Neglect and Failure to Thrive

  • Lauren R. BurgeEmail author
  • Penelope T. Louis
  • Angelo P. Giardino


Neglect is the most common form of child maltreatment in the United States and manifests in many different forms such as educational, medical, physical, or emotional neglect. This chapter identifies, defines, and elaborates on neglect in childhood as well as its effects on children and their growing bodies. Certain cultural and economic factors also influence our views of childhood neglect and should be considered when treating this vulnerable population. Failure to thrive (FTT) is a well-known phrase in pediatrics used to describe children who are poorly nourished and are failing to grow and develop normally. This chapter further explores the diagnosis and management of FTT as well as offers several real-life examples for further discussion at the end of the chapter. Neglect and FTT may exist either independently or concomitantly; however, both entities affect a child’s physical and emotional well-being and should be quickly diagnosed and effectively treated so as to minimize their harmful effects on the growing child.


Faiure to thrive Neglect Medical neglect Refeeding 


  1. Ayatollahi, S.-M.-T., & Mostajabi, F. (2008). Triceps skinfold thickness centile charts in primary school children in Shiraz. Archives of Iranian Medicine, 11(2), 210–213.PubMedGoogle Scholar
  2. Barbero, G. J., & Shaheen, E. (1967). Environmental failure to thrive: A clinical view. Journal of Pediatrics, 71, 639–644.CrossRefGoogle Scholar
  3. Berwick, D. M., Levy, J. C., & Kleinerman, R. (1982). Failure to thrive: Diagnostic yield of hospitalization. Archives of Diseases of Childhood, 57, 347–351.CrossRefGoogle Scholar
  4. Bhatia, S., Maguire, S., Chadwick, B., Hunter, M., Harris, J., Tempest, V., et al. (2014). Characteristics of child dental neglect: A systematic review. Journal of Dentistry, 42, 229–239.CrossRefGoogle Scholar
  5. Bithoney, W. G., Dubowitz, H., & Egan, H. (1992). Failure to thrive/growth deficiency. Pediatrics in Review, 13, 453–459.CrossRefGoogle Scholar
  6. Black, M. M., Dubowitz, H., Casey, P. H., et al. (2006). Failure to thrive as distinct from child neglect. Pediatrics, 117, 1456–1458.CrossRefGoogle Scholar
  7. Block, R. W., Krebs, N. F., Committee on Child Abuse and Neglect, & Committee on Nutrition. (2005). Clinical report. Guidance for the clinician in rendering care. American academy of pediatrics. Pediatrics, 116, 1234–1237.CrossRefGoogle Scholar
  8. Boxer, G. H., Carson, J., & Miller, B. D. (1988). Neglect contributing to tertiary hospitalization in childhood asthma. Child Abuse & Neglect, 12, 491–501.CrossRefGoogle Scholar
  9. Brandt, L. (1979). Growth dynamics of low birthweight infants with emphasis on the perinatal period. In F. Faulkner & J. Tanner (Eds.), Human growth neurobiology and nutrition. New York: Plenum.Google Scholar
  10. Chapin, H. D. (1908). A plan for dealing with atrophic infants and children. Archives of Pediatrics, 25, 491–496.Google Scholar
  11. Chatoor, J., & Egan, J. (1983). Nonorganic failure to thrive and dwarfism due to food refusal: A separation disorder. Journal of the American Academy of Child Psychiatry, 22, 294.CrossRefGoogle Scholar
  12. DePanfilis, D. (2006). Child neglect: A guide for prevention, assessment, and intervention. U.S. Department of Health and Human Services. Administration for Children and Families. Administration on Children, Youth and Families Children’s Bureau. Office on Child Abuse and Neglect.
  13. Dubowitz, H., Black, M., Starr, R. H., & Zuravin, S. (1993). A conceptual definition of child neglect. Criminal Justice and Behavior, 20, 8–26.CrossRefGoogle Scholar
  14. Dubowitz, H., Giardino, A. P., & Gustavson, E. (2000). Child neglect: Guidance for pediatricians (Review). Pediatrics in Review, 21(4), 111–116.CrossRefGoogle Scholar
  15. Ficicioglu, C., & Haack, K. (2009). Failure to thrive: When to suspect inborn errors of metabolism. Pediatrics, 124(3), 972–979.CrossRefGoogle Scholar
  16. Fontana, V. J., & Besharov, D. J. (1979). Maltreated Child- The Maltreatment Syndrome in Children- A Medical, Legal, and Social Guide, 4th ed. Springfield, IL: Charles C. Thomas.Google Scholar
  17. Fortin, K., Kwon, S., & Pierce, M. (2016). Characteristics of children reported to child protective services for medical neglect. Hospital Pediatrcs, 6(4), 204–210.CrossRefGoogle Scholar
  18. Franklin, W., & Klein, R. E. (1987). Severe asthma due to household pets: A form of child abuse or neglect. New England Regional Allergy Proceedings, 8, 259–261.CrossRefGoogle Scholar
  19. Gahagan, S. (2006). Failure to thrive: A consequence of undernutrition. Pediatrics in Review, 27, e1–e11.CrossRefGoogle Scholar
  20. Goldbloom, R. B. (1987). Growth failure in infancy. Pediatrics in Review, 9(2), 57–61.CrossRefGoogle Scholar
  21. Golden, M. (2015). Nutritional and other types of oedema, albumin, complex carbohydrates and the interstitium-a response to Malcolm Coulthard’s hypothesis: Oedema in kwashiorkor is caused by hypo-albuminaemia. Paediatrics and International Child Health, 35(2), 90–109.CrossRefGoogle Scholar
  22. Golden, M., Samuels, M., & Southall, D. (2003). How to distinguish between neglect and deprivational abuse. Archives of Disease in Childhood, 88, 105–107.CrossRefGoogle Scholar
  23. Himes, J. H., Roche, A. F., Thissen, D., & Moore, W. M. (1985). Parent-specific adjustments for evaluation of recumbent length and stature of children. Pediatrics, 75, 304–313.PubMedGoogle Scholar
  24. Hobbs, C. J., Hanks, H. G. I., & Wynne, T. M. (1993). Failure to thrive. In Child abuse and neglect: A clinician’s handbook (pp. 17–45). New York: Churchill Livingstone.Google Scholar
  25. Homer, C., & Ludwig, S. (1981). Categorization of etiology of failure to thrive. American Journal of Diseases of Children, 135, 848–851.PubMedGoogle Scholar
  26. Hymel, K., & Committee on Child Abuse and Neglect. (2006). When is the lack of supervision neglect? Pediatrics, 18(3), 1296–1298.CrossRefGoogle Scholar
  27. Jaffe, A. (2011). Failure to thrive: Current clinical concepts. Pediatrics in Review, 32(3), 100–107.CrossRefGoogle Scholar
  28. Jenny, C., & Committee on Child Abuse and Neglect. (2007). Recognizing and responding to medical neglect. Pediatrics, 120(6), 1385–1389.CrossRefGoogle Scholar
  29. Kellogg, N. D., & Lukefahr, J. L. (2005). Criminally prosecuted cases of child starvation. Pediatrics, 116, 1309–1316.CrossRefGoogle Scholar
  30. Kempe, R. S., & Goldbloom, R. B. (1987). Malnutrition and growth retardation (“failure to thrive”) in the context of child abuse and neglect. In R. E. Helfer & R. S. Kempe (Eds.), The battered child (4th ed., pp. 312–335). Chicago: University of Chicago Press.Google Scholar
  31. Kempe, R. S., Silverman, F. N., Steele, B. F., Droegmueller, W., & Silver, H. K. (1962). The battered child syndrome. Journal of the American Medical Association, 181, 17–24.CrossRefGoogle Scholar
  32. Korbin, J., & Spilsbury, J. (1999). Cultural competence and child neglect. In H. Dubowitz (Ed.), Neglected children: Research, practice, and policy (pp. 69–88). Thousand Oaks: Sage.CrossRefGoogle Scholar
  33. Krugman, S. D., & Dubowitz, H. (2003). Failure to thrive. American Family Physician, 68, 879–884.PubMedGoogle Scholar
  34. Ludwig, S. (1992). Failure to thrive/starvation. In S. Ludwig & A. E. Kornberg (Eds.), Child abuse: A medical reference (2nd ed.). New York: Churchill Livingstone.Google Scholar
  35. Ludwig, S. (2005). Psychosocial emergencies: Child abuse. In G. R. Fleisher & S. Ludwig (Eds.), Textbook of pediatric emergency medicine (5th ed., pp. 1761–1802). Baltimore: Williams and Wilkins.Google Scholar
  36. Maguire, S., Williams, B., Naughton, A., Cowely, L., Tempest, V., Mann, M., et al. (2015). A systemic review of the emotional, behavioural and cognitive features exhibited by school-aged children experiencing neglect or emotional abuse. Child: Care, Health and Development, 41(5), 641–653.Google Scholar
  37. Manary, M., Heikens, G., & Golden, M. (2009). Kwashiorkor: more hypothesis testing is needed to understand the aetiology of oedema. Malawi Medical Journal, 21(3), 106–107.CrossRefGoogle Scholar
  38. Mehta, N., Corkins, M., Lyman, B., Malone, A., Goday, P., Carney, L., et al. (2013). Defining pediatric malnutrition: A paradigm shift toward etiology-related definitions. Journal of Parenteral and Enteral Nutrition.
  39. Mei, Z., Grummer-Strawn, L., Thompson, D., & Dietz, W. (2004). Shifts in percentiles of growth during early childhood: Analysis of longitudinal data from the California Child Health and Development Study. Pediatrics, 113(6), e617–e627.CrossRefGoogle Scholar
  40. National Center on Child Abuse and Neglect. (1988). Study findings: Study of national incidence and prevalence of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services.Google Scholar
  41. National Research Council. (1980). Recommended dietary allowances (9th ed.). Washington, DC: National Academy Press.Google Scholar
  42. Pears, K. C., Kim, H. K., & Fisher, P. A. (2008). Psychosocial and cognitive functioning of children with specific profiles of maltreatment. Child Abuse & Neglect, 32(10), 958–971.CrossRefGoogle Scholar
  43. Peterson, M. S., & Urquiza, A. J. (1993). The role of mental health professionals in the prevention and treatment of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services.CrossRefGoogle Scholar
  44. Piercecchi-Marti, M., Louis-Borrione, C., Bartoli, C., Sanvoisin, A., Panuel, M., Pelissier-Alicot, A., & Leonetti, G. (2006). Malnutrition, a rare form of child abuse: Diagnostic criteria. Journal of Forensic Science, 51(3), 670–673.CrossRefGoogle Scholar
  45. Prince v Massachusetts. 32 US 158, 64 SCt 438, 88 LEd 645 (1944).Google Scholar
  46. Puls, H., Hall, M., Bettenhausen, J., Johnson, M., Peacock, C., Raphael, J., et al. (2016). Failure to thrive hospitalizations and risk factors for readmission to children’s hospitals. Hospital Pediatrics, 6(8), 468–475.CrossRefGoogle Scholar
  47. Rabinowitz, S. S. (2016). Nutritional considerations in failure to thrive clinical presentation. Pediatrics General Medicine. Medscape.
  48. Satler, E. (1990). Childhood feeding problems. In Feelings and their medical significance. Columbus: Ross Laboratories.Google Scholar
  49. Schmitt, B. D., & Mauro, R. D. (1989). Nonorganic failure to thrive: An outpatient approach. Child Abuse & Neglect, 13, 235–248.CrossRefGoogle Scholar
  50. Sills, R. H. (1978). Failure to thrive: The role of clinical and laboratory evaluation. American Journal of Diseases of Children, 132, 967–969.CrossRefGoogle Scholar
  51. Smitt, H., Leeuw, J., & deVries, T. (2017). Association between severe dental caries and child abuse and neglect. J Oral Maxillo Fac Surg 75:2304–2306.Google Scholar
  52. Solomon, S. M., & Kirby, D. F. (1990). The refeeding syndrome: A review. Journal of Parenteral and Enteral Nutrition, 14(1), 90–97.CrossRefGoogle Scholar
  53. Spitz, R. A. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 1, 53–74.CrossRefGoogle Scholar
  54. Spitz, R. A. (1949). The role of ecological factors in emotional development in infancy. Child Development, 20(3), 145–155.Google Scholar
  55. Stephens, M. B., Gentry, B. C., & Michener, M. D. (2008). What is the clinical workup for failure to thrive. Journal of Family Practice, 57(4), 264–266.PubMedGoogle Scholar
  56. Straus, M., & Kantor, G. (2005). Definition and measurement of neglectful behavior: Some principles and guidelines. Child Abuse & Neglect, 29, 19–29.CrossRefGoogle Scholar
  57. Tanner, J. M., Goldstein, H., & Whitehouse, P. H. (1970). Standards for children’s height at age 2–9 years allowing for height of parents. Archives of Diseases of Childhood, 45, 755–762.CrossRefGoogle Scholar
  58. Tunnessen, W. W., Jr., & Roberts, K. B. (1999). Signs and symptoms in pediatrics (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  59. U.S Administration for Children & Families, Child Maltreatment 2015. Accessed 17 July 2017.
  60. Varness, T., Allen, D. B., Carrel, A. L., & Fost, N. (2009). Childhood obesity and medical neglect. Pediatrics, 123(1), 399–406. Scholar
  61. Wolock, I., & Horowitz, B. (1984). Child maltreatment as a social problem: The neglect of neglect. American Journal of Orthopsychiatry, 54, 530–543.CrossRefGoogle Scholar
  62. Zenel, J. A. (1997). Failure to thrive. Pediatrics in Review, 18, 371–378.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lauren R. Burge
    • 1
    Email author
  • Penelope T. Louis
    • 2
  • Angelo P. Giardino
    • 3
  1. 1.Department of Pediatrics, Section of Public Health Pediatrics, Child Abuse Pediatrics FellowPGY-6, Baylor College of MedicineHoustonUSA
  2. 2.Baylor College of Medicine/Texas Children’s HospitalHoustonUSA
  3. 3.Department of PediatricsUniversity of Utah HealthSalt Lake CityUSA

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