What is failure to thrive, and is my child at risk of being diagnosed with failure to thrive if he or she is in the lowest part of the growth chart?

Being small in size is not necessarily a sign of failure to thrive. For example, if your child is in the fifth percentile for weight and stays consistently in that percentile as she ages, while also meeting all of her developmental milestones, she may simply be smaller in stature. However, if your child suddenly or continually drops into a lower percentile for weight, there could be an issue with your child’s health or nutrition.

Other factors may accompany this weight change and cause further concern. If this lack of weight gain appears to be affecting your child negatively and is accompanied by some or all of the following signs: constant irritability, excessive sleeping, lack of age-appropriate social responses such as not engaging with caregivers by smiling, babbling, making little or no vocal sounds, or showing motor development delays, it may be possible that your child is experiencing failure to thrive.

Reflux, or the more serious gastroesophageal reflux disease (GERD), can occasionally cause or lead to failure to thrive when it causes babies so much discomfort that they begin to associate eating with pain. Reflux is the regurgitation of stomach acid and food into the esophagus and throat, and in more severe cases into the lungs and bronchial tubes. GERD is a more severe form of reflux, a chronic problem that will not resolve itself on its own with treatment. Babies with GERD will require treatment in order to be able to eat the appropriate amount of calories to maintain proper nutrition and growth.

Reflux and GERD can occur in infants not only due to the size and shape of their esophagus but also due to food allergies. Reflux is more common in infants, and more likely to cause infants pain. As previously mentioned, reflux or GERD may lead an infant to associate eating with pain, which can result in the infant refusing to eat or eating very little. This can lead to a drop in her weight and may contribute to other symptoms of failure to thrive.

Although not every baby who regurgitates has GERD, a dramatic change in a baby’s growth percentile may indicate a need to focus on baby’s eating habits to determine if reflux or GERD is causing failure to thrive. One clue that reflux or GERD is a factor is the smell of your baby’s breath. Infants with reflux will likely have breath that smells like old vomit or sour orange juice. Keeping a detailed daily journal or log book that includes this and other information can prove extremely helpful in finding answers:

• Number of wet and dirty diapers baby has each day
  Do the soiled diapers smell foul? Is there any mucus or blood present in the stool?

• How often baby eats, how long it takes baby to finish eating -
  and if baby seems satisfied after eating. If baby is nursing at the breast, keep track of when and how many minutes baby spends nursing. If baby is bottle-fed, keep track of when and how much baby consumes.

• The nursing mother’s diet
  Record all food and drinks that you consume. This can help in narrowing down potential food sensitivities and food allergies that could possibly be causing your baby’s reflux.

It’s important that doctors observe the infant to distinguish between reflux and GERD in order to know if their condition warrants treatment, and, if so, what type. Reflux can be caused by a mild histamine reaction to allergens such as gluten, cow’s milk, eggs, nuts, or soy proteins consumed by the nursing mother or used in commercial infant formulas. Treatments will vary but some can include dietary changes to eliminate any allergens, positioning of the baby and sometimes anti-reflux medication.

When it comes to failure to thrive, a perceptible change in a child’s size can matter. Zeroing in on your infant’s eating habits, digestion and overall disposition may be a good place for you and your health care provider to focus when you have concerns about your child’s development.