Help my Son Who is not Growing Well

Poor weight gain isn’t an uncommon problem among children, and it’s a very prevalent problem that prompts a visit to a pediatric gastroenterologist. Poor weight gain is typically noticed by the parents (usually the mother) or primary physician, who notice that the child isn’t growing well – or their weight gain deviates from a normal growth pattern. When that weight trend is poor, doctors may describe the child as “failing to thrive” or “malnourished.”

When Does a Drop in Weight Become Concerning?

Often, the trend in weight over time is more important than a single drop in weight measurement. It’s important for weight to be compared to height to ensure that the child is gaining weight well in comparison to his or her height. This height and weight correlation is plotted using a weight for length chart or Body Mass Index chart.

Sometimes, toddlers will lose weight as they become more active. In this circumstance, their weight may drop in relation to their height, but the child will still continue to progress at a normal rate for their age. When there is a significant drop in weight with a single measurement, that may be concerning. In this situation, the child will have to be seen by a doctor and re-measured in order to see if the drop in weight is significant enough to warrant further action.

What Are the Reasons a Child May Not Grow?

The most common reason that accounts for over 90 percent of these cases is a lack of adequate caloric intake. This can occur when a child is not interested in eating due to variety of reasons, or when there is a lack of understanding by the parents regarding the caloric needs of the child. This happens with toddlers who are active and otherwise well, but who are less interested in eating. For even younger children in their first few months of life, this may be due to an inadequate supply of breast milk or to the improper mixing of formula in a formula-fed baby. Occasionally, a caregiver with emotional problems may not adequately feed the child. In the case of an older child or teenager, they may limit calories secondary to body image issues, which is considered nutritional insufficiency (previously called anorexia nervosa).

A child may also not feed well if he or she has heightened oral sensitivity or neurological issues. Such problems may affect their ability to swallow and may be caused by conditions such as cerebral palsy or a cleft palate. Sometimes, a child cannot keep their formula or food down due to excessive vomiting. This may be due to severe acid reflux; in a child with neurological issues, this causes low muscle tone and a variety of other disorders. Most infants with acid reflux will improve, and their growth will continue without issue. Less frequently, a younger infant with excessive vomiting may have a narrowing of the outlet of the stomach called pyloric stenosis and may need a special evaluation that would include an ultrasound of the abdomen.

A child with the inability to digest food due to poor capacity of the pancreas may not gain weight well. In this scenario, parents report their children as having bulky, frothy, loose, foul smelling and greasy stools. Disorders affecting lining of the bowel, including celiac disease or Crohn’s disease can also cause children to have poor weight gain. In celiac disease, symptoms start when foods that contain gluten are introduced into the diet.

In some situations, a child may burn too many calories if he or she has an over-active thyroid gland. A child with a heart disorder that leads to heart failure may also not feed well if they’re working too hard to breathe. Rarely, kidney failure or other kidney disorders will affect weight gain (as well as height) by affecting certain mechanisms of growth. Additionally, some children may have genetic disorders that affect weight gain and require evaluations by specialists.

How Should Poor Weight Gain Be Evaluated and Managed?

If you’re concerned that your child is not gaining weight well, you should seek the help of your child’s primary care provider. The child would need a good physical exam, and his or her doctor should be looking for signs of medical disorders other than simply inadequate caloric intake. The BMI chart may need to be closely monitored, and your child may need frequent follow-ups and weight checks during this time. Negative signs from the exam would be fatigue, paleness, thin extremities, loose folds of skin on the arms and thighs, and loss of fat over the cheeks. The provider may run tests to evaluate for anemia, nutritional status and kidney function. Based on the clinical assessment, further tests may be ordered to check for possibilities of celiac disease, Crohn’s disease or a pancreatic enzyme deficiency. For these, the provider may seek the help of a specialist like a pediatric gastroenterologist or pediatric dietitian.

Most children require subtle increases in their caloric intake to improve weight gain. This may require some imagination on the part of parent, and extra calories could be in the form of additional oil, sugar or special formulas in the diet. Interestingly, growth only requires 5 to 10 percent of the total caloric intake after six months of life.

A child with persistent poor weight gain despite increase in caloric intake may require admission to the hospital to observe weight and feeding trends and for testing and evaluation by a pediatric dietitian. Children with persistent poor weight gain may need be started on supplementary feeding though tubes placed into the stomach through the nose called naso-gastric feeding. Certain medications that stimulate appetite may be beneficial in some children. Diet modification in the form of a gluten-free diet will be required for celiac disease, digestive enzyme supplementations will needed to aid pancreatic enzyme and the help of specialists should be sought to treat heart problems, Crohn’s disease, thyroid problems or pyloric stenosis.