Augusta University
Children's Health Nutrition

Is your baby or toddler eating enough?

Is your baby or toddler eating enough?

Here’s when you want to see that number on the scale go up and up and up: those first few years of your child’s life.

Of course, your child should grow and be healthy all during childhood—and into adulthood too. But consider this: Your child’s brain grows as much in the first year of life as it does throughout the rest of childhood.

So healthy weight gain? That’s pretty important to make sure your child’s brain grows as it should—and that he or she meets those key developmental milestones, like crawling, walking and talking, at the right times.

When your child doesn’t gain weight or loses too much weight during these first few years, that has a name: Failure to thrive. Here’s how you can avoid it.

Newborn days
As soon as you bring your newborn home, a little weight loss is normal for the first few days. After all, your baby is getting used to drinking from your breast (or from a bottle if you choose to or need to formula feed) instead of getting all that rich nutrition immediately from the umbilical cord—and it’s a lot to learn.

But that’s why keeping that first pediatrics appointment when your baby is two to five days old is so important. Then, making sure to go to those well-child visits at 1 to 2 weeks, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, 2.5 years, 3 years, and annually after that.

During every visit, a nurse will weigh your child and measure his or her height and head circumference, which are plotted on a growth curve. Your doctor will examine those numbers to see where your child falls compared to other children his or her age.

“Most kids will follow a steady upward line on the growth curve, with a little variation here and there due to illness or infection,” said Dr. Candice Castellino, a pediatrician at Augusta University Health West Wheeler. “But when children drop down inappropriately below the 3rd to 5th percentile, that’s when we consider it failure to thrive.”

Having problems feeding is the most common reason for failure to thrive in newborns. Maybe a baby isn’t latching or is having trouble learning how to drink from a bottle. Maybe there’s a physical problem, like cleft palate or tongue tie. Or maybe there’s an ongoing issue, like reflux, chronic diarrhea or a metabolic disease that’s keeping your baby from absorbing the nutrients he or she needs to grow. Babies with low birth weight, or who were premature, can also be predisposed to failure to thrive.

While that weight check is the main way doctors diagnose failure to thrive, parents can keep an eye out for other signs too:

  • Is your baby pooping and peeing as much as he or she should? During the first six weeks, babies can poop from two to 10 times a day and should pee that often too.
  • Does your baby want to constantly feed? For some babies, wanting to feed constantly and for a long time is normal (yes, really!). But if the constant feeding is combined with fussiness—as in, “I’m trying to eat, but I’m still hungry,” that could be a sign that the baby isn’t getting enough.
  • Does your baby seem tired all the time? It might be a little hard to tell, but unlike what you might hear (or wish!), newborns don’t just sleep all the time. Newborns may sleep for a total of 16 hours a day, but they don’t tend to sleep for more than two to four hours at a time. And they need to eat at least every three hours at the beginning. Watch if your baby seems tired or lethargic during his or her wake times or is sleeping excessively.

“If you even think there’s a problem, always go get it checked out,” said Castellino.

Failure to thrive—in older kids?
Most people may not realize this, but failure to thrive is a risk up until about age 3. “Poverty—and not being able to provide enough food—is the number one reason for failure to thrive later on in childhood,” said Castellino.

If children have several different caregivers, lack of communication is another reason—as in, “I thought he/she was eating with grandma every morning.”

Good eating habits also help. While it’s tough when we’re all so busy, try not to eat on the go. Instead, have children sit down in their high chair or at a table so they can focus on eating. Beware of the juice cup—children who drink a lot of juice may fill up their tummies on that and not have any room left for actual food.

At the same time, pressuring a toddler to do something almost always backfires, so do your best to have a low-pressure, easy eating environment. Play games, be silly, praise children for eating and using their utensils, and show them how mommy or daddy is eating too. Remember the mantra “Try, try again,” because it can take a toddler 10 to 15 tries before they like a food.

How to fix it
It sounds simple, but the treatment is to make sure a baby or child is getting enough calories.

Your pediatrician may ask you to keep a food journal to get an idea of what your child is eating. For young babies, your doctor might prescribe a more concentrated, higher-calorie formula to supplement their diet. For older children, your pediatrician and/or a pediatric dietitian can work with you to figure out ways to get more calories into your child’s meals, which could include adding in more cheese or butter to foods and making sure to drink whole milk. Nutrition drinks like PediaSure are another option. “For severely underweight children, we will typically focus on the quantity of the food and calories rather than the quality,” said Castellino. “So if they’re picky and all they want is chicken nuggets, let them have all the nuggets they want. After they’ve gained some weight, then we can work on a nutritionally complete diet.”

For moms of newborns who are very focused on being able to breastfeed, it’s important to remember that if a baby is losing too much weight or not gaining weight appropriately, it may be important to supplement with formula. But it is not “a forever thing,” said Castellino. “It’s just until mom is producing enough milk to sustain the baby’s growth. This can be more common in moms who have had C-sections because it may take the breast milk a few extra days to come in after the surgery.”

But if you think your child isn’t gaining enough weight, always check with your pediatrician. If being petite is just in his or her genes, then you can relax. But if your child is truly failing to thrive, you have to get help now to get the right nutrition during these months of growth.

“It’s so important to follow up with your child’s doctor because you have to follow the weight and see if it’s changing over time,” said Castellino.

Establish with a pediatrician at the Pediatric clinic at West Wheeler. Visit augustahealth.org/westwheeler for more information or call  706-312-5437 to schedule an appointment.

About the author

Children's Hospital of Georgia

Children's Hospital of Georgia

Children’s Hospital of Georgia is the only facility in the area dedicated exclusively to children. It staffs the largest team of pediatric specialists in the region who deliver out- and in- patient care for everything from common childhood illnesses to life-threatening conditions like heart disorders, cancer and neurological diseases.

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