Faltering Growth / Failure to Thrive

General Symptoms of Cow'S Milk Protein Allergy.

Faltering growth is defined by the WHO as a fall in weight for age Z-score of ≥ 1.0 SD that merits evaluation.1 The term is used to refer to a slower rate of weight gain in childhood than expected for age and sex.


However, in a recent review they propose that a time frame should be added to ensure children are not falsely categorized with growth faltering, especially following an acute illness such as diarrhea or vomiting.3 

As there are many biological, psychosocial and environmental processes that can lead to malnutrition, FTT should never be a diagnosis in itself.4

If we consider average growth, then most infants have tripled their birth weight by the first birthday and increased their length by about 24 centimetres.5 But all babies are different, and their growth comes in spurts, so it not constant.


What Causes
to Thrive in

Growth problems can be caused by a number of factors both organic (illness) and non-organic (non-illness related), including genetics, hormonal disorders, illnesses, and poor absorption of food.6

Organic causes include a Cow’s Milk Protein Allergy (CMPA), congenital and metabolic disorders, as well as infections, which result in inadequate nutrient uptakes for the infant to achieve optimal growth.4,7

Could It Be a
Symptom of
Cow’s Milk
Protein Allergy?

In cases of severe CMPA in breastfed infants, failure to thrive has been reported, which can have detrimental long-term consequences. Failure to thrive is one of the general symptoms of CMPA and may result as a culmination of several other factors.8,9

It is recommended that infants presenting with failure to thrive (and sick infants with hematochezia), require urgent referral and full diagnostic work up.

Overview of Symptoms

Respiratory icon


Up to 30% of affected infants with CMPA have respiratory symptoms15,20

Anaphylaxis icon


Anaphylactic shock is a severe, immediate, allergic reaction, which can affect many organ/systems

Skin icon


Up to 75% of infants with CMPA can have skin-related symptoms21

General Symptoms icon


Inconsolable crying is very common in infants with CMPA associated with sleeping problems and food refusal