Article Text

Download PDFPDF
A picture is worth a thousand words
  1. C J Kistin,
  2. H Bauchner
  1. Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
  1. Caroline Kistin, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA; caroline.kistin{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


JB is a 5-month-old infant who is referred to a growth and nutrition clinic for poor weight gain. He was born full term with a birth weight of 6 pounds 10 ounces (3000 g), and there were no complications during the pregnancy or delivery. He has a history of spitting up (mild vomiting) after feeds and has been tried on a number of different formulas. He is currently taking seven or more bottles per day of 6–8 ounces (177–236 ml) of formula. He has no history of diarrhoea and no recent infections. There is no family history of growth problems or other illnesses. In the clinic, his height, weight and head circumference are measured and plotted on growth charts along with his prior measurements (figs 1 and 2). Based on these data he is diagnosed with weight faltering, with moderate malnutrition. In addition to seeing the doctor, JB is evaluated by a nutritionist who recommends decreasing the total daily volume of formula intake while increasing the caloric density of the formula. A plan is made to follow up in 2 weeks with interim home visits by the nutritionist and by a social worker.

Figure 1 Case 1 JB: length for age and weight for age percentiles.
Figure 2 Case 1 JB: head circumference for age and weight for length percentiles.


Weight faltering, also known as failure to thrive, is an imprecise term used to describe patients who are not growing as expected. The cases and growth charts included here are drawn from those belonging to patients in a growth and nutrition clinic in the United States and focus on the growth of children 0–5 years of age with no known chronic medical conditions, such as cystic fibrosis, that can be associated with poor growth. It is important to note that weight faltering in resource-rich countries is substantially different from growth failure in low- and middle-income countries. It is rare that micronutrient deficiencies, other than iron and zinc, …

View Full Text


  • Competing interests: None.