When a child is not gaining weight

Evgeniya Loik — GP, pediatrician, gastroenterologist, nutritionist

How to read percentiles

A percentile shows what proportion of peers a child is above on a measure. The tenth percentile means 10% of children of the same age and sex weigh less — and that is a normal weight, not a deficit. Somebody has to be on the lower percentiles by definition; it is not a diagnosis.

What matters is not the point but the trajectory. A child growing steadily along their own channel is well. What concerns us is different: crossing two or more percentile lines downwards, a plateau in gain, weight loss, or a situation where weight falls while height continues — or where both are affected.

Common and benign causes

Constitutional build — slim parents, slim child. The period after an illness: children lose appetite and weight, then catch up. The natural slowing of weight gain after the first year, which alarms parents used to the pace of the early months. Fussy eating in preschoolers where growth continues normally.

When it needs looking into

• a fall of two or more percentile lines;
• no weight gain in an infant over a month;
• accompanying frequent loose stools, bloating or fatty stools;
• repeated vomiting or distressed posseting;
• chronic cough or recurrent infections;
• lethargy or delay in developmental skills;
• a child who eats little and tires visibly while feeding — in infants this can be an early sign of a heart problem.

What is looked for

Feeding first: what, how much, how often, and how feeds go. In infants a common cause is difficulty with attachment and inadequate volume rather than disease. Then, as indicated: anaemia and iron deficiency, coeliac disease, food allergy, malabsorption, parasites, endocrine and chronic conditions. Testing is targeted: at GMS a coeliac profile is AED 450, calprotectin AED 350, ferritin AED 210 and a full blood count AED 100.

What not to do

Force-feed, offer rewards for finishing, turn meals into a battleground, or add calories through sweets. All of this worsens appetite and the relationship with food without producing weight gain. And avoid comparisons with the neighbour's child: the normal range is very wide.

At the clinic

Here a pediatrician consultation is AED 600 and a combined pediatric nutritionist and gastroenterologist consultation AED 750 — covering both feeding and possible causes. Age-based check-up programmes are available: the 6-month check AED 1,500, the 12-month check AED 2,100 and the check from 2 years AED 4,000.

Guidelines referenced

• World Health Organization. Child Growth Standards
• American Academy of Pediatrics. Growth and Development

FAQ

My child is on the lower percentiles — is that bad?

No. The tenth percentile means 10% of children of the same age and sex weigh less, and that is a normal weight, not a deficit. Somebody has to be on the lower percentiles by definition. What matters is the trajectory, not the point.

When does poor weight gain need looking into?

With a fall of two or more percentile lines, no weight gain in an infant over a month, accompanying frequent loose or fatty stools or bloating, repeated vomiting, chronic cough or recurrent infections, lethargy or delay in developmental skills.

What does the doctor look for?

Feeding first: what, how much, how often and how feeds go — in infants a common cause is difficulty with attachment and inadequate volume rather than disease. Then, as indicated: anaemia and iron deficiency, coeliac disease, food allergy, malabsorption, parasites, endocrine and chronic conditions.

What should we not do?

Do not force-feed, offer rewards for finishing, turn meals into a battleground or add calories through sweets: all of this worsens appetite and the relationship with food without producing weight gain. And avoid comparisons with the neighbour’s child — the normal range is very wide.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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