To Your Health

Although it has been recognized for more than a century, failure to gain weight, or 'failure to thrive,' still lacks a precise definition

Q. I have two children, who are doing well, but my 3-month-old son spits up a lot and is not gaining weight. The only unusual thing about my pregnancy with him is that we moved to a Texas border town a few months before he was born. What might help this baby to gain weight normally?

A. Fifty to 65% of normal 2-month-old infants spit up three or more times a day, but by 3 months of age, only 4% still have this problem. Known as gastroesophageal reflux, it occurs when the valve between the esophagus (the tube that connects the mouth to the stomach) and the stomach opens too easily, and its opening is not synchronized with swallowing. He may yet outgrow this problem.

Although it has been recognized for more than a century, failure to gain weight, or "failure to thrive," still lacks a precise definition because it is not a specific disease. Once your pediatrician has ruled out serious medical problems, consider the common causes of FTT, which include vitamin and mineral deficiencies, intestinal parasites, and persistent diarrhea (diarrhea lasting two weeks or more). Until a cause is found, feed your son smaller, more frequent meals that won't create as much pressure in his stomach, and avoid situations that lead to excessive coughing, straining, or crying.

Among the nutrients, deficiencies in vitamins A, D, C, E, K, B-complex (especially vitamin B-12), iodine, and iron are most often mentioned in relation to FTT. Under the supervision of a nutrition-oriented health professional, modest supplements of all of these nutrients are safe. If you are breast-feeding you should take these same supplements along with your son. Although zinc supplements theoretically should help FTT, in a recent study adding zinc did not improve growth. However, once your child begins to grow, zinc requirements may increase, and a supplement is worthwhile.

An allergy to milk protein can lead to difficulty in absorbing nutrients. Unfortunately, it also puts an entire class of food out of reach for your child, making it harder for you to find a variety of safe and nourishing foods. If you are breast-feeding, you should avoid cow milk for a few weeks and watch for a difference in your son's health and growth rate. If cow milk seems OK, for a few weeks write down the foods you eat and how your son responds to them. This can make you more aware of any other foods besides cow milk that he may have a problem with.

Limit fruit juice to 8 to 16 ozs. per day. Fruit juice can contribute to poor growth by diminishing your son's appetite for breast milk, leading to decreased caloric intake.

The use of probiotics and prebiotics has recently become more widespread. Probiotics are the microorganisms that live in the gut and have beneficial effects on their host. Prebiotics are the nutrients and food components that our probiotics feed upon, thus increasing their numbers. We are rapidly learning that there are strong interactions between probiotic organisms and human cells, and also between probiotic and disease-causing organisms. We are now able to encourage the growth of probiotics by supplying the food (prebiotics) they like best.

With an energy need that per pound is almost triple that of adults, infants can quickly fall behind on growth but can also respond quickly to improved conditions.

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