Poor Weight Gain
Roy Nattiv, MD
Diagnosing a treating children with gastrointestinal and nutritional issues.
Poor Weight Gain and Weight Loss in Children
The 6 Most Common Causes for Poor Weight Gain and Weight Loss in a Child
A child’s weight gain typically follows a predictable course from the newborn through adolescence and into adult hood. The weight is typically plotted on a growth curve and followed closely by pediatrician or other specialists. Weight less than the 5th percentile is often a red flag but maybe normal depending on the patient’s height (or length in infants). When providers see sudden weight loss or slowing of weight gain there may also be a cause for concern.
- Food Insecurity – By far the most common cause for poor weight gain is inadequate food supply – government programs such as WIC help to fill this gap but far too often children cannot meet their caloric needs.
- Pain – Discomfort associated with eating such as gastroesophageal reflux, constipation and dental caries.
- Dysphagia – Problems with chewing and swallowing are common in kids with prematurity or more permanent neurologic or neuromuscular issues such as cerebral palsy.
- Behavioral Issues – Aversion or refusal to eat can result power struggles between parent and child. Oral aversion can result from learned behaviors associated with food smells or textures.
- Increased Caloric Demand – Children with underlying heart, lung, kidney or metabolic issues may often require increased caloric demands. Ad they burn through, more calories there breaks down fat/muscle as energy and they may lose weight.
- Poor Intestinal Absorption – Inflammatory conditions of the intestine or pancreas may result inqdequate digestion or absorption of food across the intestinal wall. Children with celiac, cystic fibrosis, food allergies or inflammatory bowel disease may require special medications or diets to aid in improved intestinal absorption.
Evaluating and Treating Child with Poor Weight Gain
Growth Charts, Exam and Testing
The evaluation of a child referred for suboptimal weight gain begins with accurate measurement of height and weight. These two measures independently may give some of idea of the severity of malnutrition. Equally as important is the weight-for-length or BMI – this is a measure of proportionallity. A child who’s height is weight is declining despite adequate linear growth is concerning for inadequate calories or malabsorption of calories. However, a child whose weight and height are both low but who is proportional may reflect genetic causes or low growth hormone levels. just an ov temporary slowing of growth.
A thourough phsycal exam should be performed to evaluate for signs of chronic heart or lung disease. Other signs of malnutrition and vitamin deficiencies may be visible on exam. Blood tests may be performed in a step-wise fashion including screening for chronic infections, celiac disease, inflammatory bowel disease and vitamin deficiencies requiring supplementation. A Pediatric Gastroenterologist is typically consulted for more advanced testing to including stool tests to screen for infections/parasites or malabsorption of nutrients including pancreatic insufficiency which is required to absorb fat.
Treatment of children with suboptimal weight is first and foremost aimed at addressing the underlying causes of malnutrition. A Pediatric Gastroenterologist may help familyies navigate any additional specialists or therapists that need to be involved. A nutritionist may help to assess the necesssary fat, protein and carbohydrate caloreis necessary for “catch-up growth”. Nutritional supplements may be offered to the child. These may come in the form of home-made smoothies or shakes or highly-specialized supplements purchased from pharmacies. These are often taoilerd to the child’s specific needs including any dietary reestriciotns and cultural beliefs. Occasionally, appetite stimulants may be used for short periods of time to help improve oral intake. In rare instances, critically ill infants and children who are unable to eat by mouth or consume sufficient calories to maintain there normal growth and development may require feeding tubes known as a gastrostomy.