Failure to Thrive

Failure to Thrive

 A diagnosis of failure to thrive hurts – I have yet to meet a parent that doesn’t feel some sense of personal failure when this diagnosis is attached to their own child. As a medical student, you are taught to view failure to thrive as a generally nonorganic phenomenon – as in, not a condition which results from actual disease – more of a social issue – lack of appropriate nutritional intake, diluting formula to make it last longer, irregular meals and chaotic schedules, a problem with the parent-child relationship…

I still remember when my own child started to slip on her growth curve – I was expecting my third child in a matter of weeks and my daughter’s 18 month growth curve showed her slipping in weight, as well as height and head circumference. She was and is exceptionally bright, so development was on track, but her growth had stalled. My pediatrician and I discussed nutrition – specifically the protein and fat content of her diet, her daily diet routine etc. He was however, generally unfazed – she’d level out —but by 2 years she had fallen dramatically – both her height and weight had slipped below the 5th%, she was irritable and honestly appeared weak. The search for organic disease began – labs were drawn, bone age evaluated, sweat tests and growth hormone stimulation tests ensued, and a GI scope and brain MRI were ordered. What if all was normal? I’d be thankful, but then the diagnosis of ‘failure to thrive’ would be explained by nonorganic disease – she just wasn’t eating enough to grow… How is that possible? Living in the land of plenty, the refrigerator overflowing…

 But then the diagnosis of failure to thrive was explained by nonorganic disease – she just wasn’t eating enough to grow… How is that possible? Living in the land of plenty, the refrigerator overflowing…

My now thriving daughter’s case is extreme, and luckily, not something I see on a day to day basis in my office. What I do see daily, however, is the fear that our children aren’t getting enough nutrition to support their growth in a healthy manner. We often rely on heavily processed, calorically dense foods for growth because it is all our kiddos will eat. Often times kids do just fine, especially when your criteria for measuring growth is the pediatric growth curve, but how does the diet we feed our kids support their brain development, their behavior, their overall wellness. I would say most of us don’t support our children’s growth as well as we’d like, partly because our finniky kids won’t tolerate – much less enjoy – the options on the market today.

When my daughter needed a nutritional supplement, I was told to use Pediasure or Carnation instant breakfast. In fact, most pediatricians will recommend these two products to parents whose children are either gaining weight slowly or just as a way to add more protein, fat, vitamins and minerals to their child’s daily intake. Have you ever read the ingredient labels on these products? Even for someone who has a pretty relaxed interpretation of an overall diet, these two foods completely miss the mark. They are casein based (a milk protein that lots of kids and adults don’t tolerate well), they are loaded with sugar and they contain a slew of artificial ingredients and preservatives. Where are the natural alternatives?

Today, adult diet trends are focusing on enjoying a relatively raw, minimally processed, reduced gluten diet. With our children, however, I feel the market is pushing a low fat/fat free diet secondary to the obesity epidemic, and almost forgetting the benefit of some healthy fats, the importance of protein in supporting growth and the need to minimize the processed foods that our children currently consume in large quantities.

How can we as parents improve the quality of the calories our children consume? A few ideas…

  1. If your kiddo refuses milk – add a chobani tube of lowfat greek yogurt to a glass of milk – it adds flavor, protein and probiotics (not just sugar like chocolate syrup).
  2. Still refusing protein rich drinks? Whether it be milk, almond/cashew milk or coconut/rice milk – consider adding fresh fruit, a touch of honey, agave nectar or stevia and freezing into popsicles! Makes for an awesome summer treat!
  3. Follow the advice of the chefs in our midst – hide veggies in kid favorites – smoothies, pasta etc.
  4. Encourage your kids to help you prepare meals- the process of preparing the food can stimulate the drive to eat it!
  5. Make sure your child gets at least 3 servings daily of vitamin D, calcium rich food or drink, and if they don’t — make sure to supplement with between 600-1000iu of Vitamin  D3 daily. This supplement can, without question, impact the overall growth and health of your child.
  6. Make sure to include iron-rich foods in your child’s diet as well – such as beans, greens, eggs, nuts, dried fruits and fortified grains. If needed, an iron-rich containing vitamin can help too (just make sure to keep out of reach of little ones as iron can be toxic if consumed at above recommended levels). Of note, have yet to find a gummy vitamin that contains iron, go for a kids chewable instead!  The dentists aren’t fond of the gummies anyway!
  7. Check out Orgain for Kids – a healthy tasty alternative to Pediasure.
  8. Always attempt to couple a protein to a carbohydrate-loaded snack – add cheese or nut butters to crackers, Greek yogurt to fruit!
  9. Try to enjoy meals – don’t get into a push-pull with your kids over food — it just doesn’t work! Don’t bribe, praise or punish – if they dawdle over one meal they are likely to devour the next!