13 month old labeled "failure to thrive"

Hello. My 13 month old daughter has been diagnosed by the pediatrician as failure to thrive - primary. She is growing tremendously lengthwise, but not gaining much weight. She averages a gain of about half a pound per month here lately. Birthweight was 6 lbs 7 oz. At her nine month checkup, she was 27 1/4 inches long and 14 lbs 11 oz. At her twelve month check up she was 29 3/4 inches and 16 lbs 1 oz.

She was bottle fed with Similac Advance until she started refusing the bottle right around her first birthday. She does not eat much. I have been trying everything I can to boost her caloric intake, but it's hard to do when she doesn't want anything in her mouth. She is pushing away food, blocking her face with her hands when we try to bring finger food or a spoon to her mouth. She will take a bit or two, sometimes none, and then knock the food off of the highchair tray onto the floor. We do not offer any fruit juice or plain water. We have been giving her organic, hormone-free vitamin D milk, with carnation instant breakfast mixed in for the extra calories. We have also been giving vanilla pedia sure. All of my time is spent trying to get more calories into her.

She is a happy person. She has hit all milestones appropriately. She is walking everywhere, pointing, trying to say words. She is very interactive and funny. She has four teeth. She sleeps 11 hours at night and takes two 2 hour naps during the day. I am a small person at 5'4'' and 108 pounds. I've always been small. Her father is 5'9'' and 150 lbs, so he is also small. My seven year old son is 48 inches tall and weighs 47 lbs. He is a stick.

We have done bloodwork that all came back as normal. All newborn screenings were normal. Is there anything I could be doing to get her to eat more? The ped wants her to see a GI specialist. I'm not sure I see the point in that, as he hasn't told me what it is that the GI doctor would be doing. We are on an HSA health plan, and there is no money at this point to go see a specialist. However, we will have to find the money if it's absolutely necessary. Is it absolutely necessary? Is the ped overreacting? Is she really failure to thrive when she is growing two or more inches every three months? I don't want to be the one underreacting, but I also don't want to spend the money on a specialist, and put my daughter through more testing, if it's not absolutely necessary. What is the GI doctor going to do? I would appreciate your thoughts on this entire matter.

Thank you so much.

[selmaS]

HI...I am not a dr, but, if ur DD is  not in pain and does eat some and is growing, then she is thriving, just not according to their records....it is possible she is diff than the majority....I am sure u r trying to get her to eat, and as long as she is not sickly bcuz of this...I would not do much more...of course unless there was a change.

Y take a happy child and make them miserable bcuz she doesn't fit the "norm" .....crazy....

I pray all is well with ur DD and she begins to show the drs she is thriving : )

Again these r just my personal feelings

Good luck
"selma'

[geminigirl1963]

I would agree that so long as she seems to be doing well otherwise as far as milestones and growing in height, as well as not getting sick all the time, then I woudn't be too worried.  if she's staying healthy, then obviously she's getting enough nutrients from what little she does eat/drink.  however, I would defintely watch for signs of dehydration - maybe start offering water - of course not right before meals or in large quantities as it could diminish her appetite even more if she fills up on it, but getting adequate liquids are essential.

A GI consult may not be a bad idea, either.  My niece was also given the diagnosis of failure to thrive when she was an infant - granted she was a preemie (3.8 when born), but she also refused to eat/drink.  When they brought in a pediatric GI doc, they discovered that she had a SEVERE case of GERD and even as an infant, she was able to associate eating/drinking with pain, so therefore she was refusing.  She was normally a happy child until it came time to eat or drink - then she would cry, scream, hit, throw food, etc.  Once they got her on some medication for the GERD, they were able to slowly start increasing her food and drink.  it took a good while before she was really comfortable with food, and is still a picky eater, but there was quite a difference between before the meds were introduced and after.

I'm not saying that your daughter has GERD - just suggesting that a GI consult might not be a bad idea just to rule out the possibility of that or something else that is causing her to not want to eat.  it could very well be genetics since you are all quite small.

Another thing my niece's doctors told my sister in law and brother in law - was don't make a big deal out of meal time.  Try to make it as pleasant as possible - try not to force her to eat, but rather offer many different types of food and see what she may be drawn to.  Adn also don't offer large quantities at a time - it can be overwhelming for a child to see a full plate - they can always request more if they finish what they've been given - start out with small quanitities and move up from there.  When my niece was reintroduced to food, her doctors had us using those little medicine cups they give you pills and stuff in.  At first she woudl start out with only a half of one of those of baby food, but eventually was able to finish an entire jar!!

Best of luck!

[mammo]

I think your daughter is just fine, and there is no reason for her to see a specialist.  She is growing, meeting milestones, happy and not sick.  Some children just don't eat a lot and unless it is affecting her adversely, it's nothing to worry about.  GERD causes pain, and if your daughter had this she would be crying a lot and you don't mention this. When my daughter was 2 she was so skinny and wore a size one. But she quickly caught up.  You're doing everything right with your daughter, and kids WILL eat when they are hungry....period.  She just doesn't have a big appetite, and she comes from a small family.  Doctors today make so much more out of this than when my kids were babies.  We accepted that every child is different, and grow at different rates.  What food you are getting in her is nutritious, just don't make it too big of a deal.  Sometimes you may want to sit down with just something for you to eat, kids want what they think they can't have, and if you don't offer her any she may ask for some.  It's a tricky way to get them to try new things.  She's fine, relax and enjoy your little girl.  Take care...

[evsmom]

Thank you all so much for the information, I really appreciate it. She drinks about 16-20 fl oz a day, in addition to whatever she eats.

I have two questions regarding reflux...

1. How do they test a child her age for reflux?
2. If she had reflux, wouldn't she refuse ALL food, ALL the time? Or might she eat some meals just fine?

For example, she ate nothing today that was offered for breakfast, but for lunch, she ate part of a meatball, a whole fish stick, part of a chicken nugget, all with dipping sauce. She was also offered Texas Toast and sliced bananna, but didn't touch either of those. It would  be my guess that she will eat nothing for dinner. We offer snacks between meals, but it's hit and miss with her. Just like everything else, sometimes she eats them, and sometimes not. She does not cry when she eats at all, only if we try to make her, so we don't do that. When she does eat, she enjoys it. Could she still have reflux?

[mammo]

No, she's fine.  Reflux causes a childs throat to burn, it's basically stomach acid backing up in her throat, and this would make her cry.  Sometimes the acid is like they are throwing up a bit in their mouth, and it also causes acid indigestion.  If a child as young as your daughter had this, you would know.  It would definitely affect her when eating.  I'm sure you know that any good pediatrician will tell you that it's more about how your child is acting verses any symptoms.  Your daughter sounds perfectly fine to me, and I honestly wouldn't worry.  Don't try to make her eat, just continue to offer food, if she is hungry she will eat.