Our kids had their one-year appointment and sad to say, they are underweight and have crossed three major percentile lines over their last two visits. At six months of age, they were 50th to 75th percentile for weight. Now, Eleanor is at the 15th percentile, and Miranda is at the 5th percentile. In pediatrics, we call this “failure to thrive”.
Failure to thrive is often psychosocial, and when you see a patient who is “FTT”, you look first to the parents, i.e. is this child being neglected? All I can say is, it is really weird being on the other side. I know Bernard and I were being judged by the pediatrician, since I do it all the time at work. You look for maternal depression, poor parent-child interaction, inappropriate feeding practices, like, the belief that cholesterol is bad for the baby. In the child, you look for apathy and poor development, skin problems (from vitamin deficiencies), poor hygiene, dirty clothes, and badly neglected diaper rashes. I don’t think we demonstrated any of the above, but I definitely heard, “Spend more time with your kids” twice.
Failure to thrive has biologic causes which are poor cardiac, lung, or gastrointestinal function. Also, neurologic, genetic, kidney, and endocrine disorders can account for it as well. Our pediatrician did mention that we may have to do a workup in the future for the biologic causes of failure to thrive. This involves blood, urine, and stool studies at first, then, more expensive tests later.
Personally, I know why our kids aren’t gaining weight, and I don’t think we’ll need any of the tests for failure to thrive. I blame myself and daycare. Our kids started daycare at six months, and since then, they’ve been sick at least once a month for the last six months. Also, daycare exhausts them. When I pick them up, they are keeling over, and I barely have time to feed them dinner, give them a bath, and put them in bed. This is why they go to sleep before 7pm and wake up the next morning at 6am. Also, I am lousy at making food for them. Their contact sheets at daycare often say “refused food from home”.
Well, things will have to change. We have a “weight check” in four weeks, i.e. “we’re weighing your kids in a month and they better have gained weight”. Sigh. I can’t believe our kids have to have a weight check. When we have patients who fail weight checks, we admit them to the hospital and stuff them with food and watch them turn into plump, happy kids. This proves that the failure to thrive was psychosocial and not biologic. Then we call Child Protective Services. Okay, I know I’m going overboard. I guess we’re not too worried because the kids just don’t look thin–they have fat cheeks and lots of fat folds in their legs.
Anyway, one major change we’ll have to make is they need to eat more fattening foods. At Failure to Thrive Clinic (yes, we have a weekly clinic where we see all the FTT kids), they teach the parents how to add butter and heavy cream to all the kid’s food. I’m serious. Today, my kids refused the raw tofu and steamed broccoli I sent them to daycare with, so starting tomorrow, they get all their food with cheese sauce and butter.
Part of my anxiety is that I always feel like an inadequate mom when it comes to making their food. When Bernard and I were childless, we would come home from work, say, “What do you feel like eating?”, then go to the grocery store and make something from scratch. We would never plan ahead. Our freezer was always empty because we only ate fresh food. Now, cooking for the kids takes an inordinate amount of planning. Last weekend, I made some meatballs for the kids and froze them. I took them out and put them in the refrigerator to defrost them on Monday night. Now it’s Thursday and they’re still frozen solid! I have no idea how to defrost food from the freezer. Do people use the microwave? Soak the tupperware of frozen food in water? Help!
agnes, you’re a good mother and doing the best you can under the circumstances. getting sick takes its toll. what i did when lucas lost a bunch a weight at one checkup and when he gets sick is that i start spiking his milk with formula. i put an extra scoop of formula in his milk. also, i made my own babyfood, which i call baby chopsuey, because he hated store bought baby food. it has everything in it already, semi-pureed. i would make a bunch at a time, freeze it and take it out as needed to feed him. he ate that and baby fruit puree for about 6mo. it made my life a lot easier b/c i don’t have to think about what to feed him daily. he didn’t mind eating the same thing everyday either. he outgrew it about the time he can start eating chopped up table food.
defrosting food from the freezer… it depends on what it is and how much… for good amount of meat, i take it out in the morning, soak the whole bag in a container of water so by the time i get home, they will be done. you can probably do the same for frozen meatballs. if they are individually frozen, you can probably nuke them. freeze cooked food in small amounts if it’s for the girls.
Agnes and Bernard, I was hoping to make it to S CA to see you this summer but the past weeks have flown by and we will be going back to Shanghai next week. I just wanted to say that although I haven’t met your girls or seen you since you were a few months pregnant, I know you’re wonderful parents.
The FTT diagnosis isn’t much to worry about since you know they don’t have any risk factors for it. Keaton’s weight went from 75th percentile at 6 months to 10th percentile at 12 months. Our pediatrician was never worried because his height and weight always remained proportional to each other. That’s really the most important thing. Neither Bennet nor I are big people so we expected him to be below average. Nowadays, he’s still at 10th percentile for height and weight… he’ll always be small for his age, but we know that as long as he’s developmentally normal (even advanced… you should see him play violin! but I’m bragging :)) and emotionally happy, who cares about height and weight? On the other hand, Mathew is checking in at 60-70th percentile for height and weight. So, what this means is that I’ve got boys 2 years 2 months apart, and yet people ask me if they’re twins. Nope, just a small 5-year old and a big almost-3-year old.
One of my best friends has a 5-year-old son who is very thin, and has been since about 9 months. He was diagnosed at 12 months as FTT and they started adding a tablespoon of oil to every meal he had. Ultimately he was diagnosed with a wheat allergy that interfered with his body’s ability to absorb nutrients. He’s done better since they’ve become aware of his food sensitivities (milk, wheat, eggs, strawberries, wheat, soy!!), but they’ve also just accepted that he will be skinny… just like mom and dad.
Do the kids feed themselves? Out of survival, I started allowing my kids to feed themselves finger food at an early point. Favorites were FRESH (in water) mozzarella cheese cubes, diced avocado, cooked baby carrots, cooked spiral pasta, and canned beans – they loved garbonzos and kidney beans – and it was so easy to open a can and scoop out some onto the highchair tray! Messy, but it was time efficient, and allowed me to finish cooking before I joined them at the table with some calorie-rich grown-up food which I’d also offer them.
Anyway, your gut instincts as parents have not failed you in the least so just trust yourselves, continue being conscientous and loving, and the FTT label will be just another interesting blip in their early years.
Enjoy the upcoming year! I think the time between 12-24 months is absolutely the best time. Not to say that it’s downhill afterwards (!) but it’s really fun to watch so many milestones – walking, talking, interacting – before they experience frustration, test their independence, and become really inquisitive (the never-ending “why” questions can be tiring).