She was a small, pink bundle resting quietly in her mother’s embrace. Yet, in looking closer, and even before unwrapping her gently tucked outer layer, I could see that her eyes were wizened and weather-beaten. The bony prominences of her cheeks jutted out inorganically; the overlying skin was pallid. She was 2 months today but could not have appeared larger than a 2-week-old. Her beanie engulfed her head, oversized like that of a doll in dress-up clothing. It was clear that she was not growing. That was why she was here.

Though recent literature has transitioned to the use of the term “growth faltering” to better underscore the anthropometric parameters associated with growth challenges in infancy and to eliminate undertones of parental blame and guilt, “failure to thrive” remains an imbedded aspect of our every-day jargon in pediatrics. At its core, it encompasses a 3-pillared framework that helps delineate...

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