Poor Weight Gain (Failure to Thrive)

Also called: FTT, Growth Faltering, Faltering Weight, Growth and Weight Faltering

Overview

What Is Poor Weight Gain?

Poor weight gain is when kids don't gain weight as they should. It’s not a disease or disorder itself. Rather, it's a sign that a child is undernourished, or underfed. In general, kids with poor weight gain aren’t getting enough calories to grow and gain weight in a healthy way.

Treatment depends on what’s stopping your child from gaining weight.

Top Things to Know

• Poor weight gain means a child isn’t gaining weight as expected.
• Signs can include slow growth, feeding trouble, and delays in walking, talking, or learning.
• Treatment focuses on helping kids get enough calories and finding out what’s causing the problem.
• Regular checkups help see if your child is gaining weight and growing well.

Signs & Symptoms

What Are the Signs & Symptoms of Poor Weight Gain?

Many babies and kids go through brief periods when they don't gain as much weight as expected. But if a child continues to not gain enough weight or loses weight, it may be due to this problem. Kids may have poor weight gain if they weigh less than most children their age or aren't gaining weight as quickly as they should. They also may not grow as long or tall as expected.

Babies may cry and sleep more than usual, and even go to sleep while feeding. They may also have developmental delays for their age, like not copying movements you make with your face.

Kids need to get enough calories to learn and develop well. So children with poor weight gain might start to walk and talk later than other kids, and can have trouble learning in school.

When to See a Doctor

Call your doctor if your child:

• develops new symptoms like vomiting, diarrhea, or fever
• doesn't begin to gain weight as expected
• loses appetite
• is tired a lot or doesn't have the energy to do everyday activities
• misses developmental milestones like sitting up, walking, or talking

Go to the emergency room (ER) if your child:

• is vomiting over and over again
• isn't drinking at all or has signs of dehydration (not enough water in the body), like a dry or sticky mouth, sunken eyes, less pee or darker pee than usual, few or no tears when crying, or unusual sleepiness

Causes

What Causes Poor Weight Gain?

Different things can cause poor weight gain, including:

Not Enough Calories

Sometimes a parent or caregiver measures or mixes formula incorrectly, so an infant doesn't get enough calories. Problems with breastfeeding or starting solids also can cause poor weight gain in newborns and infants. Some families have trouble affording enough food for their kids. And sometimes parents miss their child's hunger cues.

Eating Too Little

Some kids have trouble eating enough food. This might be due to a developmental delay, being a very picky eater, a medical condition that affects swallowing (like cerebral palsy or a cleft palate), or a condition like autism spectrum disorder in which kids don't like eating foods with some textures or tastes.

Digestive System Problems

Problems with the digestive system can prevent a child from gaining weight. Conditions like gastroesophageal reflux (GER), chronic (long-lasting) diarrhea, cystic fibrosis, chronic liver disease, and celiac disease can make it harder for kids to absorb enough nutrients and calories to gain weight.

Food Intolerance

A food intolerance means the body is sensitive to some foods. For example, milk protein intolerance means the body can't absorb foods such as yogurt and cheese, which could lead to poor weight gain.

Ongoing Medical Condition

Kids with conditions involving the heart, lungs, digestive system, or endocrine system might need more calories than other children. It can be hard for some to eat enough. Other kids may be taking medicines that make it harder to gain weight, and they need extra support.

Infection

The body can use up a lot of calories as it fights an infection. And kids who don't feel well might eat less than usual.

Metabolic Disorder

Metabolic disorders are health conditions that make it hard for the body to break down, process, or take energy from food. They also can cause a child to eat poorly or vomit.

Multiple or Unknown Causes

Sometimes a mix of things leads to poor weight gain. For instance, if a baby has severe reflux and is reluctant to eat, feeding times can be stressful. The baby may be upset and frustrated or in pain, and the caregiver might not be able to get the baby to eat enough.

Other times, doctors aren't sure exactly what causes the problem.

Diagnosis

How Is Poor Weight Gain Diagnosed?

Doctors will ask for your child's health history, including a feeding history. This helps them see if underfeeding, household stresses, or feeding problems might be causing the problem. They’ll also ask about your child’s birth and family medical history to see what other factors may have influenced growth. A dietitian or other healthcare professional may track the calories in your child's diet to make sure your child is getting enough.

Doctors also measure kids’ weight, length, and head circumference at each well-child checkup and put the results on a growth chart.

Sometimes doctors track a measurement called the z-score, which tells how close to average a child’s growth is. It’s an easy way to follow a child’s weight gain over time.

Your child might have tests (such as blood tests, urine tests, stool tests, or X-rays) to check for medical problems that could affect weight and growth.

Treatment & Care

How Is Poor Weight Gain Treated?

Treating kids with poor weight gain involves making sure they get the calories needed to grow.

Usually, kids who have poor weight gain can be treated at home. They'll also have regular doctor visits to check on weight gain. Doctors often recommend high-calorie foods and, for poor weight gain in babies, a high-calorie formula.

Doctors also might recommend:

• spacing out meals to make sure kids are hungry
• avoiding "empty" calories like juices and candies
• offering foods of certain textures if sensory issues are a problem
• other strategies depending what's causing the poor weight gain

Weight gain takes time, so it might be several months before your child is back in the normal range.

When a Hospital Stay Is Needed

Some kids with poor weight gain might need care in a hospital. They'll be fed and watched all day and night for several days (or longer) until they gain some weight. After leaving the hospital, kids will continue treatment at home.

Who Else Might Treat My Child?

The care team also will address any underlying causes for poor weight gain.Your child's care team may include:

• your primary care doctor
• a registered dietitian
• occupational therapists to help with sensory or coordination problems
• speech therapists to help with any sucking or swallowing problems
• a social worker if your family has trouble getting enough food
• psychologists and other mental health professionals for any behavioral issues
• specialists (like a cardiologist, neurologist, or gastroenterologist) to treat health conditions that could affect your child's weight

How Can Parents Help?

It can be hard to learn that your child has poor weight gain. No matter what's causing it, there are ways to help and support your child. You can:

• Follow the advice from your doctor or the dietitian.
• Take your child to all recommended doctor visits.
• Call your doctor if your child develops new symptoms, like frequent diarrhea or vomiting.
• Learn about any medical conditions that your doctor finds in your child.
• Talk to your doctor or a therapist if you feel stressed or frustrated about problems with feeding your child.

You can also talk with your doctor about things like healthy newborn weights, how much weight per week a newborn should gain, normal infant weights, and healthy growth for older kids.