Failure To Thrive – What Who When Which Why and How?

Posted 4.12.16 | Nutrition Specialist

Anytime your child is sick can be an anxious time as a parent. A diagnosis can bring some comfort, but not always. One diagnosis that can often strike fear and guilt into the heart of any parent is the diagnosis of “Failure to Thrive.” Many parents immediately feel that they have done something wrong, or perhaps failed as a parent. It is easy to quickly worry that perhaps your child may have a dim future when hearing a diagnosis of “Failure to Thrive.” Let us put your mind at ease to know what this diagnosis really means, and that your little one’s healthcare team will have suggested solutions that are often simple and quick.

While the name of the diagnosis is unsettling, the reality of what it means is far less hopeless. “Failure to Thrive” simply means that your child is not gaining weight, or not growing at the rate expected in some way such as their height, head size, or other developmental milestone. “Failure to Thrive” is still a very important diagnosis that needs to be addressed quickly by a healthcare professional, but there is no reason to fear the worst. Most children will start to gain weight and get back on track with developmental milestones very quickly with some small interventions or changes to their diet. Perhaps after some medical attention, you may also receive a diagnosis from your healthcare team of what might be causing your child to struggle with weight gain (allergy to food or perhaps a related GI condition).

So how exactly do you know if your child is not gaining weight, or more importantly not gaining enough weight? Let’s discuss a few of the terms that you might hear from your pediatrician or dietitian, and look a bit more at some of the tools they might use or show you to help you prepare for this journey and treatment.

Healthcare Terms You May Hear

“BMI” is a term that you may hear often, but what does it really mean? BMI stands for body mass index, and it is simply a number based on height and weight. It is a way to judge your weight in comparison to you height and determine if your weight is healthy, too high (overweight or obese), or too low (underweight). For adults the calculation for BMI is simple, since we have reached our maximum height. For children and teens that are still growing, the determination of their BMI is a bit different.

Infants and children until the age of 20 will have their BMI given in terms of a percentile. Percentile is a math term that can confuse many people (healthcare professionals included). A percentile ranks you in terms of 100 people. The 50th percentile means that out of 100 people, you are right in the middle or that there are 50 above you and 50 below you. In terms of weight the 80th percentile means that out of 100 people there are 20 that are larger or weigh more than you and 80 that are smaller or weigh less than you. In the same way the 20th percentile means there are 80 bigger and 20 smaller than you in weight.

Healthcare professionals use a growth chart to plot your child’s growth and determine their BMI and the percentile that their weight falls in. Let’s take a closer look at growth charts and what your healthcare professional will be looking for when talking about your baby’s weight gain and percentile.

How Does Your Child’s Growth Measure Up?

So how exactly would a healthcare professional determine that your child is not growing at the expected rate? One tool that is used and that you may see is a growth chart. Growth charts are used for the specific reason of charting an infant’s growth through the age of 2 years, and then children through their teen years to determine if their weight gain, BMI or other growth measurements are typical.

Weight is the most sensitive measure for nutrition in infants and small children. Between birth and 2 years of age is an important time for development and weight gain, so during the first 2 years of life your healthcare team will closely monitor your child’s weight gain or trend in weight gain. If your child has been diagnosed with failure to thrive, then their weight will be monitored much more frequently and more closely to provide them with the care they need to get back on track.

Once they pass 2 years old they will be monitored on a different growth chart, and their weight will likely be monitored on a much less frequent basis. Their height is usually measured while standing after 2 years of age as well, instead of their length while lying down.

Here is an example of how weight and more specifically BMI is monitored on a growth chart after 2 years of age. You will see that children below the 5th percentile are usually classified as underweight while children between the 5th and the 85th percentile are often classified as a healthy weight. Children that fall above the 85th might be considered overweight while children over the 95th percentile might have interventions to avoid gaining more weight as they grow.

It is important to ask your healthcare team what is best for your child, and remember that every child is different. Your healthcare team will look at what is best for your little one in particular, and make recommendations or perhaps a diagnosis based on what your child is specifically experiencing.

When it comes to weight and BMI, it is important to know what percentile your child’s weight falls in, but more importantly to know the trend their weight gain is following. Whichever percentile your child falls in, it is important that they continue to follow the trend of growth for that percentile. So if they are in the 10th percentile, as long as they continue to gain weight and follow the line or trend of weight gain for the 10th percentile then they are gaining weight as expected. Each healthcare professional will use their discretion when making a diagnosis or caring for your particular child, so it is important to know that not every child will follow the same standards as another child or perhaps receive the same diagnosis when they experience similar issues.

Let me tell you some standards that many healthcare practitioners will use to diagnose failure to thrive. Often a child will be diagnosed with failure to thrive if their weight drops below the 5th percentile, and sometimes even if they drop below the 10th percentile. Rate of weight gain is the most important factor that many healthcare professionals watch, so if your child’s weight drops down to a percentile lower than the one their weight was previously following, then they will often be diagnosed with failure to thrive as well if there is no obvious reason for the change in weight.

Here are some links to growth charts so you can take a look for yourself and see what your healthcare team might be looking at when they are following your child’s weight gain.

·         World Health Organization (WHO) Growth Charts

·         Centers for Disease Control (CDC) Clinical Growth Charts

·         WIC Growth Charts

What to Expect for Your Child’s Growth

Most children have small changes in weight for common reasons such as an acute illness such as a cold, or changes in eating behavior as they grow and experience new foods and textures. You should not expect your child to have a smooth growth just like the line on a growth chart, so do not worry if your child’s weight bounces around a bit as that is perfectly normal. If your child has a sudden change in weight and there is no obvious reason, or if they drop either up or down into a different percentile category these are times to take a closer look and contact your healthcare professional if they are not already aware of the change in weight.

For many families a change in weight will simply require a small change to their diet. Perhaps some diet interventions to help your little one eat more in general, or maybe to eat more calories within the items they do already eat. Maybe your family just needs a little help guiding your child to get some food into their mouth instead of on their head like this little guy here.

As fun as the feeding challenges can be for any family, some families will need a bit more help getting their child to gain weight. If your child is diagnosed with a food allergy or a related GI condition, this might be the reason they are eating but not gaining weight like they should. It is possible that your child is eating well, but not able to absorb all the wonderful nutrients they are eating because of a food allergy or related GI condition. Hypoallergenic products such as Neocate can often be a wonderful tool for children to provide the needed nutrition while avoiding the items that they are allergic to. Another product that many healthcare professionals might recommend is Duocal, which is a great source of extra calories from carbohydrates and fat and still useful for many little ones with multiple food allergies since there is no protein. Duocal is also made in the same place as our powdered Neocate products, so you can expect the same great dedication to quality and procedures to avoid common allergens as our other Nutricia products.

If you are worried about your child’s weight gain, please contact your healthcare team to discuss these concerns with them. Early intervention can often help avoid this scary diagnosis and make sure your child keeps gaining weight and meeting their developmental milestones for a bright and promising future.

Was this information helpful in your experience with a diagnosis of failure to thrive? Let us know what you experienced or how Neocate was helpful for your child in the comments section.

--Kristin Crosby MS, RDN

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Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.