Digestive; Nutrition

Why isn’t my child gaining weight? 3 factors that can cause 'failure to thrive'

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Failure to thrive is diagnosed in about 10% of children in the U.S.

Most children spend the first few years of their lives growing steadily and putting on weight. Healthy babies typically gain 5 to 7 ounces a week for the first six months and 3 to 5 ounces a week from 6 to 12 months. Children tend to gain 4 to 7 pounds a year until puberty starts.

But some children gain weight more slowly or stop growing altogether – a condition known as failure to thrive (FTT). Neither a disease nor an illness, FTT is a condition caused by getting too few calories for the child's growth needs.

FTT can develop from a range of feeding complications and underlying medical concerns. Estimates suggest doctors in the U.S. diagnose FTT in approximately 10% of children in primary care. The condition, which can also be associated with child neglect or abuse, is usually diagnosed in infancy but can develop at any age.

Children with FTT who do not get treatment face long-term challenges such as abnormal brain development, delayed milestones such as rolling over or walking, and even delayed puberty. These children often need to see more than one doctor to ensure all their needs are met.

UT Southwestern partners with Children's Health doctors to make sure families have access to specialists who can help diagnose and treat the root cause of FTT. Pediatric specialists will also be available at UT Southwestern Medical Center in Frisco when it opens in early December. 

Often, failure to thrive originates from one of three overarching nutrition issues. 

3 situations that can cause failure to thrive

1. Low calorie intake

Babies and children need different amounts of calories based on their age, size, sex, activity level, and medical needs. As your child grows, follow these guidelines to support adequate nutrition:

  • Follow your child's feeding cues: Feed the child when they are hungry. Note whether feeding slows down or ramps up, particularly in times of stress or when mood or physical symptoms arise. Avoid restricting your child's food intake unless directed to do so by a doctor.
  • Measure formula correctly: Follow the package directions and add the proper amount of water to the mix.
  • Seek the help of a lactation nurse: A lactation nurse is an expert in helping mothers and babies find comfortable, effective nursing positions for optimal infant health. Breastfed babies, especially preemies, sometimes have trouble sucking or latching, which means getting proper suction and breast placement to get milk. 
  • Use nutrition assistance resources: Many community resources are available to help families with income restrictions and limited food access. A few resources in the Dallas area include the North Texas Food Bank, the Tarrant Area Food Bank, Women & Infant Children (WIC), and the Supplemental Nutrition Assistance Program (SNAP). Your doctor can refer you to a social worker who can guide you to resources in your community.  

Some children are very picky eaters. Seeing a dietitian and/or a therapist can help older children overcome these issues. Older children might fill up with beverages such as milk or sugary juices and "run out of room" for nutritious foods. Your pediatrician might suggest nutritional supplementation or positive reinforcement when the child eats or tries a new or healthy food. 

2. High calorie demands

Some medical conditions require a child to consume more calories. For example, congenital heart disease requires the heart to pump faster to meet the body’s needs and speeds up the body’s metabolism, so the child needs extra calories to keep up with the increased demand.

If this is the case, doctors and nutritionists will help you develop a plan to meet your child’s extra calorie needs. It could include:

  • Supplements: Calorie-dense supplements can be added to milk, formula, or pumped breast milk. Older children can drink high-calorie beverages as recommended by the provider.
  • Snacks: For older children, ask your provider about how often to serve high-calorie foods as snacks, such as peanut butter and cheese.
  • Tube feeding: Infants or children with complex nutritional needs might require tube feeding (through the nostril/throat or a port in the abdomen) to supplement or replace regular feeding.

3. Other medical conditions

Conditions such as celiac disease or cystic fibrosis limit how well the body absorbs nutrients from food. Digestive conditions such as gastroesophageal reflux disease (GERD), chronic constipation, food allergies, and inflammatory bowel disease can make eating and going to the bathroom painful and stressful.

Related reading: 7 common causes of pediatric GI bleeding, plus treatment information 

Children with autism sometimes don’t like to eat certain textures or tastes, which can make it tough to transition to solid food. Older kids might want to eat just one type of food, such as only fruit or only chips. Try to encourage better eating habits by changing the texture (chop or puree it) or using tips from Autism Speaks, such as offering foods on a schedule or involving the child in the meal prep process.

Children with nutrition obstacles might need supplements to get the right amount of fiber, calcium, iron, and other nutrients in their diet. Talk to a pediatrician about your child's unique nutritional needs.

How we diagnose failure to thrive

It takes a village to diagnose, treat, and manage the health of children with FTT. So, the first step in diagnosing FTT is to have a thorough conversation with you about the child's symptoms and history.  

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If failure to thrive is diagnosed early, many children can be treated at home with ongoing pediatric care.

At the first appointment, the doctor will ask what flagged your concern and when you first noticed symptoms. The doctor will also ask about your child's medical history to look for issues that might cause poor feeding or trouble absorbing nutrients.

Specifically, the doctor will ask about:

  • Bowel and urination habits
  • Feeding habits
  • Lack of weight gain
  • Weight loss
  • Emotional, social, or mental challenges
  • Stalled growth or physical development
  • Home environment, such as access to food, safety, and risk of exposure to toxins
  • Other health conditions, such as diabetes, gastrointestinal issues, or known food allergies

The doctor will also check the child's general health and compare their measurements to standard growth chart milestones for:

  • Height
  • Head circumference
  • Weight

The standard weight indicator for FTT is when a child consistently falls below the fifth percentile for age- and sex-appropriate weight or loses so much weight in a short period of time that they dip below two major percentile lines on a standard growth chart.

Depending on the child's condition, the doctor might also recommend other testing to check for infections or underlying conditions. This might include blood or urine tests or imaging such as X-rays. 

Hope for children with FTT

If FTT is diagnosed early, many children can be treated at home with ongoing pediatric care. The pediatrician can watch for changes in the child's weight and flag any trends that suggest additional needs to address.

Family support at home is key. Children's Health and UT Southwestern offer family counseling and nutrition education to help improve and maintain the child's ongoing health.

You want what’s best for your child. Raising concerns with your child's doctor – and asking for help when you need it – can make a world of difference.

If you're concerned that your child might have failure to thrive, call 214-645-8300 or request an appointment online

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