Guest Blog Appearance by: Katja Rowell MD
She called near tears, anxious about her infant daughter, haunted by three words used years ago to describe her first son. “Failure to thrive” – few words do more harm to the feeding relationship. (OK, perhaps, “Do whatever you have to, to get food into that kid,” and the two often go hand in hand…)
“It really got into our heads,” explained Sally as she recounted the struggles she had feeding her son, who’s allergies to eggs, nuts and dairy were discovered while she was breast-feeding. Zack was small, at around the 5th percentile, but thriving socially, physically and emotionally. Doctors however, warned he was officially “underweight,” and threatened a “failure to thrive diagnosis.”
Subsequently, Sally worried and pressured, and his eating got worse, not better. Sally’s experience is supported by the research. Children pressured to eat, generally eat and grow less well.What does that pressure look like? My clients tell me about elaborate games, sippy-cups full of Pediasure, rewards, stickers, bribes, threats, tearful confrontations, putting food into little mouths, TV, video distractions…
Misplaced worry over size is one of the prime motivators behind the feeding practices that desperate parents resort to. It seems to work in the short term, but ultimately, makes feeding worse.
The good news? Most failure to thrive “diagnoses” I see are not accurate. Children who are growing consistently, even if they are at the low extreme of the growth curve are probably just fine. (The same goes for children growing at the high extreme of the growth curve who are also being mislabeled as “overweight” and “obese,“ and also suffer harmful intervention with feeding.)
What can you do if you’ve been told your child is “too small,” or even “failure to thrive?”
- Insist that your child has accurate records from birth.
- Is weighed and measured the same way each time.
- Ensure that a weight-for-stature chart is used (not just weight for age).
- Utilize a special chart if your child was born premature.
Optimize feeding with the Division of Responsibility, endorsed in 2008 by the American Dietetic Association:
- Your jobs with feeding: you decide what, when and where your little one eats.
- Your child’s job: deciding if and how much to eat from what you provide
- Provide regular meals and snacks with a variety of foods in a pleasant, neutral setting, and avoid pressure.
- Get a second opinion.
In the end, a small child can be trusted to eat and grow too, and establishing a healthy feeding relationship will make it more likely that he will grow up to be a competent eater with a healthy body that is right for him.
*A brief digression about growth:
(Weight roughly follows a bell-curve distribution; so about 5% of the population will naturally fall below the 5th %- not automatically “failure to thrive.” A child growing at the 5th% or even 1st% is more uncommon than the child growing at the 50th % but is not by definition unhealthy. If your child is crossing downwards across percentiles– that is, the rate of weight gain is slowing, or there is even weight loss, then this does need to be investigated. You and your health care provider should be asking, ”What is happening that my child is no longer able to eat and grow in a steady way?” Things to consider might be medical (including allergies), social, neuromuscular or developmental, and feeding practices– like pressure.)
Child of Mine, Ellyn Satter
Chapter 2 of Child of Mine is available free online and reviews data around eating and growth regulation for children.
Secrets to Feeding a Healthy Family, Ellyn Satter
Katja Rowell MD, owner of Family Feeding Dynamics LLC, is a behavioral childhood feeding specialist and works with clients locally in the Twin Cities area and nationwide.