director Jacob Madsen and Wife Olga Madsen, the Linex Foundation and the Danish Ministry of Social Affairs.

  • Competing interests: None declared.

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