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Friday, August 21, 2015

"Failure to Thrive" Diagnoses at 7 months - Part 1

My darling Evie  has been given the same diagnoses as Violette - at the exact same age - "Failure to Thrive", Vi's post is here.  We also had weight gain issues with my 1st daughter Charlotte from 6 - 12 months. 

Charlotte would have probably received the same diagnosis had we not been on bottles from day one because she was born five weeks early and lived in NICU her first five days thus thwarting my ability to breast feed her exclusively.  With bottles there are many tricks to increase calorie content such as adding more formula and rice cereal.  We did both heavily with Charlotte so while she was always a light weight  and did cause concern for only gaining 5 ounces from four to six months, she was always above the 5% percentile mark which didn't put her into the "Failure to Thrive" category. 

For Charlotte our pediatrician highly encouraged getting as many calories as possible into her by way of adding heavy cream, canola oil and corn syrup to her bottles.  The shock I've received from parents when I recount this is pretty common because oil just sounds gross but now that we've lived through "failure to thrive" twice, I can see how she was just trying to keep us from falling into this category.

Violette's weight went from 11.9 at six months to 14.5 at nine months and we were able to do this by supplementing with bottles and using more formula and rice cereal as we did with Charlotte. 

Evie will not take bottles and breast feeds exclusively so the general hypothesis is that I'm not producing enough milk.  I'll touch more on breast feeding in part two.  First, let review what FTT means. 

To be diagnosed with "Failure to Thrive" one must fall below the 5th (depending on what report you read) or 3rd percentile mark for weight (I've seen both 5th and 3rd mentioned).  Here is an excerpt from John Hopkins website on this subject matter:
"Children are diagnosed with failure to thrive when their weight or rate of weight gain is significantly below that of other children of similar age and gender. Infants or children that fail to thrive seem to be dramatically smaller or shorter than other children the same age. Teenagers may have short stature or appear to lack the usual changes that occur at puberty. However, there is a wide variation in what is considered normal growth and development. 
In general, the rate of change in weight and height may be more important than the actual measurements.  
Infants or children who fail to thrive have a height, weight, and head circumference that do not match standard growth charts. The person's weight falls lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve. 
The following are delayed or slow to develop:
  • Physical skills such as rolling over, sitting, standing and walking
  • Mental and social skills
  • Secondary sexual characteristics (delayed in adolescents) 
I've seen no delay in Evie's physical abilities - she rolled at three months, she's been standing with support since five months, she's scooting around the floor at seven months, she plays with toys, laughs all day and reaches for her siblings and everything in sight.  She has normal sleep patterns and loves to breast feed.  She never vomits and shows no signs of discomfort when breast feeding. 

Evie's height is in the 25th percentile and her head size is 17" which falls in the center of expectations so when I read the highlighted yellow part I can say she's only falling short on the weight factor.

At Evie's six month appointment she had only gained seven ounces in 2 months which was slightly better than Charlotte who gained five and definitely better than Violette who had only gained four ounces.  I was not worried nor surprised when the doctor asked us to bring her back in one month because we'd been down this road before.  We spent the next month in Texas, traveling and baby wanted fed every 3 hours and once every night.  I was sure she had put on weight so when she went back for the 7mo appointment we were shocked to see she had actually lost one ounce.  This is what put the doctor into panic mode because babies are not supposed to LOSE weight.  The doctor gave us a mandate to increase her weight in one week or she would be hospitalized.

I'll be honest, I was so upset I could barely breath or eat.  I called my mom and asked for prayer.  I couldn't even bring myself to attend church that evening because I was so upset.  I can say that at one week later we had an answer to prayer because at her weight check she had put on three ounces so that seemed to put off the threat of hospitalization.  We will continue to have weekly weight checks until the doctor is satisfied. 

I found this website to be very informative on FTT:  http://www.aafp.org/afp/2003/0901/p879.html
One area of interest to me was the paragraph explaining the severity of our case:
A complete physical examination is essential, with four main goals: (1) identification of dysmorphic features suggestive of a genetic disorder impeding growth; (2) detection of underlying disease that may impair growth; (3) assessment for signs of possible child abuse; and (4) assessment of the severity and possible effects of malnutrition.12,13 The severity of a child's undernutrition can be determined most easily by using the Gomez criteria. By comparing the child's current weight for age with the expected weight (50th percentile) at that age, the degree of malnutrition can be assessed. If the weight is less than 60 percent of expected, the FTT is considered severe, 61 to 75 percent denotes moderate FTT, and 76 to 90 percent is mild.14
Our case is moderate.  A seven month old at the 50 percentile mark is 17 pounds.  Evie is 11.8 pounds so she's at 70% mark.   Considering the doctor was recommending hospitalization a week ago I find her reaction to be on the extreme panic side because she was only reacting to the one number that she didn't put weight on for a month.  She also failed to consider that scales can be off as much as 3 ounces, something I learned as I did research on buying a home scale to monitor Evie's weight.  Was the baby weighed on more than one scale?  No.  Ironically this also means her recent weigh in might be off but I'm still going to take it as a positive sign as it helped us remain in control of Evie's health and eating needs.

An important factor to consider in your child's pediatrician is someone who can calmly assess your situation and advise solutions.  We were given a medicine for potential reflux issues and one week to improve her weight with the threat of putting her in the hospital if we didn't comply.  This disturbs me on many levels.  While I welcome opportunities to take Evie to a specialist such as the gastroenterologist or lactation consultants since she's so determined to avoid bottles, I do not welcome an option that will deprive me of the ability to breast feed my child and hospitalization would certainly create complications.  There is also the issue that if we don't comply the doctor could call CPS to investigate our family and after hearing horror stories of how families in Maryland have been treated I find this to be a further threat.  I need solutions and specialists, not threats. 

This will be an ongoing issue until we can get Evie's weight to an acceptable number.  We are exploring feeding options in many ways which I'll go into in my next post.  This post was more to introduce the issue and potentially provide some guidance to any parent dealing with this issue.  My advise would be to read up on the issue as we have done and go to your doctor informed about the situation.  Take a chart of your babies eating schedule for the past three days.  If you breast feed exclusively, consult your local lactation consultant.  We found ours through the local hospital where Evie was born. 

Finally I do believe prayer to be a factor in any babies growth because we are all God's children and if he made us then he's the one who knows how to fix what's not working.  Therefore I must reiterate that we are grateful for the prayers from our local congregation and family and we are thankful to God for intervening and helping Evie put on 3 ounces in one week.

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