Has your baby been diagnosed with “failure to thrive” or “growth faltering”? These are medical terms that raise concerns about growth and development of children.
If this is the case for you, we want to acknowledge that you may be feeling a whole host of emotions, including feelings of inadequacy, confusion, fear, and maybe a bit isolated? We hear this often from parents we meet in the clinic.
When parents hear the doctor say “failure to thrive” they sometimes end up internalizing the message and feel like it’s also a “failure to parent” diagnosis.
I know it may feel hard to believe, but you’re not a failure of a parent, okay?
We know that you want the best for your child and there are numerous medical reasons why a child may be experiencing failure to thrive.
Speaking of that strange term, what exactly is failure to thrive or growth faltering? The Merck Manual defines it as “a delay in weight gain and physical growth that can lead to delays in development and maturation.”
Essentially it’s when a child isn’t putting on as much weight, or increasing their height or head circumference as we would expect them to.
Using multiple growth measurements and comparing them to standards (growth charts), health professionals are able to determine whether a child’s growth is not matching up to expectations.
Please note that simply having a small weight is NOT a diagnosis for failure to thrive. Some babies are naturally small and as long as they’re plotting along nicely on a lower percentile on the growth chart, their growth is healthy and what we’d expect it to be!
Some bodies are meant to be on the smaller side. Some bodies are meant to be on the larger side. It’s important for health professionals to determine whether something is inhibiting genetically expected growth or whether someone is simply naturally on the small side.
What NOT to do when your child is diagnosed with failure to thrive
Before we get into our tips on what to do, we want to strongly emphasize one thing NOT to do!
While we know parents have the best intentions when they do this, what we REALLY want you to train yourself not to do is PRESSURE your child to eat.
Pressuring can take make forms including:
- Distracting your baby and then quickly shoving a spoonful of food into their mouth when they don’t expect it
- Using airplane motions with the spoon to try and get them to open their mouth
- Requiring a child to eat a certain number of bites before being excused from the table
Applying pressure tactics most often backfires. In the end you are further from your goal than when you started. When children feel pressured, they tend to push back with even more strength and refuse to eat. Obviously, that’s not what we want to see happen!
What you can do, however, is get creative on the back end and use the following strategies to help increase your child’s caloric intake!
8 strategies to help your baby gain weight
1. Plump up Their Food
Add more fat to your baby’s food! Gram for gram, fat has more than double the calories than protein or carbohydrates. Since babies often have relatively small appetites, you want to maximize each bite they ingest by packing as many calories in as you can.
Here are some ways to increase fat:
- Stir peanut, nut butter, or tahini into infant cereal
- Make banana egg pancakes with almond flour
- Add 1 tsp of neutral tasting oil to a puree
2. Embrace Purées
Let’s face it: purée foods are easier to eat! For babies who are just learning how to munch their jaws and manage new texture in their mouths, handheld foods offered baby led weaning style may be harder to ingest. It’s not always the case, but sometimes babies who are fed baby led weaning style may tire out or get frustrated with solid foods.
If your baby has been medically determined to be underweight, then we’d encourage you to embrace feeding more puréed food textures. Now, you can still serve finger foods along with purees. Or, we can reconsider more challenging textures down the road.
3. Embrace Finger Foods
In the same way, if you’ve been only exclusively offering your baby purée foods and haven’t moved very far in terms of texture, it might be time to advance to more finger foods. The benefit of purées is that we can often jam a lot of nutrition into the recipes but if your baby is well over spoon feeding and wants to feed himself, he might do better with finger foods like a meatball, french toast or an egg muffin.
4. Hydrate with Human Milk or Formula
Once a baby turns 6 months old, in general, we recommend introducing water so that baby begins to understand that her thirst can be satisfied with good old H2O. But water doesn’t have any calories so again, for the baby who needs to gain weight, we want to try and get calories into them as often as possible! So for these babies, you may want to delay introducing water and keep offering human milk or formula to satisfy thirst.
5. Dial Down the Fibre
This may be a surprising recommendation but for babies who need to gain weight, you may want to lean in on the refined grains more often than the whole grains! Dietary fibre is the part of the plant that doesn’t get digested in the upper digestive tract and thus, doesn’t provide any calories. (Okay, to get technical, some of it does get broken down by the bacteria in our colons, and provides some calories for the colon wall cells, but that’s very minimal!)
Fibre is one thing we recommend in adults to increase feelings of fullness without adding calories. This is essentially the opposite goal we have for our kiddos who need to gain weight!
As such, feel free to choose white rice, white bread, regular pasta, etc more often for your baby! And again in all of these examples, you can add fat!
6. Add in Another Meal
If your baby is taking well to solids and you have the opportunity in your daily routine to add in another meal or snack, then hop on that opportunity! Each child is different but some kids need to have an eating opportunity every two hours that they’re awake. To help you out, we’ve created a guide to baby feeding schedules.
7. Investigate Food Allergies and Intolerances
If your healthcare provider has not already done so, you could request that your child be examined for food allergies and intolerances. An allergy or intolerance could disrupt the body’s ability to digest and absorb food properly.
In particular, during infancy, inadequate growth can sometimes be attributed to an allergy to cow’s milk. In this Italian study, 77% of children who presented with failure to thrive had an undiagnosed cow’s milk allergy.
One form of gluten intolerance, an autoimmune condition called Celiac disease, can also cause a disruption in growth.
8. Connect with a Registered Dietitian or an IBCLC
It might be helpful at this point to connect with a local Registered Dietitian. They can complete a nutrition assessment on your unique child and offer you tailored advice that will work for you and your family. Sometimes, Dietitians may suggest concentrating formula or human milk but things like this should always be done with supervision.
Additionally, if you’re a nursing or pumping parent, it might be helpful to connect with someone, such as an IBCLC (international board certified lactation consultant) who can support your lactation journey. These professionals can help to determine if there are concerns with the latch and help you optimize your milk supply.