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

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 concern any parent is the diagnosis of “Failure to Thrive.” Failure to thrive (or growth faltering) can be a potential sign or symptom of food allergies in infants.

Many parents can feel that they have done something wrong, or perhaps failed their little one somehow. It is easy to think negative thoughts when you hear the term “Failure to Thrive.” Let us put your mind at ease by explaining what this diagnosis really means, and that your little one’s healthcare team will be there to help.

While the term is unsettling, the reality of what it means is often far less hopeless. “Failure to Thrive” simply means that your child is not growing at the rate expected. This could be in their weight, height, head size, or other developmental milestone. “Failure to Thrive” is an important diagnosis that needs to be addressed quickly by a healthcare professional. However, there is no reason to fear the worst.

Small interventions or changes to the diet will help most children to get back on track with developmental milestones in short order. Perhaps after some medical attention, the healthcare team might also uncover something that’s affecting your child’s ability to grow normally. An allergy to food or perhaps a related GI condition can be a factor.

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

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 a number based on height and weight. It is a way to compare weight to height (or for babies, length). For adults, BMI isn’t perfect, but is used to indicate whether weight is healthy, too high (overweight or obese), or too low (underweight). BMI for adults is a number.

For infants and children up to the age of 20, the equation for BMI is different than it is for adults, and it is a percentile. 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, 20 are larger or weigh more than you and 80 are smaller or weigh less than you.

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 you may see is a growth chart. Growth charts are used to chart an infant’s growth through the age of 2 years, and then into their teen years. Growth charts show how a child’s weight, height (length) and BMI compares to a typical group of children.

Weight is the most sensitive measure for nutrition in infants and small children. The first 2 years is an important time for development and weight gain, so during this time the healthcare team will closely monitor your child’s weight trends. If your child has been diagnosed with failure to thrive their weight will be monitored more often to track progress.

Once they pass 2 years old, children are monitored on a different growth chart, and their weight will likely be checked less often. Height is usually measured while standing after 2 years of age, whereas an infant’s length is measured while lying down.

Here is an example of how weight and BMI are monitored on a growth chart after 2 years of age. You will see that children between the 5th and the 85th percentile are often classified as a healthy weight.

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 your little one as an individual. They’ll make recommendations or perhaps a diagnosis based on what your child is experiencing.

When it comes to weight and BMI, it is important to know what percentile your child’s weight falls in, but more important to know the trend their weight follows. Healthcare teams often want children to continue to follow the trend of growth for the percentile they’ve tracked in. For example, as long as a child in the 10th percentile continues to gain weight and follow the trend of the 10th percentile, then they are gaining weight as expected.

Each healthcare professional will use discretion when making a diagnosis or caring for your child. It is important to remember that not every child will follow the same growth pattern as another child or perhaps receive the same diagnosis when they experience similar issues.

Let me share some standards that many healthcare teams use to diagnose failure to thrive. Children may be diagnosed with failure to thrive if their weight drops below the 5th percentile. The diagnosis might also be made for children who drop below the 10th percentile. Rate of weight gain or loss is another important factor that many healthcare professionals watch. If your child’s weight drops down to a percentile lower than the one their weight was previously following, then they may diagnosed with failure to thrive, especially 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 healthcare teams use to follow children’s weight.

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 like the flu, 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 that exactly follows the line on a growth chart. 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, the healthcare professional will take a closer look.

For many families, a change in weight may require a small change in diet, or maybe none at all. Perhaps some diet changes will 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.

Some families will need a bit more help getting their child to gain weight. A food allergy or a related GI condition might be a factor in not gaining weight as expected. It is possible that your child is eating well, but experiencing digestive symptoms because of a food allergy. Hypoallergenic products like Neocate can often be a wonderful tool for children to provide needed nutrition while avoiding common food allergens.

Another product that many healthcare professionals might recommend is Duocal, which is a source of extra calories. It’s helped many little ones with food allergies since it does not contain protein. Duocal is made in the same facility as our powdered Neocate products with the same great dedication to quality.

If you are worried about your child’s weight or length, please contact your healthcare team to discuss these concerns with them. Early intervention can often help manage this diagnosis and make sure your child grows as expected and meets 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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Last updated January 8, 2019

Published: 04/12/2016
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