Poor weight gain in infants and children

This is an automatically translated article.

The article was professionally consulted with Master, Doctor Doan Ngoc Quynh Tram - Department of Pediatrics - Neonatology - Vinmec Nha Trang International General Hospital.
Weight gain is a predictable process from infancy to adolescence. However, some babies are poorly malnourished from birth and gain weight slowly, while others gain weight normally for a while, then slow or stop gaining weight. Slow weight gain often appears before the child stops growing in height.

1. Definition of poor weight gain in infants and children

A child's "normal" weight range is usually assessed against standard growth charts developed by the CDC and WHO. These charts are designed for both boys and girls, suitable for all races and countries. Poor weight gain is defined as a child gaining weight at a slower rate than other children of the same age and sex.
Children under 2 years of age will use WHO growth standards. Children 2 years of age and older use CDC growth charts. Children with specific genetic syndromes may need special growth charts. For example, the CDC publishes growth charts specifically for children with Down syndrome.
Usually, weight gain is a predictable process from infancy to adolescence. However, some children have malabsorption of nutrients from birth, so their weight gain is slow; Others gain normal weight for a while, then slow or stop gaining weight. Slow weight gain often appears before the child stops growing in height.
Children are said to have poor weight gain if they are not growing at the same rate as children of the same age and sex.

2. Causes of slow weight gain in children

Slow weight gain in children is not a disease but a symptom caused by many causes. Some causes of slow weight gain in children include:
Not consuming enough energy (calculated in calories) or not having a balance of protein, fat and carbohydrates; Children malabsorption of nutrients; Higher-than-normal energy expenditure (in calories). In addition, delayed weight gain in children can also be caused by medical problems, social development, behavior, poor nutrition, or a combination of these factors.
Common causes of slow weight gain in children according to age can be:
2.1. Before birth Intrauterine growth restriction; Premature birth ; Prenatal infection ; Birth defects; Exposure to growth-restricting drugs/toxins during pregnancy (eg, anticonvulsants, alcohol, tobacco smoke, caffeine, narcotics). 2.2. From birth - 6 months Poor feeding quality (both breast and bottle feeding); Mixing milk with incorrect formula; Mother has problems with breastfeeding; Insufficient number of feedings; Infants with malabsorption of nutrients (eg, the child vomits or vomits while feeding and the parent assumes the child is full); Quit suckling; Birth defects that affect the child's ability to eat or drink normally, leading to poor absorption of nutrients; Breastfeeding sparingly (due to poverty or failure to understand the infant's needs); Milk protein intolerance; mouth/throat problems that make it difficult for the baby to suckle or swallow (eg, cleft lip and palate); Medical problems that cause poor absorption of nutrients in children; Medical problems that increase caloric needs (congenital heart disease); Gastroesophageal reflux . 2.3. From 7 to 12 months From 7 to 12 months old, the cause of slow weight gain in children is mainly due to eating problems, for example:
Between children and parents do not agree on food; Problems in the child's mouth that make it difficult for the child to adapt to chewing or swallowing food Starting solids late; Refusing to eat food at first introduction, after which parents stop giving food; Parents do not give their children enough or not enough foods. In addition, children at this age can also have intestinal parasites or food allergies leading to poor weight gain.
2.4. Over 12 months Behavior (eg child is picky or easily distracted during meals); Sick; Family stress (divorce, job loss, new baby, death of a loved one, etc.); Social factors (feeding less for fear of children eating too much, not having many food choices, economic difficulties); Sensory eating disorders of children with developmental disorders (eg, autism spectrum disorder); Swallowing dysfunction leads to poor absorption of nutrients; Drinking too much milk or juice; Not getting enough food or meals without a variety of healthy foods; Celiac disease; Food allergy.

3. Diagnosing children with slow weight gain

For babies and children who have slowed or stopped gaining weight, it's important to try to identify the underlying cause for the right treatment. The first step is a complete medical history and physical examination. Most children won't need blood tests or imaging, only certain cases are recommended. Parents should ask a doctor if their child has signs of slow weight gain:
Vomiting, diarrhea or chewing (swallowing, regurgitating, then swallowing food); Avoid foods with certain textures (for example, don't eat them hard or crunchy). This could be a sign of problems chewing/swallowing; Avoid certain foods (eg, dairy, wheat). This could be a sign of a food allergy or intolerance; Drink plenty of low-calorie liquids, low-fat milk, or juice. These drinks can prevent your child from eating solid foods, which contain more calories; Drinking a lot of whole milk, can lead to iron deficiency anemia. Follow a strict diet (e.g. vegetarian, no lactose, wheat or gluten); Unusual behavior, dislike or refusal to eat. Parents should also let their doctor know if they've eliminated certain foods from their child's diet because they're worried these foods will cause colic, diarrhea, or "hyperactivity."
The doctor may also ask about the child's family about things like:
Recent changes or stressful situations (eg divorce, illness, death, new sibling) ; Medical history of the people in the household, including history of eating disorders, mental illness, illness; Food supplies (eg, not having enough money to eat, going hungry). While these questions can be difficult to answer, it's important to be honest. In some cases, the doctor will ask parents to keep a record of everything the child eats and drinks for several days. This can help determine if your child is eating the right amount and variety of foods.

4. Treatment for children with slow weight gain

The goal of treatment for children with delayed weight gain is to provide adequate nutrition so that the child can "catch up" to a normal weight. Your doctor may order changes to your child's diet, feeding schedule, or nurturing environment. Parents and child health professionals should work together to develop a plan that meets their needs.
Specific treatment depends on the main cause of your baby's slow weight gain, the underlying medical problem, and the severity of the situation.
Most children with mild to moderate malnutrition can be cared for at home with the help of a health professional (e.g. dietitian, psychotherapist, speech and development ). Severely malnourished children are often required to be hospitalized so that the doctor closely monitors the child's diet and weight. 4.1. Nutritional therapy This is the mainstay of treatment for children with delayed weight gain. The goal of nutritional therapy is to help a child gain weight at 2 to 3 times the normal rate for a child's age. The best way is to increase the energy in the diet (measured in calories). In some cases, a multivitamin supplement may be needed.
For infants The number of calories in breast milk can be increased by pumping breast milk and adding an amount of powdered formula. The way to increase the calories in baby formula is to add little water to the powder or add a calorie supplement, such as maltodextrin starch or corn oil. For infant safety, this form of treatment should be given under the supervision of a healthcare professional or dietitian.
Plant-based milk (e.g. soy, almond, rice, coconut, etc.) is not suitable for infants because of the lack of protein, calcium, vitamin D and other nutrients.
Infants aged 0 - 4 months need frequent feedings, usually 8 - 12 times per day; Older infants need 4-6 feeds per day.
As your baby gets older, calories can be increased in servings by adding rice cereal or formula powder to pureed foods.
For older children In older children, calories can be increased in servings by adding cheese, butter or sour cream to vegetables or using a high-calorie milk drink instead of whole milk.
For children who cannot tolerate animal milk, popular alternatives include soy, almond, rice, coconut and hemp milk. Newer dairy alternatives include: quinoa, oats, potatoes, and mixed-grain milk. Soy milk has the closest nutritional composition to cow's milk, the better when fortified with calcium and vitamin D. But in general, plant-based milks still have protein, calcium, vitamin D and energy content. (calories) low; lack of vitamins, minerals and other fatty acids found in animal milk.
Greek yogurt is a good choice because it contains twice as much protein and calories as regular yogurt. Low-fat and fat-free yogurt should be avoided.
During treatment, the amount of calories and protein the child eats is more important than the variety of foods eaten. For example, if a child is willing to eat fried chicken and pizza, but refuses all vegetables, this is acceptable. At meals and snacks, give your child solid foods before liquids. It should be limited to 118 - 230 ml of 100% unsweetened fruit juice per day.
Older children should eat often (every 2-3 hours, but not continuously). Children should eat 3 main meals and 3 snacks according to a fixed schedule. Snacks should be streamlined so that children do not lose their appetite (e.g. snack time should not occur within an hour of the meal; snacks should not be offered until the main meal has been completed. ). Examples of healthy snacks include: crackers, peanut butter, cheese, hard-boiled eggs, pudding, yogurt, fresh fruit or vegetables. In some cases, a child may be recommended to take a multivitamin and mineral supplement.

4.2. Eating environment Changes in the eating area can help children eat more. All family members should be aware of the importance of these changes.
Should put the child to lie down with his head high and comfortable. Children should be allowed to feed themselves (eg, holding a bottle or eating food with their fingers). You may have to give your baby soft foods with a spoon. Be prepared for the messy situation when a child learns to feed himself. After feeding the children, then clean up. Minimize mealtime distractions, such as television, phone calls, and loud music. Stick to consistent mealtimes, no matter who feeds your baby. Mealtimes should be relaxed, encouraging eating with other family members and pleasant conversation. Eating with others allows children to observe how others make food choices, thereby encouraging healthy eating habits. Don't be discouraged if your child refuses a new food. New foods may need to be offered many times (even more than 10 times) before they are accepted. For upset children (eg, children with autism), new foods may need to be presented up to 30 times before being accepted. Do not compete for food; Children should be encouraged, but not forced. In addition, food should not be offered as punishment or reward. Praise children when they eat well, but do not punish them when they do not eat. 4.3. Medical treatment for children with delayed weight gain Children with an underlying medical problem that leads to slow weight gain are usually treated by a specialist, eg:
Allergist/child immunologist food application; Gastroenterologist for children with gastroesophageal reflux; Nutritionist. These therapists can guide the elimination of certain foods. Foods (eg dairy products) should not be eliminated without the advice of a doctor to avoid further increasing the risk of malnutrition in children.
Undernourished children are at risk of complications, including an increased risk of common infections. Precautions should be taken, such as washing hands and avoiding contact with sick people. However, there is normally no need to prevent a child from going to school or daycare.
Children need to continue to be vaccinated on schedule.
4.4. Behavioral and developmental treatment for children with delayed weight gain Developmental and behavioral problems can increase the risk of low birth weight babies. For example, if the child has difficulty chewing or swallowing food, the child may not consume enough food.
Should intervene early to stimulate the normal development of children. Some children also need to see a developmental behavioral pediatrician or behavioral psychologist for extra support.
4.5. Psychosocial problems In some situations, slow weight gain is related to problems such as:
Not having enough food in the house; Parents' views on certain foods (eg, fatty foods); Medical or psychiatric problems in the parents (eg, alcohol/drug abuse). In these situations, the family needs support to ensure there is enough food for all family members, as well as to educate parents about the importance of adequate nutrition.
Children with low birth weight are often seen by a health care facility periodically after starting treatment; The frequency of visits depends on the individual situation. The baby will be weighed and measured while the doctor talks with the parents. Regular visits will continue until the baby's weight is near normal and is steadily increasing. If the child can absorb enough calories, within 3 - 6 months of treatment will catch up with the weight of his peers.
To protect children's health, parents should do well to breastfeed their babies exclusively for the first 6 months (if possible) and vaccinate on schedule. As soon as the child shows symptoms such as anorexia, fatigue, crying, it is necessary to take the child to the hospital to be consulted by a specialist for monitoring and treatment. Currently, the Pediatrics Department at Vinmec International General Hospital is trusted by many parents to examine the diseases that infants and young children are susceptible to. Vinmec brings satisfaction to customers and is highly appreciated by industry experts by::
Gathering a team of leading pediatricians: Including leading experts with high professional qualifications (professor, associate professor, doctorate, master), experienced, worked at major hospitals such as Bach Mai, 108.. The doctors are well-trained, professional, conscientious - understanding and understanding young psychology. Besides domestic pediatricians, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. upon reaching adulthood. Advanced techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, hematopoietic stem cell transplantation in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to play comfortably and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment.

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Reference source: update.com