Failure to Thrive & GORD

Failure to Thrive

Failure to thrive is a condition characterized by the inability of a child to grow up to the expected weight and height for age. There are numerous causes of failure to thrive and the most common are psychological, emotional and family-related causes. Treatment aims at restoring proper nutrition to ensure adequate growth.

Cause of failure to thrive:

Organic failure to thrive

This is when there is an acute or chronic disorder that interferes with nutrient intake absorption, metabolism and excretion. Some of these causes include pyloric stenosis, celiac disease, cystic fibrosis, inborn errors of metabolism and diabetes mellitus.

Non-organic failure to thrive

This occurs in about 80% of the cases where the failure to thrive is primarily due to environmental neglects such as lack of food, stimulus deprivation or both. This is a rather complex cause because it involves interaction between the child and the caregiver.

Mixed failure

Mixed failure to thrive encompasses all the above with a less than obvious cause for the failure to thrive.

Signs and symptoms

Growth monitoring is a very important part of your baby visits to the clinic. It is important that the weight and the height of your child are taken at every visit. As a parent, it is your responsibility to ensure that your child demonstrates consistent growth at any one point.

In the first year of life, normal growth is very important. Failure to thrive is common in the first year because this is the year that rapid growth occurs.

The classical first sign of FTT is a child who has normal skeletal and head growth without weight gain.

Call us immediately if the following occurs:

If your child experiences difficulty feeding and pain when swallowing.
Food vomit that’s green in colour, or bloody or that looks like coffee grounds.
Pain related to eating or refusing to feed causing weight loss.
If there is increased vomiting at any point. Forceful or otherwise.

Children at risk of failure to thrive:

Babies born premature tend to be smaller and may gain weight slowly. Their nutrition should therefore be closely monitored.
Multiple pregnancies, twins or triplets may be smaller than average at birth. Because of this, they may experience growth faltering in the first year of life.
Children with lung diseases or heart disease are also highly likely to be considerably smaller in size compared to children their age.
Thyroid hormone imbalance, urinary tract infections, inborn metabolic disease, genetic abnormalities, severe GORD etc.

The great news however is that failure to thrive can be corrected with a thorough history, exam, and nutritional amends.

Diagnosis

Treatment

In children whose failure to thrive can be pinpointed to inadequate intake, adequate nutrition in the right types and quantities can and will go a long way in improving growth. Treatment of the underlying condition such as coeliac disease will also serve to improve growth and enable thriving.

For children who are struggling emotionally, emotional support will help in their growth and nutrition.

In general, failure to thrive is a multidisciplinary condition which requires the support of a variety of medical personnel.

GORD

Commonly initialized as GORD, gastro-oesophageal reflux disease is a condition where food and stomach acid move back up (reflux) the tube that goes from the mouth to the stomach (oesophagus).

The mechanism that explains this reflux is dependent on the stomach, the valve and the abdomen. In a normal system, the contents of the stomach are kept in check by the shape of the oesophagus and the curve of the stomach fundus. In GORD, there is no explanation for the reflux except a defective valve. This is a fairly common condition and occurs in more than half the babies between birth and one year. The great news however is that children outgrow this and more often than not do not require surgical intervention.

Signs and symptoms:

Frequent spitting and vomiting
Choking, coughing and trouble breathing
Fussiness and crying especially after feeding
Restlessness due to difficulty sleeping
Pauses in breathing also known as apnoea attacks

These symptoms tend to worsen in a child lying down and improve when the child is held upright.

Due to the discomfort and reflux caused by this disease, these babies tend to have these additional problems:

Diagnosis is made from a thorough history and physical exam. As such, our Paediatricians may ask you a few questions about your child’s feeding habits. Be sure to answer truthfully and honestly. Some of the rather mundane things may be especially helpful in this diagnosis.

Treatment of GORD

Medical treatment of GORD

1. Proton pump inhibitors (PPI)

Gastric contents are very acidic as they contain hydrochloric acid. Due to this, reflux of stomach contents into the oesophagus may cause pain and heartburn to the child. Our doctors will recommend antacid syrup for your child. This will help with the pain of the heartburn and ease the discomfort of dyspepsia.

2. Caloric supplements

Children with GORD are always vomiting, because of this they may experience growth faltering causing a failure to thrive.

We are likely to suggest the following:

Note:

Keep your child in a straight upright posture as often as you possibly can.
Make your baby’s food as thick as possible to ensure it stays down.
Feed your baby small amounts and burp them often.
Give your baby medicines that reduce stomach acidity.

3. Tube feedings

Sometimes, children with pre-existing conditions such as congenital anomalies may end up failing to feed before falling asleep. Due to this, our doctors may suggest a feeding method that will ensure the child receives a small continuous infusion of food. This is called tube feedings.

A nasogastric tube is then placed through the nose of the child and into the stomach. This may be substituted instead of formula. They are not painful and will help the child feed well and maintain growth. Surgery may be recommended in situations where there is no improvement even with these interventions.