Understanding What is the Diet for Failure to Thrive?

October 20, 2025 •

4 min read

Research indicates that most cases of failure to thrive (FTT) are caused by inadequate caloric intake, often due to behavioral or psychosocial issues. For parents navigating this challenge, understanding what is the diet for failure to thrive is the most crucial step towards recovery and healthy growth.

Quick Summary

For children with failure to thrive, the dietary approach centers on increasing calorie density and balancing key nutrients to promote catch-up growth. This involves strategies like fortifying foods with healthy fats, scheduling regular meals and snacks, and creating a positive feeding environment.

Key Points

Increase Calorie Density: Pack more calories and nutrients into smaller portions by fortifying foods with healthy fats like butter, oil, and full-fat dairy.
Focus on Nutrient-Rich Foods: Prioritize proteins (meat, eggs), healthy fats (avocado, nuts), and complex carbohydrates (whole grains) over empty calories from sugary drinks or junk food.
Establish a Feeding Routine: Implement a consistent schedule of three meals and two to three snacks to manage appetite and avoid constant grazing.
Create a Positive Environment: Reduce mealtime stress by minimizing distractions, avoiding pressure, and observing the child's feeding cues.
Consider Supplements and Fortified Formulas: In some cases, a medical professional may recommend high-calorie formula or vitamin/mineral supplements, particularly iron and zinc.
Seek Multidisciplinary Support: A team approach involving pediatricians, dietitians, and feeding therapists offers the best chance for successful intervention.
Be Patient: Catch-up growth takes time. Consistent and targeted nutritional support is more important than short-term results.

Failure to thrive (FTT) is a medical term for infants or children who do not gain weight and grow at the expected rate for their age. The primary goal of a diet for FTT is to provide the child with adequate calories and nutrients to support "catch-up growth"—a period of accelerated growth to compensate for previous nutritional deficiencies. This dietary management is most effective as part of a multidisciplinary approach involving pediatricians, dietitians, and other specialists.

Increasing Calorie Density

Since many children with FTT have small appetites, the core strategy is to increase the calorie density of the food they do eat. This means packing more nutritional punch into smaller amounts of food, which can be done through fortification and smart food choices. Instead of low-calorie options like juice, the focus is on nutrient-dense foods.

Food Fortification Techniques

Fortifying foods involves adding extra calories and nutrients to a child's regular meals and snacks without significantly increasing the portion size.

Add fats: Mix healthy fats like butter, margarine, olive oil, or mayonnaise into vegetables, pasta, and mashed potatoes. For infants, a dietitian may recommend adding calorie-dense oils like MCT oil to formulas.
Use full-fat dairy: Switch from low-fat to full-fat dairy products. Add cheese to scrambled eggs, pasta, or vegetables. Use whole milk or cream in sauces, soups, and puddings.
Add powders: Mix dried skimmed milk powder into milk, custards, and mashed potatoes to boost protein and calories. Commercial protein or carbohydrate powders, like ProMod or Polycose, can be used under a doctor's supervision.

High-Calorie Food Choices

For infants and toddlers
- Breast milk/fortified formula: For infants, a doctor may prescribe a high-calorie formula or provide instructions for fortifying breast milk.
- Calorie-rich fruits: Introduce pureed or mashed bananas, mangoes, and avocados.
- Full-fat yogurt and cheese: Full-fat yogurt and soft cheeses are excellent sources of calories and protein for babies over one year.
- Legumes: Pureed pulses and lentils provide protein and nutrients.
For older children
- Nut and seed butters: Peanut butter, almond butter, and sunflower seed butter are calorie-dense and versatile.
- Eggs: Scrambled eggs made with half-and-half and cheese are a great option.
- Starchy vegetables: Sweet potatoes, potatoes, and yams.
- Snacks: Nutritious, calorie-dense snacks like cheese and crackers, fruit smoothies with yogurt, and high-energy milkshakes are encouraged.

Optimizing Macronutrients and Micronutrients

While calories are essential, a balanced diet with proper macronutrients (protein, fat, carbs) and micronutrients (vitamins, minerals) is vital for healthy development.

Proteins: The building blocks for tissue growth and repair. Good sources include lean meats, eggs, poultry, fish, beans, and lentils.
Fats: Crucial for brain development and a concentrated source of calories. Healthy fats from avocados, nuts, seeds, and fatty fish like salmon are recommended.
Carbohydrates: Provide energy. Focus on complex carbs from whole grains, starchy vegetables, and fruits for sustained energy.
Micronutrients: Children with FTT often require supplements for vitamins and minerals like iron, zinc, and vitamin D, as determined by a pediatrician.

Creating a Positive Feeding Environment

Stressed or rushed mealtimes can worsen feeding difficulties. Creating a calm, positive atmosphere can make a significant difference.

Offer frequent, smaller meals: Instead of three large, overwhelming meals, offer three meals and two to three snacks.
Maintain a routine: A predictable schedule helps manage expectations and hunger.
Minimize distractions: Turn off the TV and put away tablets. Mealtime should be focused on eating and positive interaction.
Avoid pressure: Forcing a child to eat can create negative associations with food. Let the child decide how much they will eat from the options provided.
Address feeding difficulties: For sensory, sucking, or swallowing issues, specialized feeding therapy may be necessary.

When Specialized Nutrition is Needed

In severe or persistent cases of FTT, more advanced nutritional support may be required.

High-energy commercial supplements: Drinks like PediaSure or Boost can provide a significant calorie boost.
Enteral nutrition: For children who cannot take in enough nutrition orally, a feeding tube may be recommended. A nasogastric (NG) tube or a gastrostomy (G-tube) can provide consistent nutrition and calories directly to the stomach.

Comparison of Feeding Strategies for FTT


Strategy	Description	Best For	Considerations
Food Fortification	Adding high-calorie, nutrient-dense ingredients (fats, powders) to existing foods.	Mild-to-moderate FTT, picky eaters, boosting intake without increasing volume.	Requires careful monitoring to ensure proper nutritional balance. Must avoid "empty calories."
Scheduled Meals & Snacks	Offering 3 meals and 2-3 structured, nutritious snacks per day, avoiding grazing.	Most cases of FTT, improving eating habits and managing appetite.	Requires consistency and patience from caregivers. Child must be hungry at mealtimes.
High-Energy Oral Supplements	Liquid nutritional drinks (e.g., PediaSure) provide extra calories and protein.	Children who struggle to meet calorie needs through fortified foods alone.	Should be used under medical supervision. Can decrease appetite for solid foods if overused.
Enteral Tube Feeding	Delivering nutrition via a tube (NG-tube or G-tube) directly to the stomach.	Severe malnutrition or underlying conditions that prevent sufficient oral intake.	A major intervention requiring medical guidance and support. Can be temporary or long-term.

Conclusion

Addressing the diet for failure to thrive requires a multi-faceted and patient approach. Focusing on increasing calorie density through food fortification and high-energy options is critical, but it must be coupled with creating a positive and supportive feeding environment. The specific nutritional plan should be individualized based on the child's age, appetite, and any underlying medical issues, with the guidance of a pediatrician and registered dietitian. By implementing these strategies consistently and patiently, families can support their child's recovery and help them achieve the healthy growth they need to thrive. For additional resources on pediatric nutrition, families can explore reputable organizations like the American Dietetic Association or specialized pediatric clinics.

Frequently Asked Questions

Focus on calorie-dense, nutrient-rich foods such as full-fat dairy products (whole milk, cheese, yogurt), healthy fats (avocado, olive oil, nut butters), and protein sources (eggs, lean meat, pulses). Fortify meals by adding butter, cheese, or milk powder to increase calories.

You can fortify foods by adding extra fat and protein. Mix butter or oil into vegetables and pasta, add grated cheese to soups and eggs, or blend dried milk powder into custards and drinks. A dietitian can provide specific, safe recipes.

High-calorie drinks, such as homemade milkshakes with full-fat milk, yogurt, and fruit, or commercial supplements like PediaSure, can be effective. However, they should be offered between meals, not before, to avoid spoiling their appetite for solid food.

Establish a consistent routine of three regular meals and two to three snacks per day. Avoid allowing the child to graze between these structured feeding times, as this can lead to them being less hungry for larger, more nutritious meals.

No, it is not recommended to rely on empty calories from junk food like lollies, chips, or sugary drinks. While they are high in calories, they lack the essential vitamins and minerals needed for healthy growth and can reduce the child's appetite for nourishing foods.

Patience is key. Do not pressure your child to eat, as this can make mealtimes more stressful. Continue to offer healthy options consistently and create a positive feeding environment. For persistent issues, a feeding therapist can provide specialized help.

In severe cases where a child cannot consume enough calories orally due to medical or developmental issues, a feeding tube (nasogastric or gastrostomy) may be recommended by a medical team. This ensures the child receives consistent and adequate nutrition.