Ask Dr. Paul Library
Inadequate Weight Gain: A Serious Problem
DEAR DR. PAUL: My 3 year old daughter is not growing very well. My doctor weighed her and told me that she is failing to thrive. What does this mean? Is it serious?
PEDIATRICIAN DR. PAUL Answers: One of the most important parts of the routine pediatric check-up is to weigh and measure children in order to ensure that their growth is normal. Also, when evaluating children for any given problem, the pattern of weight gain is a key clue. When a parent is concerned that a child is not eating properly or is always sick, I first look at the weight gain. Regardless of the parental concern, it is reassuring if the weight gain is normal. Having said that, "failure to thrive" (inadequate weight gain) in children, is something that we take very seriously.
What causes failure to thrive? Although there are many possible causes, it really has to do with 2 basic elements: The amount of calories consumed and the amount of calories used or lost. Let me explain further; Depending on size and age, children need a certain daily amount of calories to grow normally. Obviously, if a child is not eating enough, the growth will be inadequate. On the other hand, a child may be ingesting enough for growth, but is losing the calories by not absorbing food well such as with cystic fibrosis or other intestinal problems (inflammatory bowel disease). Some children with inadequate weight gain have underlying conditions causing them to burn more calories than normal: Such conditions include chronic lung problems, heart defects and persistent urinary tract infections. Still, certain children with genetic abnormalities just seem to have a higher caloric need for their age. When we evaluate a child with failure to thrive, we focus on:
- A calorie count; a detailed calculation of exactly how many calories per day a child is eating.
- A complete physical assessment including the necessary tests; to diagnose any physical problem, anomaly, genetic abnormality or infection.
- The family and social situation; children who are emotionally deprived can actually stop growing; this can be reversed by providing a loving family/social environment.
The treatment of failure to thrive focuses on treating any associated condition (if any) and ensuring adequate caloric intake including any necessary vitamin/mineral supplementation. Most of the time, an underlying cause or problem is not found. However, for all children with failure to thrive, our goals are: to achieve "catch-up growth" and to subsequently maintain normal weight gain.
The treatment team can consist of a variety of specialists including, doctors, dieticians, nurses, social workers and psychologists. Which specialist gets involved and whether the treatment and evaluation takes place at home or in hospital, depends on the individual situation and severity of the growth delay. Extra calories are provided by the addition of protein and carbohydrates to meals.
Another important source of extra calories are certain specially designed beverages or supplements. These drinks contain all the necessary calories as well as nutrients, vitamins and supplements. This can be a frustrating experience for all involved. However with patience, proper caloric/nutritional supplementation and with the appropriate treatment and support from the various specialists, most children do begin to gain weight.