The diagnostic skills acquired by the physician has traditionally been regarded as the art of medicine. The emphasis later moved to focusing on the science of medicine, especially nowadays when imaging technology and molecular medicine are major players that pervade all facets of clinical practice. At least the importance of communication skills is afforded high priority in the training of doctors at both undergraduate and postgraduate levels. This Perspective is designed as an over-arching comment relating to a quartet of articles (two original papers linked with their cognate perspectives) in this issue of the journal which deal with failure to thrive (FTT).^1–4 We need to analyse qualitatively whether there is any art or science on offer when considering this clinical phenomenon which, until recently, was peculiar to paediatrics. At present, it is a term that is used in gerontology to describe an elderly patient who undergoes a process of functional decline, progressive apathy and a loss of willingness to eat and drink that culminates in death.⁵ The Institute of Medicine has defined FTT in this context in clear terms, including eliminating its usage in the normal consequence of ageing, or as a synonym for dementia or as a description of a terminal disease.⁶ Where is there such clarity that FTT is used as a label for problems at the beginning of the age span?

The word thrive has several connotations …