Poor growth, also known as failure to thrive, occurs when a child/infant is not gaining weight at an adequate rate or if they are much below children of the same age and gender – assessed by dietitians and GPs using growth charts.
Some children can just be smaller than the average and can fall below the 3rd percentile but still be healthy. It becomes a concern when their weight is tracking downwards across the percentiles instead of steadily increasing. This could impact growth and general health, and is an indication for nutrition and medical assessment to rule out any concerns and to improve weight gain.
Hearing this can be stressful for parents. It is important for parents to remember that poor growth may not necessarily have negative implications in the future if everything appears to be in order and there is no evident cause such as: health or psychological problems, or nutritional deficits. In saying that, it is still vital to rule out any potential causes prior to dismissing poor growth.
Causes for poor growth in infants and children
There can be a number of potential causes for poor growth ranging from issues that will impact nutrient intake to the utilisation of nutrients. They have been outlined in the table below that was adapted from the Royal Children’s Hospital Melbourne.
Symptoms and investigation
Most medical practitioners and dietitians will begin with collecting a thorough history to gain a good knowledge of the child’s background.
This will include:
- Medical history – any known medical conditions or past illnesses that may be impacting a child’s desire to eat e.g. tonsillitis can having lasting impacts on children due to the pain associated with eating.
- Weight/measurements history – looking at tracking along the percentiles.
- Family history – any illness/disease, stature of parents.
- Social history – family dynamics, any financial concerns (inadequate housing /money for food/support) and any other relevant information.
- Thorough feeding history – timing, amount of food, places eaten, people eating with.
- Parents’ knowledge of food/nutrition and feeding.
Sometimes a child/infant will appear perfectly healthy. Other times, there can be some small signs that the child may not be receiving adequate nutrition to meet their needs and maintain good health.
Signs of poor nutrition may include:
- Poor energy levels.
- Evidence of muscle/fat store wasting – best assessed by a professional.
- Pale/unwell looking.
Blood tests/urine samples/stool samples may also be taken to ensure all levels are within the normal ranges and that there are no deficiencies present, malabsorption, or any underlying conditions.
Management will likely involve a multidisciplinary team approach – this is most effective. For example, a paediatrician and dietitian. Speech pathologists, psychologists, and occupational therapists may also need to be involved depending on the issue and can be extremely useful for tackling behavioural issues too.
Any underlying medical concerns should first be ruled out along with a nutrition assessment performed by a dietitian. If the infant is eating well and appears to be otherwise healthy, then their weight should be monitored. The dietitian can provide some tips on gradually increasing weight gain and ensuring nutritional adequacy. Once all major concerns have been ruled out, the parents should try not to stress too much as this can also inhibit adequate feeding processes and environments.
Contact us for results focused nutritional advice
This article was written by our dietitian Belinda Elwin who is a Dietitians Association of Australia member and Accredited Practicing Dietitian and Nutritionist. If you have questions about nutrition, make an appointment. We‘ll provide you with a simple and effective routine targeted to your concerns. Contact us today!
- The Royal Children’s Hospital Melbourne. Poor Growth [internet]. Parkville, VIC (Australia): The Royal Children’s Hospital Melbourne; [cited 2016 April 6th]. Available from: rch.org.au