Feeling defeated about failure to thrive

My friend S just found out that her 2 1/2-year-old is being officially diagnosed as Failure To Thrive. He is a happy, connected kid who is hitting all developmental milestones, and is ahead of things verbally (in two languages). His caregivers at daycare give him glowing reports and he's just generally a funny, engaging kid. But he's not gaining weight.

For years she and her husband have been trying to get extra calories into him, but he's still not gaining weight the way her doctor wants him to. He's always been on a low curve percentile-wise but is falling off that curve, and his head circumference isn't growing like it should, and his height is lagging, too.

I recommended a) a second opinion, and b) finding out if he has food allergies or sensitivities that could be preventing him from gaining weight.

I know some of you have dealt with this and would love both some suggestions of things for S to look at, but mostly some encouragement. She's feeling completely defeated and inadequate as a mother at this point, and needs some help.

Comments

[MLB]

I would recommend a thyroid check. Friend of mine had a daughter whose thyroid just quit around the same age. It's worth a test to rule out. More info can't hurt

[Catherine]

Man, I completely agree with the second opinion, and especially to ask if there is a gluten issue. I used to think "gluten issues" were a bunch of bunk, until a very close friend's son was diagnosed (after he moved to Europe, actually) and the difference in his ability to "thrive" (i.e. grow and gain weight) was INSANE.

As for the other: he's obviously thriving in every other sense, and while this is frustrating, it is not a reflection on your parenting AT ALL. You're doing what you can to get him what he needs. Keep doing!!

[Erin B]

The parents decide what and when to feed their kids and the kids decide how much to eat.

With mine the more I struggle with them the less they eat. I go for homo milk and full fat dairy. I've got a horribly picky eater and getting non-dairy protein into him is a struggle. We have dessert tofu on hand. I also make breakfast bean cookies and high-iron pumpkin muffins. I keep giant bags in the freezer. I always put a few chocolate chips in these to help keep them eating.

She's a good mom. A great mom. A good parent tries. And she's trying. If she was a bad mom they wouldn't be trying so hard to help her child.

http://www.foodily.com/r/qystAEL9F-breakfast-bean-cookies

[Spacemom]

a) second opinion
b) thyroid/ parathyroid check
c) check out allergies
d) endocrinologist should be brought in for other metabolism issues.

my nephew was a FTT and ended up taking growth hormones for 2 years.

My daughter is low BMI and low weight, but high enough to stay on the charts. We have to give her Carnation Instant breakfast every night for extra calories. Part of her issues appear to be a fast metabolism.

[Jacquie]

I haven't dealt with this issue, but in general, I've found Ellyn Satter (http://www.ellynsatter.com/) to have a lot of practical, non-hysterical advice on feeding issues. Katja Rowell (http://thefeedingdoctor.com/) who's trained in the Satter method is also great.

[Enu]

Don't let the doctors and/or social services people determine that unless it can be proven otherwise it is about your failure as a parent and/or abuse/neglect. There is possibly an un-diagnosed underlying cause, which may at some point be recognized and treated, or may remain unknown. But the fallback position for not being able to determine what it is should not be that it is because of you. Unless, of course, you do abuse and neglect your child, you know?

Totally second opinion and specialist follow-ups. Note that this sort of thing can take a very long time, as they rule out increasingly less likely possibilities.

Try not to let the whole thing dampen your joy in your child or your confidence as a parent.

Wishing you and your child all the best!

[Michelle]

Is he a picky eater or does he eat well and just not gain weight? I would certainly have some blood work done to check for celiac and other malabsorption issues.

My stepson was failure to thrive but in his case he had a urea cycle disorder that left him nauseous all the time. He had a feeding I've put in but after he ham his liver transplant, it was more of a retraining to like the taste of food.when I married my husband, Iworked to increase healthy fats I his diet and offered snacks round the clock. He is allergic to fish but that's it. He turns 14 next month and is still around the 20th percentile but eats like a typical teenage boy, meaning everything in sight.

Good luck!

[Elizabeth]

I've not dealt with failure to thrive but just wanted to chime in with my encouragement. My first child was a total butterball - fat rolls and at the 99th percentile for weight (on breastmilk alone).

My second child looked like a scrawny chicken and you could see all her ribs. If I had been living in N. America at the time, I can almost guarantee I would have been dealing with alarmed doctors and specialists. But - she was fine and meeting milestones. She's now a sunny, healthy, kind, happy 3 year old who skis, swims and is starting to read!

All that to say, it is NOT a reflection on your parenting. I did the exact same thing with both babies and the results could not have been more different. I would have been questioning EVERYTHING about my parenting if baby #2 had been my firstborn.

Hang in there. Get a second opinion. You are doing a great job.

[Tine]

My nephew is a peewee dynamite, too. He too is 2.5 yrs. and doing great developmentally (in both cognitive and motor skills). But not so much growthwise. He will soon be outstripped in size by his little sister, who is 16 mos. younger.

In his case, we all suspect it is related to sleep troubles (because kids grow while they're sleeping). He has had chronically swollen tonsils and adenoids and related sleep apnea for the last year or so. He is just now fully recovered from a tonsillectomy and adenoidectomy 10 days ago. He is already sleeping and eating SO much better. We have high hopes that his weight gain will soon pick up, too.

We know another little boy who was having sleep-related growth issues as well...seems like an issue worth looking into, among others of course.

A neighbor boy (much older--10 yrs.) is having growth problems, too. In his case, it seems to be a hereditary thing. He is seeing a pediatric endocrinologist. So that's another avenue to explore.

To Moxie's friend S: You are an excellent mom. You're just the mom your kid needs. You are doing everything you can possibly do, and you will find the answer. ((hug))

[Ruta]

Hang in there mama!! It is a good sign that he is meeting all his milestones and is a bright, engaged kid!

If you haven't already, I would first ask for a referral to a pediatric endocrinologist to make sure there are no endocrine or metabolic disorders that are causing the slow weight gain/growth, especially since he is falling off his curve. If all those issues check out ok, then I would recommend seeing (if you haven't already) a pediatric nutritionist. Depending on where you live, you may be able to find one who really specializes in working with preschoolers. Young preschoolers can already be difficult to get adequate calories into (this is when they get picky, food aversions pop up, they are super active, etc), but it sounds like there are some more complicated issues here that are making things even more difficult. Hope you can get some answers soon!!

[yasmara]

I know it's difficult to tell by such a short exposure, especially when it's someone writing in for a friend, but my alarm bells immediately started going off in regards to the pediatrician.

Please, please, please urge your friend to get a 2nd opinion. "Failure to thrive" in a preschooler seems, as Enu said, designed to set up the parent for intervention by social services. The pediatrician should be aggressively investigating the underlying cause...as others have said, referring your friend to a pediatric endocrinologist, allergist, etc. & not just writing off this child!

[Tine]

P.S. I just remembered another family I know who dealt with this in their preschooler. It turned out that he had celiac disease. Exit wheat, and he is now back up on top of that growth curve.

[han]

I really don't like that term "failure to thrive", since as another commenter stated, S's son IS thriving in so many ways. I understand how demoralizing it must be -- we try to get our little guy to eat, eat, eat, and he's only somewhat interested. Some nights during and after dinner, I think WTH?! I am sending best wishes to S --it's clear that she and her husband are doing everything they can. Maybe just internally they can come up with another term to reference the diagnosis, maybe something they find sweeter (e.g., it's ASB - our awesome skinny buddy! I don't say that to minimize the possible medical causes, but just to not focus so much on the word "failure"). It's such a charged phrase, I think, that you can't help but feel a bit defeated. I would definitely second the second opinion/food allergy/endocrinologist suggestions. I might pull out all the stops and look into a naturopath or chiropractor too. Take good care, S.

[Enu]

P.S. Ultimately my FTT baby was diagnosed with Crohn's Disease (at age 10) - which can certainly cause FTT, but a determination was never made that that was the cause of her early FTT (and not parental neglect.) Me, bitter?

Oh, and...btw? She's now a totally awesome adult, and a normal height and weight.

[Sonia]

Yes! Second opinion! Get thee to specialists. They will help you figure out 1) if his growth IS actually stunted and 2) why it is and what you can do about it. He may not be thriving growth-wise, but from Moxie's comments, he seems to be thriving developmentally and intellectually. So, you are doing well by him -- you are doing your job as his parent to teach him. You can't control how he grows, and you are reaching out to the professionals who can help you solve that problem. Best of luck!

[Kinky]

Homeopathy. Magnesium.

[Cloud]

Definitely go get the medical possibilities checked out- thyroid, growth hormone deficiency, etc. All of these are treatable.

But also, ask the grandparents how you and the father grew as kids. I have a friend whose first was very small in preschool, to the point that the doctors were worried, his younger brother weighed more than him, etc., etc. But also hitting all the developmental milestones. And then her husband's mother pipes up and says "oh, his father was like that, too. Was the smallest kid by far until (some age that I can't remember), and then he started growing." The father is now over 6 feet tall, and clearly has no growth defect. So some kids just don't get the memo about the growth charts.

[AmyRenee]

One thing that stood out to me in the email was the "in 2 languages" part. Are S and her husband of a culture/ethnicity that is typically smaller than the average American - Japanese, for instance? If so, it may be helpful to look at growth charts for that country or the WHO growth charts, not the CDC growth charts. Is the doctor more concerned about lack of growth between visits or overall placement on the growth charts? Is there an extenuating circumstance that could have caused low weight gain between visits, like the child recently had the nasty flu that's been going around?

[Beate]

Definitely get a second opinion. You need a doctor who is willing to look at multiple variables and think in complex ways: height, weight, height/weight, growth pattern over time, height of ancestors, eating behavior, reactions to specific foods, developmental milestones, etc. Test thyroid levels and check for gluten sensitivity. It would be good to also get a smart pediatric endocrinologist involved--thyroid issues tend to be complex and even more so when kids are involved.

My 3yo is at the bottom of the height distribution for her age, as well as at the bottom of the weight distribution for her age. But height/weight is less dramatic--she is short but not skinny. Her doctors have looked for long-term patterns, checked iron and lead, and considered the fact that grandma is extremely short. There are no symptoms that would indicate gluten sensitivity. She meets the milestones, though her height limits what she can do gross-motor-wise: balance bikes tend to be too big and heavy, for instance.

Anecdotally, I find it reassuring that 2 other girls in her preschool class are even shorter at the same age--people do come in different shapes.

The connection with sleep is interesting.

[brianne]

I wish I had encouraging words but instead I'm just excited to read these comments - my daughter is in same boat - pediatrician threatened a feeding therapist if she doesn't gain "sufficient" (WTF) weight by her 2 year appointment (she gained nothing between 15-19 months).

[Katherine]

I was diagnosed with FTT around that age and my Dad sat down and read a medical dictionary, then insisted I get tested for celiac disease, which it turns out I have. Fast-forward 28 years, I don't have any major medical problems and I would say I'm doing ok.

[Elizabeth]

I was coming in to recommend Katje Rowell too, Jacqui.

[Doris Beers]

Full medical review by specialists, including geneticist. Genetic illnesses are sneaky. It took til age 19 to get a proper genetic diagnosis for my son. There are so many things this could be and the standard run of tests a pediatrician would look at might not show show them. If there is a medical center anywhere nearby that specializes in diagnosis and treatment of FTT or metabolic illnesses, find a way to get there. The earlier a kid is diagnosed, the easier life will be.

[Doris Beers]

Full medical review by specialists, including geneticist. Genetic illnesses are sneaky. It took til age 19 to get a proper genetic diagnosis for my son. There are so many things this could be and the standard run of tests a pediatrician would look at might not show show them. If there is a medical center anywhere nearby that specializes in diagnosis and treatment of FTT or metabolic illnesses, find a way to get there. The earlier a kid is diagnosed, the easier life will be.

[albe]

This is such a tough topic. Others have addressed the medical issues, but I'd like to talk about feeding, etc. My daughter has been underweight her entire life, and as a baby this set off visits to the GI specialist, gastric emptying studies, visits with the dietician, etc. I was instructed to supplement nursing with special high-calorie formula, and once she started eating we supplemented all of her food with tricks to add calories (adding avocado oil to everything, for instance).

The whole thing was horrible and drove me insane. One thing I learned, looking back on it, is that you can't force a baby/toddler/preschooler to eat. My daughter would simply self regulate, and if she was eating especially high calorie food, she would just eat less of it. Over time eating became terribly fraught and the pressure to eat caused all sorts of problems. It can drive a parent crazy, but I think it also sets up the kid to dislike mealtimes, and it becomes a self perpetuating cycle. If you can avoid that and trust your child to eat what he needs, that will help so much.

I still shudder to remember the one time I gently encouraged my 18-month old daughter to eat just one more bite, just one more bite, and she sweetly did it to please me, and then threw up right at the end of dinner because I had overstuffed her. I have never felt so guilty or horrible as I did then.

When my daughter was 2, my mother found all of my own baby records. Lo and behold, at each same-age visit, I actually weighed the same or slightly less as my daughter. But back then, in the 70s, it was just fine and I was at the 10th percentile on the charts. (As an adult I'm petite but not unusually so, and am healthy and normal). I finally said forget it, started following the division of responsibility stuff with eating, and stopped trying to control how many calories she took in. Everything improved so, so much. It had no effect on her growth, but mealtimes stopped being a battle. Everybody's lives improved a great deal.

My daughter recently turned 5 and we just had her well check up yesterday. She is a normal, healthy kid who has hit all of her developmental milestones early. She is extremely active and she loves to read. She also weighs 27 pounds. It still bothers me to see the nurse write "0%" on her weight, but I know that she is healthy and thriving - just tiny.

I wish I could tell every parent struggling with a kid's weight gain or eating to be kind to themselves, to know that you cannot force a child to take in more calories, that it will be okay in the end. Get a second opinion, get the necessary tests done to rule out any medical issues or address them if they exist, but more than that, know that you're a good parent doing everything you can for your son.

[giddy]

And I second the recommendation for Ellyn Satter.

[sasha]

I would second the recommendation for tonsil/adenoids check. My daughter was diagnosed FTT due to sleep apnea caused by enlarged tonsils (19 lbs at 2 years old, 22lbs at 3 years old). When we were working with our ENT and pediatrician, we found out that Asians are more likely to have enlarged tonsils leading to sleep apnea than the general population but also less likely to be diagnosed (our doctor was Asian as well, and very up to date on this issue).

After her tonsils/adenoids were removed - she literally gained 6 lbs in the next month. It was like a switch had been turned on and she could finally grow. Now, I will say she is a little peanut still at 8 years old - but very healthy and has stayed on her little line for the last 5 years (3rd percentile in height, 8th percentile in weight).

The only other thing I might suggest is to talk to your doctor about how to make each calorie count. We were given a lot of very good advice on how to make every bite of food be as healthy and high calorie as possible. Our daughter's tonsils were so large that it made eating painful. We learned a lot about how much protein and fat she needed to eat each day to make sure that her body was being nourished effectively and we put our energy into finding high calorie choices that were the least painful. Avocados were definitely our friends. ;)

[Celeste]

Second opinion time, with a specialist. I agree with the ped endocrinologist. It may be a growth hormone issue; a friend's child is going through that. With that resolved, he is not only getting taller but filling out. He too is an awesome kid just like the OP's. My friend worked through the local Children's Hospital, so maybe that is avenue in the OP's area? I wouldn't just assume it's a feeding clinic issue because those tend to deal more with sensory issues of children having oral aversions. If he eats comfortably and with any variety at all, I don't think it's a "feeding" issue. Celiac disease is worth looking at; it is pretty fixable as these things go, and these times are really great for being able to find more options at stores and restaurants.

Finally a friend's child also had small head size but it began to grow and get back on the charts after 3. There can just be so much variation in this and nobody tells us that up front; it's super scary to hear it from a doc, though. Clearly your child's intelligence and language ability is NOT being affected by it, so I hope that a specialist consult can help you feel better about this as well.

I'm sorry that you're having this rough patch; nobody worries like a mother. Nobody.

[Elizabeth]

We had this exact problem with our now 5 year old, so here's what we did. He lost weight from 15 months to 18 months...that's...not good in an 18 month old. (This comment might be a novel.)(After the annoying suggestions like, make him eat ranch on all his food.)

1. he had a sweat chloride test to make sure he did not have cystic fibrosis. I carry the gene for CF and my husband does not, but they only test for the MAJOR genes so it's not a guarantee that this not an issue. He did not have CF. (And I knew he didn't but I wanted him to have the test to rule it out)
2. He had metabolic tests to make sure it wasn't his thyroid or a lack of growth hormone. It wasn't, but we saw an endocrinologist just to make sure and this was very helpful.
3. He had the blood test to see if he had celiac disease. This is where it gets a little wonky. According to the test, he did not have celiac disease, but at that time, the test was wildly inaccurate. (not sure if it still is, though). It only picked up on actual damage to your celia, not a gluten sensitivity or a wheat allergy. If you want to VERIFY celiac disease, you need to do minor surgery to look at the intestine, which we opted not to do. However, when you look at the symptoms of a gluten allergy, Eli had them ALL. (weight loss, distended stomach, fingernails breaking easily, eating dirt, runny poops.) And there are not that many things besides cystic fibrosis, growth hormone, or celiac disease that cause weight loss in a toddler, especially if your child does not have sensory eating issues, which ours does not.
So we decided to go against Ped advice and put him on a gluten free diet. It was a bit of a learning curve, although Trader Joes was very helpful as was the gluten free store in town, and we noticed a difference IMMEDIATELY. Maybe three days in? He started to gain weight, his stomach stopped sticking out, his poop was no longer orange and runny, and his nails stopped peeling. He eventually ended up at about 15% on the weight chart when he wasn't even on it when we started.
We continued to try gluten about every six months - we'd let him have a piece of pizza or a pretzel or something and see how he reacted. At about 4.5 - 5, it seemed to go away. He is still only about 7% for weight on the chart, but it's a steady curve, and he is no longer considered "failure to thrive."

It was an INCREDIBLY stressful experience to have a child fall off the weight chart, to not know what was wrong with him and to try to figure out what was wrong with my baby. I ended up severely depressed and needing to talk to someone and be on an SSRI for some time, so I would recommend paying careful attention to how you are doing through this experience, it really threw me.
Good luck, I know how much this sucks. If you want to email me, or ask any questions, please feel free.

[Kate]

Sounds exactly like a friend's kid who got celiac dx at 3.5. (She also had pretty thin hair that didn't grow as fast as it should, that turned out to be another tip off.)

Definitely second opinion for celiac and all the other things people have mentioned with interfering with growth (allergies, apnea, endocrine issues). These are all treatable.

And possibly a new regular pediatrician? You want to feel like you and your kid's doc are on the same team...

[SarcastiCarrie]

I don't see the pediatrician as being the bad guy at all in this situation. Don't you have to have a billable diagnosis for insurance to cover referrals to specialists? I think you do. This diagnosis might be the ticket to the second opinion or the pediatric endocrinologist or gastro.

As much as I didn't like my first trimester bleeding to be called a threatened abortion, that's the diagnosis code that needed to go on the paperwork to ensure that my blood tests and ultrasounds were covered.

So, the pediatrician might be using the term Failure to Thrive so that the child can be referred for additional testing, etc and not realize that the term freaks parents the eff out. I think everyone is on the right track with places to look.

Hedra has talked about the feelings of guilt associated with watching her kids fall off of the growth curves prior to their malabsoption diagnoses.

[Ang]

My pediatrician diagnosed my DS as "failure to grow" instead of "failure to thrive" since he was hitting all of his milestones. We ended up getting his adenoids and tonsils out which helped him sleep better, although not great. She then put him on a nightly dose of melatonin. OMG. Much better sleep and overall happier child. The extra sleep did seem to help his growth. We are now going up the chart. Not at any great speed but...

Reading the comments I'm going to try gluten free. My sister is sensitive and he has some of the symptoms so maybe that will help too. I love this site.

[Megan]

S you are doing a great job! We went through a similar thing w/our son btwn 9 mos and 2 years...monthly weight checks, tests, scores of "how to get your toddler to eat more calories" handouts, websites, books, etc. and it was really frustrating and discouraging. One thought regarding the diagnosis of FTT, and I would hope the ped would communicate this if it was the case, but is it possible that in order to be seen by specialists/to have certain tests and be covered by insurance, you need to have a diagnosis of some sort? The only reason I mention this is that after our son had basic bloodwork to rule out easy/obvious things, they wanted him to be seen by pediatric nutrtionist, etc, and our insurance would not cover it AT ALL unless there was a diagnosis in place- i.e. it had to be "medically necessary", and an FTT diagnosis was mentioned at that point, by the nuritionist's office and the medical billing folks- essentially saying "Does your ped want to diagnose as FTT so that you can come see us or are you not at that point yet?" I do not think that giving a serious diagnosis essentially as an insurance work around would be a good way of doing things, and again, I would hope if this was the case the pediatrician would explain it, but only mention it as a data point that was part of our experience.

[Brooke]

He is a little old to meet the criteria I think, but this may be helpful for someone else. My daughter almost certainly has constitutional growth delay. We didn't know about it when she was small and not growing(even though we were seen at a great university hospital), but learned about it later. It is a variant of normal growth where kids start fine and fall of the growth curve and stay small until puberty. Apparently it is diagnosed by a hand x-ray.

[nej]

Haven't read everyone's comments bc I am elbow deep in the snot of two children, but when E finally got diagnosed with a dairy allergy, he grew almost four inches and gained almost four pounds in less than a year. It caused him physical pain to grow that much so quickly, which was the only sucky part. However, I managed to feel huge relief at watching him chug right back up that curve.

[Wilhelmina]

I agree absolutely with the paediatric endocrinologist recommendation. It is a very, very good place to start. They work with nutritionists and all other branches of medicine.

I also suspect gluten sensitivity. There's eating of food and then absorbing of the nutrition in it, and those are separate things.

And family history etc. also matters.

My just turned 5 year old daughter was referred for suspected precocious puberty based on her height. On the charts here she'd be a 7-8 year old.

It was suggested her diet was wrong etc. etc. I can see it is a lot better than being accused of not feeding enough!

The endocrinologist did blood tests, X-rays and abdominal ultra sound and all was normal. She has Dutch ancestry through both parents and I am short in my family at 5 ft 9. The only female below 6 ft. My grandfather way back was 6 ft 4.

She's just tall.

As the OP's little boy is hitting all milestones he really is thriving. The OP is doing a great and difficult job here.

[A.M.]

I'm looking forward to the comments, too--my 11 mo has fallen off the weight charts, even though he's hitting all developmental milestones and very happy. His older brother and sister were/are all squarely 50th percentile pretty much all the time. My ped threatened to have a feeding tube put back in his nose (baby was hospitalized for 5 weeks with infant botulism) which would mean that he'd be not allowed back to daycare and I'd have to take leave/quit my job to take care of him at home. DS had a slight dairy sensitivity (one spoonful of yoghurt would make him break out in hives all over his face and sometimes his torso as well), but no other obvious symptoms of other sensitivities or allergies. We feed him often, with a lot of variety, and enrich his spooned foods with rice cereal and olive oil or coconut oil. Every half ounce he gains is hard-won. We try not to stress, but DS is a slow eater who stops as soon as he feels full (no one can make a kid eat!). He is mostly enthusiastic about eating (like any normal kid).

Another pediatrician tried to reassure that this wouldn't necessarily be the case, as growth trajectories have individual variations. We have a GI appointment coming up. I remember very well the intense feelings of shame, sadness and anger when a clueless pediatric resident told me they were planning to supplement with formula while DS was in intensive care because I was failing to produce enough breastmilk (even my husband didn't understand--his response was "Big deal!"). I felt like I'd really let my son down in so many ways at that point.

I sympathize with your plight--and wish you the best of luck. Lots of people who know about my struggle to get my son to gain weight usually have some story about themselves or of a grown child who always trailed along the bottom of the charts as babies/toddlers/young children but managed to grow into perfectly normal (or even tall) older children or adults. I hope some of that gives you comfort, even if you don't find a medical cause of the low weight gain.

[pea]

I know this seems super obvious, but make sure the doctor is using the CORRECT growth charts. My doctor freaked about about my skinny baby 'falling off the charts' and did a bunch of tests and gave me a bunch of referrals. Scarying me half to death and making me feel horrible in the process.

I started doing research and plotted my own curves on the WHO charts. He was fine! I talked to the dr and she was mortified. She had clicked the wrong button and used the wrong charts (repeatedly).

[Shelby]

My older son is not FTT, but close. A lot of times he is not on the growth chart. Fortunately, we have a great pediatrician, who is not concerned. My husband and I were both like this, and we grew up to be healthy adults (I was actually diagnosed as FTT, then a whole other story). My older son is 5 now and it is a struggle to get him to eat. He is picky, he doesn't eat much, and pretty much never has. Some things have helped. Allegra to address some environmental allergies. He had congestion a lot and then didn't want to eat because he felt bad. He is allergic to almost everything like grasses and molds and such. I still do whole milk with him. I do shakes, granola, peanut butter, hummus, high calorie carrot cake muffins, all relatively good for you high calorie foods; so that when he does eat, he gets a lot of calories. I have to (and constantly remind myself) believe he will grow out of this, and he will. What he eats is relatively good choices. He will not choose to eat most of a piece of cake at a birthday party. He simply does not have interest in food, but would rather be doing something else. Again, he was this way from birth. I tried to nurse, but that didn't work out, and then exclusively pumped until 7 months. Find a good pediatrician who believes in you and pretty hands off.

It is a tough road and I completely sympathize.

[Catharina]

As everyone else has already stated, I would definitely seek further medical evaluations.

However, I would also look at possible feeding disorders. "Failure to Thrive" is a very unfortunate diagnosis because it can have so many causes! Anything from a medical to a behavioral issue, even neglect/abuse as some have stated, can lead to FTT. Luckily, a few dedicated researchers are taking a closer look at various feeding disorders in infancy and early childhood. I only know the research by Dr. Irene Chatoor, who differentiates between 6 types of feeding disorders. Nothing is mentioned specifically about this little boy's eating habits, though it did sound like it's been a struggle ("trying to get extra calories into him" for years) and that made me wonder if this little boy's possible FTT might be connected to one of these two feeding disorders:

1) infantile anorexia: Not to be confused with anorexia nervosa! Children with infantile anorexia naturally have a reduced hunger feeling/appetite. Other than that, they thrive cognitively and socially. Food is just not interesting to them. As Dr. Chatoor says: These children are hungry for everything but food! Add the frustrating power struggle that emerges as parents desperately try to get these children to eat and you've got a recipe for a very difficult situation.

2) Sensory Food Disorder: Some children seem to be more sensitive to certain textures (as well as smells, etc.). This means that it is very unpleasant for them to eat certain foods and it might escalate to them refusing most foods altogether.

This is a good article that sums it all up a bit:
http://www.bcmj.org/article/feeding-disorders-infants-toddlers-and-preschoolers

Dr. Chatoor also has a very good book that is aimed towards parents and has lots of tips on what to actually do about these disorders.

Sorry, I didn't mean to ramble quite this much, but this is information that is just beginning to be recognized by the medical community and is not commonly known. I think it could help a lot of frustrated, worried parents (and their children).

All the best to the worried mom and her little boy!

[xast]

My 14-month old has been hovering at the 1st-3rd percentile for weight since about 4 months, and her height has been average since birth. She's never lost weight, but just seems to gain the absolute minimum. I fear she'll drop off the chart completely at her 15-month checkup because she's started walking and likes to do everything at top speed.

I don't know how worried to be? On the one hand, both her father and I were very small as infants/toddlers and are both completely average-sized adults. In fact, my mom reports that I was diagnosed as FTT but they never found a cause. On the other hand, in my early 20s I was diagnosed with Crohn's Disease and I can't help but wonder if there is some relationship. I worry about whether she's absorbing nutrients and all that stuff. Would a food allergy always have other symptoms? Because other than the low weight she seems healthy and happy (although she isn't talking much yet).

Right now we don't stress too much about feeding her - we offer lots of snacks and try to give her high fat things (cheese, avocado, butter on all veggies, etc), and I'm still breastfeeding at least 2x a day. But... she eats what she eats and really, you can only do so much. Somedays she's an enthusiastic eater, some days not so much.

The doctor is slightly concerned (extra weight checks) but so far has not suggested any furthur intervention or testing. I've been contemplating whether or not to ask for a specialist referral, or whether that will just cause unnecessary stress.

[Anon]

Just chiming in to say I have a friend whose tiny 3 year old was just diagnosed with Celiac disease. Now that the offending foods have been removed for a few months there has been amazing improvement and growth. Could be worth investigating.

[RDS]

Two comments which echo what has been said above:
1) My kids are small, and did the 90% at 6 months all the way down to 2% by 3 yrs of age, all th time eating and "thriving" emotionally and developmentally. They are small and have been at 0-5% ever since. At 2 S's child may just be in the midst of that process of falling off growth. For example my now 9 yo son (52 lbs at 9 BTW) was 18 lbs at 6 mo, 20 lbs at 1 yr, 21 lbs at 2 yrs and 23 lbs at 3 yrs. He grew taller during that time, but not enormously. We are small people. He will be small. (my 5ft 2in 13 yo is 85 lbs by comparison)
2) My son for a brief time stopped growing taller altogether and it was apnea from tonsils / adenoids which we had been hoping he'd "grow out of" He got enormously better and had a big growth spurt once he started sleeping after removal, but has gotten back to his 5% curve again.

[Nutmeg]

I'll just add another voice here. I think we were lucky to have a pediatrician who was less concerned about our son's weight then we were.

He dropped from 60th at 12 months, to 3rd %ile at 18 months. His height was considerably shorter than one would expect for a child with taller than average parents.

He stayed at his lower curve for years and then slowly climbed back up. I remember he gained 0 lbs between 3 yo and 4 yo (and he didn't start off with room to spare! Then he would gain a half lb and loose a lb and then gain another lb.

And our doctor (who was never alarmist about things, but took other ailments he had seriously eg Asthma, reflux, adenoids, alarming joint pains) just never raised a flag about it. Whenever I met other parents who's pediatricians were raising alarms about FTT I referred them to our practice.. who looked at the kid (whose ribs you could count from across the room through his shirt) and saw how active and happy he was, and how he never. stopped. moving. They reassured me he was fine every visit.

Now, this isn't to say that's what's going on here, but a second opinion with visits to specialists is definitely worth it. And hopefully this data point will ease S's mind somewhat.

[Hebbie]

My two cents are 'silent reflux', i.e. eating is painful unless in tiny doses. Heard of a kid that wasn't eating, got put on anti-acids, and voila, eating became normal.

[thalia]

Lots of help here. Also thinking there is a blog that I am sure I found through this site where the woman concerned has 4 children and 1 or 2 of them have I think a fructose intolerance that caused failure to grow? I remember reading that it was incredibly hard to diagnose. I am sorry I cannot remember her name (?hecate?) but she refers to her children as miss m and mr....

[Betty M]

I think it is important to remember that's rom the perspective of a medical professional failure to thrive is more a descriptive term rather than a diagnosis and in itself isn't or shouldnt be a value judgment on the parents. I know it doesn't feel like that at the time and the use of the term is yet another instance of when medical professionals need to understand better how such terms come across when they are used. I would second the great suggestions for further investigations to determine the cause as at the moment it doesn't seem like the dr has done anything beyond identifying that the child isn't meeting the expectation in the charts ( and the charts aren't infallible either exclusively breast fed babies often came out badly on the charts in use a few years ago when in fact there was no cause for concern). It must be a really tough time for the family and I hope they get good answers soon.

[Brigid Keely]

Some friends of mine are dealing with this with their daughter. However, both parents (and parents' sibs) are shorter than average and slender so the doctors are keeping a tab on things and assuming it's primarily genetics, that their daughter is just a small baby who grew into a small toddler who will grow into a small child and a small adult.

[Jan]

Some friend of ours had a little guy who wasn't getting enough calories in spite of their best efforts, and at three, finally got diagnosed with some huge-ass (<---technical term) tonsils that were interfering with his ability to swallow and made eating physically unpleasant for him.

He was also having trouble sleeping -- snoring would awaken him a lot.

They had his tonsils removed and he has jumped way up on the growth curve. Might be worth a shot.

[Cloud]

@thalia, that is Hedra. She blogs at Hands Full of Rocks, or something like this. Perhaps she'll drop by and comment on this thread later, too.