Failure to Thrive: Unknown Reason

Doctors may be running different tests to rule-out different things and trying to eliminate one thing at a time. You did not mention what this child's parents are feeding or how much. You did not mention what has been tested for or what has been ruled-out as a possible cause. You did not mention how big or small the parents are. They might not be happy with all the tests, but if they want answers, there is a process involved. Doctors don't know right away what is going on and it's not always necessary to run every test imaginable right off the bat. Common things tend to get ruled-out first. My first thoughts would be some kind of issue with food allergies, or Celiac Disease/wheat gluten intolerance, or some condition where the nutrients in the food are not getting absorbed or processed correctly. I would agree that it would be interesting to hospitalize the child for a short period of time, monitor the diet and the eating, and see if there is any improvement. Sorry to sound this way, but parents sometimes intentionally harm their kids or make them ill in order to gain attention and sympathy - it's called Muchasen's (sp?) by Proxy. I sincerely hope this is not what is going on. Hopefully this child is just a tiny kid and it's just the way he/she is made. I was really thin as a kid too and on the small side (5th percentile for weight but average height) but still healthy - just skinny.

Not to be picky, but I find it odd when people say "my sibling" and "my child" instead of being specific - my sister's son, my brother's daughter, etc. I do hope the parents get the help they are looking for though. Good luck!

Actually I had this same problem with my daughter. She is 5 years old and has held the scale at 34 lbs for the last year. We had bloodwork done, I took her to a nutritionist, revised a special meal plan just for her, etc.Shes still wearing 18 & 24m old shorts You know what Ive come to understand? Shes just small...shes vibrant, healthy, happy, & bright. Thats all I can hope for. She eats when she wants & I do my best to sneak in more healthy carbs when I can. Some babies are just on the little side. If the blookwork is saying normal nutrition-well then you cant argue with that. =)

ouch - my son weighed 17 pounds at 3 months!!!

I can understand your sister being upset that her child is being poked and prodded! At least they are trying to figure out what is going on...

High caloric formula and feed the kid...maybe they should put the kid in the hospital for one week to see how he eats and metabolizes his food - input and output - it won't be fun but really? something needs to be done...if he gains weight while away from his parents - then something is going on at home...

GOOD LUCK!! I hope they find it is a blood disorder that can be easily fixed or something with the thyroid that they can fix easily too!!

I don't have any suggestions as to what they can test for, but I can share our story. We went through this, it started when my son was 9 months old. It's frustrating. And I think "failure to thrive" is the worst name ever! I finally just declined any more tests. I was sick of watching all the poking and prodding. My kiddo was also tiny, but energetic. We fell off the charts. He was almost 10 lbs at birth (96th percentile) and by his 18 month check up he was at the second percentile. At first, I wasn't concerned. He didn't act ill. He wasn't lethargic or cranky. And he ate. The doctor seemed concerned, so I got worried. At first I agreed to all the tests. The last test was a sweat test. They needed a urine sample after that test. My son wasn't peeing fast enough for the tech, who "need to leave", so they threatened to catheter him. I absolutely refused the invasive procedure for convenience sake. After that, I had it and told the doctor I didn't want to run any more tests unless there were indicators of problems other than low weight. The doctor reluctantly agreed, but made some conditions. We had to keep a food journal and go in every three weeks for weight checks. The weight increases were very slight, but as long as it continued to climb, the doctor said he wouldn't push for more tests. We did all the "tricks". A high fat diet. We added butter to many things (I didn't add it to everything because I didn't want a 10 year old who thought you couldn't eat peas without them being slathered in butter), lots of protein and lots of avocado (good for you fats). Pediasure shakes helped A LOT. I basically made milk shakes and added pediasure instead of milk for his afternoon snack and his after dinner snack. When we started this, these were the largest jumps in weight we saw. Eventually, around 2 1/2 he really started adding weight and the doctor was happy with it and it was finally a non - issue. When my daughter came along, her weight dropped around 8 months. He started ordering tests then too. When I reminded him of what we went through with my son, he left to check my son's chart. He came back told me the dietary changes to make and that we would mark it as "family history" for now unless other symptoms showed up. Around 2 1/2 my daughter also went through a jump in weight.

I have had two children who fell in this category. They tested the first one with nearly everything. Turns out that he was a very slow eater. When the rest of the family was done, we just thought everyone was done. But, I suggested that we just all sit there for as long as this child did. He sat there forever, over an hour, eating, savoring each bite. He enjoyed his food, but slowly. I stopped removing his plate with the rest of the family and let him sit and eat as long as he wanted. He never once complained of being hungry or not being done eating before that. He is a very happy-go-lucky kid. So, I had no idea. He is 15 now, and we laugh at the idea of him being failure to thrive. He is healthy, tall, just right. The next one is still very skinny, but very tall. The docs never tested her, just assumed she was like her brother. She is fine also.

I'm going through this same problem, only my son is 9 years old. Has the dr tested for allergies, diabetes, or a swallowing/throat problem? My dr just changed my son's allergy meds to one that is supposed to stimulate the appetite and he goes in for blood work this week. Do some research online and bring that up to the dr, sometimes they don't think to check for illnesses or other possible issues. No matter what is said, you cannot nor should you force a child to eat. (I had a GI dr tell me to do that when he was little.)

Read the book "How to Get Your Child to Eat (but not too much)." The author includes an excellent discussion about children who are labelled "failure to thrive"....but have nothing wrong with them.

Some kids are just small. Some kids are just skinny. Some kids just don't grow very fast. It's okay.

It sounds like your sister has done all the tests and ruled out serious health problems. The child's behavior sounds well within norms for age. Is there any indication of a problem other than size? If not, perhaps it's time to push back against the doctors and refuse any further tests.

Not all variations from the norm are pathological.

Good luck.

My daughter is 11 and petite and on the low end of the height and weight scale, but healthy and happy. We did find one thing that helped her: a book we read mentioned "snack, snuggle and snooze", meaning have another little snack at night. She now has about 8 ounces of milk at night with whatever we have left over. Sometimes some corn, sometimes cold green beans, or a slice of cinnamon bread, or even graham crackers. She has not gained lots of weight all of a sudden but it has helped her to sleep. In my daughter's case, she just has no idea what hunger feels like, and she eats tiny amounts, but then later will be tired and not know why. She even came to me once and indicated her stomach and said: "I have this funny feeling right here" and I told her she was probably hungry, and she ate a lot right after that. So we now make sure to stop and have snacks, make sure to give her time to eat, make sure to give her a before-bed snack, and she is just fine. Good luck. OH - she was also drinking PediaSure from age 15 months to about age 6 because she went from the 15% to the 1% on the chart. We switched to Carnation Instant Breakfast (vanilla flavor) in 2% chocolate milk at age 6 since it is sooo much cheaper than Pediasure.

My son had failure to thrive. At 9, he is still in the 5th percentile for weight. Before he was 1 we went to a nutritionist, endocrinologist, and other specialists. Seeing other people's perfectly chubby babies would bring me to tears. I had to weigh him before and after feedings and I got so paranoid that I would take pictures of all his meals. Our pediatrician made us go to parenting classes and threatened to report the case to CPS.

We switched pediatricians, found that he was perfectly on track to be the same size as his dad when he grows up, and his growth chart looked very similar to mine when I was young. At age 4, we found out that he had a hole in his heart. Maybe his body was having to work harder to make up for the inefficiency. After he had surgery to repair his heart, he immediately gained 4 pounds. I was reluctant to give him medications for allergies that can have a side effect of decreased growth, but the doctors reassured me that untreated allergies could be just as bad for growth. I also delayed giving him ADHD meds as long as possible because they reduce his appetite. We don't give it to him on non-school days so he can catch up on eating then. He's no longer the smallest kid in his class.

Does this child have frequent bouts of diarraha? He could have celiac disease. I would switch to whole milk and keep offering high calorie but nutritious snacks; such as whole fat yorgert, cheese, even cookies and milk on occasion. Stay away from regular cereal for a while and offer rice cereal or oarmeal. I would also stay away from foods containing wheat for a week or two.

My daughter, 24, was recently diagonsed with celiac and her doctor told her she has had it all her life. I breastfed her almost 2 years and her doctor said that is what kept her symtoms from showing up sooner.

My 4yr old the failure to thrive workup (labs and stool specimens) twice. Once when he was like 18mo or a little under. We did Carnation Instant Breakfast (1/2pack after breakfast) and Pediasure after lunch for about a year. Then had another workup by GI around 3 1/2yr. He weighs about 29 lb now and is around 38in I think. He's still in the 5th percentile for wt and the 10th for ht. It's been determined he's just small, but so was I when I was young. We still do Carnation Instant Breakfast (a full serving) with 2% milk almost every day. He doesn't eat alot most of the time, but some days he eats great. We'll see if our 6mo old follows his brothers footsteps....

My kids have always been TINY! My oldest at 16 finally went from the 5th% for weight to the 50th. My doc always kept saying - as long as they are following the same curve around, all is good. Its when they start losing ground that he was concerned.

My 5 year old weighs 32 pounds. The 12 year old is hovering around 70, the oldest at 16 was excited because she finally hit 100! We teased her for years that she would have to sit in a booster seat to drive.

They are all healthy, just tiny.

So here is my answer. I am almost 30 with 3 kids. It took having 3 kids to finaly get over 100 lbs on a normal basis. I'm very healthy I feel great, just a smaller person! My kids are also small when they are little, however my 7 year old is tall but still very skinny. My 9 month old is so small we have to come in for weight checks all the time. I keep telling then there is nothing wrong, but she is at the bottom of the percentile so the MD's are sure there is something wrong!!! I say diff body types= different bodies! She will be jsut fine!

My friend has 2 kids that have a malformed pituitary gland (no idea why, their middle child is fine), but it affects the prodcution of growth hormone. One child's produces a tiny amount and the other none a all. They actually receive growth hormone shots every day now that they have figured out what was wrong. At one point before they started the shots, their oldest who is 4 actually looked the size of a 2 year old. Everything was fine as far as intelligence and learning things, he just wasn't growing!

Failure to thrive isn't a diagnosis. My 2nd grandson was diagnosed as failure to thrive and later as acid reflux. Both diagnosis were incorrect. He was actually allergic to cow milk. When my daughter removed it from his diet the acid reflux disappeared and he started to put on weight.

My own children were always small and underweight compared to their peers. But since they were on the same growth curve from visit to visit I decided that it wasn't an issue and didn't let the dr do any testing.

I'd say to look at what the child eats, concentrate on high nutrition foods rather than high calorie and see what happens.

hmmmm. maybe nothing. My little ones hit a time like this on the growth chart too. One place was concerned with the weight and tried to tell me to stuff calories in everything (such as butter, cheese and syrup). However I did not want my children to learn unhealthy habits and didn't do it. Now my 5 year old won't stop growing and her feet grew a full size in the last month. My 5 year old is a very bird like eater too and never really has a full belly either.

maybe nothing? I feel your siblings pain! My daughter has been thru all sorts of tests over the past year and she was sent to Children's hospital to the feeding and growth clinic. (She was 21 months, 16 lbs 7 oz) So far all we have learned is that she starts to aspirate when she swallows so her pediasure is mixed with Thickit. They replaced all milk with pediasure in June - she was put on it to supplement milk in December. She just turned 2 on Saturday is now 19 lbs 7 oz. We have every other week weight checks. She is on a 3 hour feeding schedule. Pediasure at the end of meals and no longer than 30 minutes at the table. Medicine to increase her appetite and medicine for reflux. Monday she goes in for something where they check from her throat down to her bowels. They want her to see a psychiatrist for her behavior problems when she eats (she eats, finishes and says I'm done - wish I had that problem!).She is happy and developing on track. I think she's just little. I didn't hit 20 lbs until I was 2 and neither did her 12 yr old sister! (who this spring finally hit the 12 percentile - before that her high was 7%!)

Not very encouraging I know...but just another experience to share! I often wonder what would happen if I just say no more to this! Or where a dr is who won't freak over a little girl!

I don't have any ideas for you.

Just wanted to say that I have a great-nephew who is TEENY-TINY.

Otherwise healthy. His parents aren't giants, but average.

His growth curve for height and weight IS following a curve, so the doctors are not concerned. Is your he/she following the curve of growth? It's when it kind of "stalls out" that they get serious.

Also, there IS a wide variety of "normal" between children. My son (8) and his BFF are about 20 lbs. different. Honestly, his friend scares me with just HOW thin he is but again--both are well within the normal range.

Good luck! I really hope it's just nothing.

I didn't read all the comments, so I don't know if anyone said this or not, but my friend had two daughters. One had "toddler diarrhea" and the other was really small. The one with "toddler diarrhea" was eventually diagnosed with Celiac disease. The whole family changed their eating habits, and then the small one started gaining weight. She was tested as well, but nothing showed up on the tests. When she stopped eating gluten-containing foods, she started growing like a weed!

I am not saying that your niece has Celiac disease, but there might be something that is just really hard to diagnose. See if your sister can find a doctor willing to explore all the options and help her find an answer!

I suggest going to a naturopathic doctor and having the child tested for food allergies and food intolerances, something allopathic doctors are reluctant to do and, even if they do test, they usually don't know how to accurately read the tests. Why? Because most doctors don't believe that food/nutrition can have such an impact on one's health. I know; it took until I was 40 years old and became horribly sick to find out that I have gluten and soy intolerance, casein allergy, and a host of other food intolerances. Why so many/so sick? Because I was probably allergic to milk since a baby, and since I didn't know it and didn't quit drinking/eating milk products, I developed Leaky Gut, which then made my body start rejecting one food after another. It is a long, long process to rebuild one's system after food attacks it so bad, lots of supplements and whole organic foods and nutriceuticals. I probably will be "doctoring" to get my body healthy for the rest of my life. Finding food issues early and staying away from them helps enormously in having a body that works correctly.

Most people don't have enough good probiotics in their gut. That would be another good place to start, getting a good probiotic into the little one's gut. I'm assuming the little one is eating solids; put the probiotic into his food. I give my daughter Florajen3. It can be opened up and put on top of food and/or stirred in.

Since the regular doctors can't figure out the problem/issue, I would think about trying alternative medicine/a naturopathic doctor and getting another opinion outside the allopathic medical community. Since my family has started seeing/using a naturopathic doctor, it is absolutely amazing how much stuff we've discovered that is wrong with us and needs to be taken care of. Stuff that our allopathic doctors never, ever even mentioned or hinted at.

Good luck.

We went through this with our second child, and it turns out he had reflux, just not the kind where he spit up all the time, so it wasn't obvious what we were dealing with. After all, until they can talk, they can't tell you what's bothering them. For the most part, he was an extremely happy, active child. Bedtimes were horrible, but since we had dealt with a very colicky first child, it didn't seem like anything particularly unusual (it's all about perspective, you know; hard to call it out of the normal range if you haven't experienced the normal range). We were told, "he's healthy, just active with a high metabolism", but as he fell and fell and fell on the growth chart, I was convinced there was a problem, especially since he never seemed to eat long enough to be satisfied. He was only 11 pounds when he was a year old and looked skeletal. It was truly frightening. We eventually switched doctors because they weren't listening to me, and the new doctor immediately sent us to test for reflux. We had to have a tube inserted down our son's throat for 24 hours with a little backpack that he had to wear. It monitored the acid levels throughout the day, and we found that particularly in the night, he was having severe reflux. He went on medication (prevacid), and while he is still small, he is within a normal size range now, active, and healthy and happy. I'm not saying your sibling's child is going through the same thing, but if they haven't tested for it, it's common enough in little ones to request testing. I know this is a scary time for the family, and hope they find answers soon.

I just wanted to second Tracy's story. I have had two friends who actually had very chunky and thriving infants, but once they started walking their growth charts started to decline and never went back up as expected. Turns out both had issues with their hearts. One actually required surgery to fix at 3. He is now putting weight on and back on track. I'm thinking since they are looking hard for a reason they would have already ruled this out, but if not I would definitely explore that option as well.

Good luck, btw my first son was way off his charts too, well below the 5th % until just recently. My nephew is 5 and just the same, in fact he wasn't even on the charts at all. He and my 3 yr old are now the same weight, doesn't appear his pediatricians are too worried, might also seek a second opinion too. Some drs are really overly aggressive with weight issues.

I wish you all the best!

Ist his child meeting other developmental milestones such as walking and talking? Has the growth been consistant and steady or did it all of a sudden stop? How long was the baby when born? My children were 21.5" at birth.

It sounds like it may be time to see an Endocrinologist if they haven't already. This specialist could rule out potential serious diseases.

Good luck to all of you. I am sure this causes a lot of anxiety.