A sample of 177 children between 3 and 30 months old was recruited from a University of Maryland pediatric clinic serving low-income, primarily black families. Four groups were formed, based on neglect and FTT status: (1) neglect and FTT; (2) neglect only; (3) FTT only; and (4) no neglect or FTT. FTT was defined as weight-for-age below the 5th percentile on growth charts. To avoid biases associated with child protective service reports as definitions of neglect, the HOME scale was used to define neglect. The cognitive performance of the group with neglect and FTT was significantly below that of children in the neglect only, FTT only, and no neglect or FTT groups. Findings support a model in which the accumulation of risk factors is detrimental to cognitive functioning. Results also underscore the need for thorough evaluation when one risk factor has been identified. Growth failure may come to the attention of medical personnel but neglect may not be detected, and a child experiencing both neglect and FTT may be at risk for significant deficits in cognitive functioning. 33 references, 1 table, and 1 figure