Failure to thrive (FTT) or poor weight gain refers to a condition in which an infant or child does not gain weight at the expected standard of growth. FTT is not a disease, but rather a sign that a child is undernourished. Because FTT typically occurs in infants and toddlers, it is important to address quickly, as this is a crucial time in brain development. Poor or inadequate nutrition can have permanent negative effects if not corrected. Regularly scheduled well-child appointments with your doctor are the first line of defense against it.
FTT is usually the result of one of three main categories:
- Inadequate nutritional intake
- Inadequate caloric absorption
- Excessive caloric expenditure
Inadequate Nutritional Intake
This is the most common reason for FTT. Parents can sometimes mistakenly give too little food if concerned with weight or if the baby is a fussy eater. Depending on the age of the child, FTT can be a result of:
- Breastfeeding difficulties (low milk supply or latching problems)
- Improper preparation of formula
- Difficulty transitioning to solid foods
- Behavioral feeding issues
- Gastroesophageal reflux
- Mood, eating disorders, or irritable bowel syndrome (particularly in older children)
Inadequate Caloric Absorption
FTT can occur if a child is unable to utilize the nutrition being given. Health conditions that can prevent a child from gaining weight include:
- Vomiting from acid reflux or food allergies
- Food intolerance
- Celiac disease
- Inflammatory bowel disease
- Cystic fibrosis
- Chronic diarrhea
- Metabolic disorders
- Protein-losing enteropathy
- Gastrointestinal malformation
- Chronic liver disease
Excessive Caloric Expenditure
Excessive caloric expenditure is generally a concern for children who have a history of:
- Chronic infections
- Congenital heart disease
- Chronic lung disease
- Hyperthyroidism
- Prematurity
Some infections force the body to use nutrients more quickly while decreasing appetite. Other conditions cause a natural excessive expenditure of calories, making it difficult for the child to keep up with required calorie intake. Most cases of FTT caused by excessive caloric expenditure develop within the first two months after birth.
How Is It Diagnosed?
Diagnosing FTT involves keeping accurate measurements of a child’s weight, height (length), and head circumference over a period of time. Generally, a child whose weight falls consistently below the 5th percentile on a growth chart, or whose weight deceleration crosses two major percentile lines, is considered to be failing to thrive. While some children may have other factors contributing to low weight, such as small parents or premature birth, any child who meets the FTT criteria should be monitored closely.
How It’s Treated
Treating FTT involves a regiment of nutritional counseling for catch-up growth. Depending on the child’s age, measures may include:
- More frequent breastfeeding
- Lactation support
- Formula supplementation
- Varying formula concentration
- Consumption of higher calorie foods
- Avoiding empty calories, such as juices and candy
- Nutritional supplements
The overall goal in FTT treatment is to provide adequate nutrition for the child in order to ensure proper long-term growth and development, while giving parental support in any area needed. If you would like more information about gastrointestinal (GI) digestive disorders and nutrition in children, please contact Dr. Mona Dave’s Plano Office or Southlake Office.
