What is Weight Faltering (Failure to
Thrive) and When Does it Become
a Child Protection Issue?
Charlotte M. Wright
Failure to thrive (FTT) is strongly associated with child neglect in professional understanding. This is so much the case that failure to thrive was until recently listed as a category of abuse under child protection guidelines (and still is in Scotland). When I first encountered this condition in the 1980s, I was working in a deprived inner-city area with an active interest in child protection. At that time it was assumed that most children with failure to thrive were living in conditions of extreme poverty and neglect and the only recognized intervention was removal into care. This stimulated us to start a programme of research into community-based treatment approaches in partnership with the NSPCC. However within a few years it was obvious that in fact most children with failure to thrive were neither neglected nor ill and that this was primarily a dietary or behavioural problem. Much of our energy since then has been directed to reframing practitioners' ideas about this condition so that it can be managed more successfully and with less stigma. However, although only a minority of all cases, neglected and abused children are still more likely to fail to thrive than other children and tend to be the most challenging of such cases to manage.
This chapter will first outline the history of research into this subject and the evidence that has led to this shift in our understanding of the causes and consequences of failure to thrive. It will then outline the process of routine weight monitoring, how growth charts may be used to identify children whose weight gain is a cause for concern and how they should ideally be managed in primary and secondary health care. Then it will discuss how we may identify