Weighing Things Up: Failure to Thrive
During the first year or so of life, most babies gain weight and grow rapidly. The pattern of this development can vary considerably, but the average term baby doubles her weight by four months and triples it at one year. However, some babies with underlying health problems don’t meet these milestones and need extra help and possibly some closer attention to find out what’s causing the problem.
If your baby is classified as ‘failing to thrive’, basically she isn’t putting on weight or growing in the expected way. ‘Failure to thrive’ is a general term rather than a specific condition, but doctors take it seriously because failing to thrive is a sign that your baby’s not getting the nourishment she needs. A baby who’s failing to thrive may:
- Become disinterested in her surroundings and feeding
- Avoid eye contact
- Become irritable or withdrawn and whiny
- Not reach developmental milestones such as sitting up, walking, and talking at the ‘usual’ age
- Have faltering weight, which drops from an established growth curve for at least three months
- Have a skinny appearance, with thin arms and legs, but with a large stomach
- Have wispy hair and dark circles around the eyes.
Finding out what causes failure to thrive
Failure to thrive can result from a wide variety of underlying causes, such as the following:
- Gastrointestinal problems: Tummy troubles such as reflux or chronic diarrhoea can interfere with your baby’s ability to hold on to the nutrients and calories from her milk or food.
- Underlying illness: Milk-protein intolerance and coeliac disease, a sensitivity to a protein found in wheat and certain other grains, can limit your baby’s ability to absorb nutrients. Your baby may eat a lot, but her body can’t absorb and retain enough food. Unless diagnosed, problems like these can cause failure to thrive.
- Underlying infection: A urinary tract infection, for example, can place great energy demands on your baby and force her body to use nutrients rapidly, sometimes causing short- or long-term failure to thrive. Underlying infection can also impair your baby’s appetite. Other conditions that can lead to failure to thrive include heart, liver, and respiratory disorders.
- Metabolic problem: Metabolic disorders, such as gluten or lactose intolerance, limit your baby’s ability to make the most of the calories consumed or make it difficult for your baby to break down, process, or derive energy from food. Other metabolic disorders can cause a build-up of toxins during the breakdown process, which can make your baby feed poorly or vomit.
- Poor nutrition: Some parents just don’t feed their baby enough or lack the knowledge of how to feed their baby healthily. For example, they may restrict the calories they give their baby because they don’t want a fat child. Other parents feed their baby according to their own limited diet. Make sure your baby is getting the nutrition she needs by giving her a varied diet.
- Unknown cause: In a few cases, doctors cannot pinpoint a specific cause.
Your baby may be slow to gain weight for a number of reasons. Genetics plays a big role in weight gain, so if you and your partner are slim your baby may not put on pounds quickly. Monitoring your baby’s weight gain from home can be difficult, so attend regular weight and development checks with the health visitor.
Diagnosing and treating failure to thrive
Your baby’s weight gain is likely to level out or even drop occasionally, but if she doesn’t gain weight for three consecutive months during the first year of life for no obvious reason, your doctor will probably become concerned.
Failure to thrive is usually diagnosed by using standard growth charts, called centile charts, where your baby’s weight, length, and head circumference are measured at each development check. Centile charts show the size of the whole ‘normal’ range of children at a given age. As a rule, your doctor will want to investigate your baby for possible failure to thrive if her weight gain slows down enough to drop down two ‘centile lines’.
If your doctor finds that your baby is failing to thrive, she will take a thorough medical and feeding history and perform a detailed physical examination of your baby. Your doctor may carry out blood and urine tests on your baby if she suspects a particular disease to be the cause.
A baby with extreme failure to thrive may need to go to hospital so that she can be fed via a tube and monitored continuously. During this time, any possible underlying causes can be evaluated and treated appropriately. The length of treatment varies. Weight gain takes time, so several months may pass before your baby is back in the normal range for her age, although after she starts to gain weight satisfactorily, she will normally be allowed home.
If your baby’s weight drops or she doesn’t seem to have a normal appetite, get in touch with your health visitor, who can tell you if you need to see the doctor. Any major change in eating patterns warrants medical advice.