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Caring for children with failure to thrive, poor weight gain and weight loss

About failure to thrive, poor weight gain and weight loss 

For various reasons, sometimes children don’t grow as well as they should. Your pediatrician might diagnose your young child as failing to thrive if your child’s growth still isn’t as good as expected when taking into account age, gender, birth weight and parental size. Doctors are usually concerned when a child falls under the second percentile on the World Health Organization’s growth chart or under the third percentile on the Centers for Disease Control and Prevention growth chart, or if a child suddenly slips from his or her usual percentile and/or doesn’t gain weight over a period of time. The term “failure to thrive” is usually used only with underweight babies and toddlers, but older children can also experience poor weight gain or sudden weight loss.

What causes failure to thrive, poor weight gain and weight loss?

In more than 90 percent of cases, the problem is that the child isn’t taking in enough calories. Other causes include children who lose calories through persistent vomiting, diarrhea or malabsorption or who have a chronic condition such as a heart or lung disease that causes them to require more to grow.

How often does this condition occur?

Although exact numbers are unknown, it’s believed to affect between 1 to 5 percent of children.

How does this condition develop?

When small children don’t take in enough calories or absorb nutrients properly, their weight is often affected first, followed by height and head circumference.

What are the symptoms of failure to thrive, poor weight gain and weight loss?

Usually the only symptom is that the child isn’t growing as well as he or she should. If the child is experiencing other symptoms, that could point to another underlying cause for your child’s failure to gain weight.

Who is at risk of developing this condition?

This condition can affect anyone, though children from lower socioeconomic backgrounds are more at risk for unclear reasons. Most children who are failing to thrive are diagnosed by age 3.

Why is failure to thrive, poor weight gain and weight loss a concern?

Naturally, we want all children to grow as best as they can. Left untreated, this condition can ultimately limit adult height, and in severe cases it can affect brain growth. Infants and toddlers who are failing to thrive might be delayed in meeting developmental milestones.

How is failure to thrive, poor weight gain and weight loss diagnosed/evaluated?

The doctor will look at your child’s medical history, conduct a physical exam and analyze your child’s height and weight gains on the growth chart. Parents’ growth history will also be considered. If your child is experiencing symptoms that point to another medical issue, the doctor might order additional tests, such as blood, urine, stool and endoscopic tests. A sweat test is used to check for cystic fibrosis, which can also cause poor weight gain.

If there’s not an underlying medical cause for your child’s poor growth, the first step is usually to increase your child’s calorie intake. That can be achieved using a high-calorie diet (including adding fats such as butter and cream) and an eating schedule that eliminates grazing between meals. In rare cases, your child’s doctor might recommend a feeding tube.

Children who are school-aged and not growing well might need to be screened for additional factors, such as psychological conditions that could impact their appetite and eating habits.

What is the treatment for failure to thrive, poor weight gain and weight loss?

For most children, the solution is to increase calorie consumption. Some children, including those with significant developmental delays, may be candidates for tube feeding.

The Feeding Program at Children’s Hospital of Wisconsin specializes in the care of children with nutritional disorders that range from failure to thrive to feeding disorders to intestinal failure. Using a combination of nutritional and medical therapies, we can work closely with families to optimize children’s growth and health.

What happens after treatment?

Treatment usually lasts from a few months to a year, until the child starts growing well. Once your child has improved in the growth percentiles, your doctor might recommend stopping the appetite stimulant. Most children are able to maintain their growth after that point.

When should you contact a physician?

Weight loss in any child is abnormal. If you notice that your child has lost weight or isn’t gaining an appropriate amount of weight, talk to your pediatrician.

What is the long-term outlook for failure to thrive, poor weight gain and weight loss?

Most of the data on children with this condition involves third-world countries where malnutrition is common. When properly treated, children tend to improve their weight and height percentiles on the growth chart and do better in life.

How do I live with this condition?

Take a look at your child’s diet to see where you can boost nutrient-rich calories and where you can eliminate low-calorie drinks and snacks. Try to avoid grazing and eating and drinking on the go so that your child comes to meals hungry and ready to eat. At the same time, try not to worry too much about counting every calorie or forcing your child to eat as that can just make meal times more stressful.

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