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Failure to thrive (FTT) in children is an important pediatric problem. Environmental and behavioral causes predominate, and detrimental effects on neurocognitive development are well documented. Multidisciplinary clinics designed to identify and treat FTT are effective but have not been widely adopted. A retrospective chart review was conducted of all patients with FTT seen at the authors' large inner-city children's hospital over a 40-month period, including those referred to a new multidisciplinary clinic. Over 40 months, only 75 children were referred and only 20 had moderate or severe FTT (z-score <-2.0). Nutritional status improved with treatment, but the small number of referrals who were severely affected led to the closing of the clinic. Recommendations for evaluating and treating children with mild FTT in primary care settings and a standardized definition of FTT that warrants more intensive treatment would help ensure that children were referred and treated appropriately.