Weight gain - slow (child 0-5 years)

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Alternative names
Growth - slow (child 0-5 years); Delayed growth; Slow rate of growth; Retarded growth and development

Definition
Delayed growth involves poor or abnormally slow gain in weight or height, or both, in a child younger than 5 years old.

Considerations

Delayed or slower than expected growth can be caused by many conditions, most of which can be corrected if the problem is recognized and the intervention is timely. Failure to thrive may be accompanied by withdrawn personality and slow mental, physical, and emotional development. Genetic diseases and chronic illness are less common causes of failure to thrive in the U.S. Social and educational causes for failure to thrive are more common.

Often, problems with infants can be prevented or modified with parental education. Expectant parents should arrange for parenting classes. Also, a child should be taken in to see the health care provider on a regular basis for well-baby checkups.

See the following for more information:

• Infant - newborn development
  o Developmental milestones record - 2 months
  o Developmental milestones record - 4 months
  o Developmental milestones record - 6 months
  o Developmental milestones record - 9 months
  o Developmental milestones record - 12 months
  
• Toddler development
  o Developmental milestones record - 18 months
  o Developmental milestones record - 2 years
  o Developmental milestones record - 3 years
  o Developmental milestones record - 4 years
  o Developmental milestones record - 5 years

Common Causes

The term “failure to thrive” means only that an infant or young child is not growing and developing as expected. Failure to thrive is often divided into two main categories: psychosocial and organic.

Psychosocial causes include problems relating to poverty, educational level, malnourishment, and environmental factors (such as abuse or neglect, maternal depression, or a parent’s substance abuse). Psychosocial causes for failure to thrive include the following:

• Parental inexperience or lack of appropriate education, such as
  o Inadequate nourishment from a feeding schedule that is rigid or allows little sucking time—for infants less than 1 year being breast-fed
  o Too much water added to powdered formula, or water added to ready-to-feed formula—for infants less than 1 year being bottle-fed
  
• Poverty and Malnutrition
  
• Neglect or abuse
  
• Mental illness in a parent
  
• Substance abuse by a parent

Organic failure to thrive includes any disease state such as chronic illness, genetic, metabolic and hormone disorders. Organic causes for failure to thrive include the following:

• Genetic causes with no underlying disorder
  
• Chronic disease such as sickle cell disease, kidney failure, or chronic infection (such as tuberculosis)
  
• Down syndrome or other genetic disorder
  
• Endocrine diseases, including problems with the thyroid, pituitary (pituitary dwarfism), adrenal, pancreas, or sexual glands
  
• Celiac disease or lactose intolerance (digestive disorders often accompanied by loose, pale, bulky, and bad-smelling stools)
  
• Adverse reaction or side effect of a drug (particularly cortisone drugs)
  
• Fetal alcohol syndrome
  
• Hydrocephalus
  
• Gastroesophageal reflux in infants
  
• Biliary atresia
  
• Congenital heart disease such as tetralogy of Fallot

Home Care

Follow the health care provider’s instructions for care. The necessary treatment and home care is as varied as the number of reasons for failure to thrive.

For slow weight gain in a child caused by malnourishment, try feeding the child on demand and increasing the sucking time. Also, prepare formula exactly according to directions. Do not dilute ready-to-feed formula, and try increasing the amount offered to the child.

Provide as much love and support as possible for the child no matter what the diagnosis. Examine feelings and behavior toward the child. If feelings toward the child are not what they should be, arrange for psychological counseling.

Call your health care provider if

• There is vomiting in an infant (0 to 6 months) after feedings or the weight gain is slow.
  
• There is any concern about whether the child is growing and gaining weight properly.

What to expect at your health care provider’s office

A thorough history will be obtained from the parents, and a physical examination of the child will be performed.

Medical history questions documenting delayed growth in detail may include:

• Has the child always been on the low end of the growth charts?
  
• Was the child growing normally and then the growth slowed down?
  
• Is the child developing normal social skills and physical skills?
  
• Does the child eat well?
  
• What type of feeding schedule is used?
  
• Is the infant fed by breast or bottle?
  
• If breast-fed, what medications does the mother take?
  
• If bottle-fed:
  o What kind of formula is used?
  o How is the formula mixed?
  
• What kinds of food is the child eating (toddlers)?
  
• What medications does the child take?
  
• What other symptoms are also present?

There may also be questions about parenting habits, social interaction with the child, and similar questions.

Repeated measurements of height, weight, and head circumference will be performed.

The number of possible tests for failure to thrive is large, but usually only a few are necessary. The tests actually done will be determined by the diagnosis the physician is considering. Some of the more common tests are listed below:

• Blood tests (such as a CBC or blood differential, hemoglobin electrophoresis)
  
• Hormone studies
  
• Stool studies (to check for malabsorption)
  
• X-rays to determine bone age (X-rays of the hands and wrists as a measure of growth)
  
• X-rays of the long bones to look for new or old fractures

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