To evaluate the growth course of children with failure to thrive (FTT) who receive aggressive management, we reviewed the 2-year experience of a secondary level ambulatory diagnostic and management clinic for children with FTT in a mostly rural state. We examined the children managed in this setting for cause of FTT, for growth outcomes after 1 year according to FTT clinical type, and for differentiating predisposing sociodemographic information Of 154 children referred to this clinic, 131 were diagnosed as suffering from FTT. Eighteen were admitted to the hospital after initial outpatient evaluation, and 93 were followed for at least 1 year. Twenty-two (17%) suffered from organic, 59 (45%) non-organic, and 46 (35%) mixed etiology FTT. After 1 year, 48 (52%) of the FTT children were improved, 37 (40%) were stable, and 8 (9%) were worse. Children placed in foster care were more likely to be improved (78%). FTT children considered improved after 1 year demonstrated the following at the time of initial diagnosis: lower maternal income, lower maternal education, and lower family socioeconomic status; higher birth order; more often black; and less likely for the father to be present in the home (all p less than or equal to .05). This experience offers several insights into the growth course and team management of FTT children.