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: 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. |
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The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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