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Ask Dr. Navitsky Your Own Question

Dr. Navitsky
Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1036
Experience:  US Pediatrician licensed in California living abroad.
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what can cause very slow weight gain since birth in a baby

Resolved Question:

what can cause very slow weight gain since birth in a baby
Submitted: 1 year ago.
Category: Pediatrics
Expert:  Dr. Navitsky replied 1 year ago.

Jnavits12 :

Hi there are you still available to chat?

Jnavits12 :

I realize your question posted a while ago and apologize that we were not able to answer it for you in a timely fashion!

Jnavits12 :

There are many many reasons that a baby can have "failure to thrive" or very slow weight gain and I would have to get a bit more information from asking you some questions in order to be able to advise you better.

Jnavits12 :

First of all how old is the baby now? What are we talking about exactly when you say slow weight gain....what was birth weight and if you can give me a few more weights as well with the time they were taken at? What is the baby eating? Does the baby appear normal besides the lack of weight gain? Any issues with the pregnancy or delivery?

Jnavits12 :

Because the differential is huge, (from issues with the feeding to congenital syndromes that cause slow weight gain) I would like to be able to talk with you. Let me know when you see the reply and we can chat thanks!!

Jnavits12 :

I will be leaving my computer for almost 2 hrs in about 1/2 hr if you happen to catch me then, but will be back afterwards for the remainder of the evening. Thanks again.

Customer:

hi the baby is six months was 6lb 7oz at birth hes 12lb7oz now some weights went up by 8oz some by only 6oz in a week

Jnavits12 :

Hi I am just about to leave to take my kids to gymnastics....that is little! What is he eating (since birth)? When did they start to get concerned about his weight gain? How easy is he to feed? Any symptoms regarding eating at all...vomiting, loose stools, blood in his stool...?

Jnavits12 :

What has his height and head circumference been doing all this time with his excessively slow weight gain....have they followed his initial % on his growth chart if not when did they start lagging?

Jnavits12 :

Is he your child or grandchild?

Jnavits12 :

I realize you are probably in the midst of typing a long summary but just want to get the questions out before I head out so don't feel pressured!

Jnavits12 :

I'm so sorry I have to head out now or we won't catch the bus. I will have my phone with me but I am horrible at typing on it and it is really slow. Leave me as much info as you think I can have and I may be able to get a few more questions in on my phone. I can definitely try to help you the best I can to see if I can think of anything that hasn't been looked at yet. Thanks and sorry for the interruption again!

Customer:

hi the baby is six months birth weight 6lb7oz hes gaining about 6to8oz a week he eats solids and formula now he only ever could manage 3oz of formula every 2hours but he does great on solids 3 times a day his development is perfect hes a very good baby his liver bloods were up slightly the delivery was induced the placenta wasnt working well enough at full term why would they do a ct scan what could they b lookin for

Customer:

hi again im his auntie they started to b concernd when he was six weeks old his head and height are developing perfect hes very active no loose stools but has a bowel movement 3 times a day since he started on solids

Jnavits12 :

Hi I am back hopefully we can connect sometime tonight (I am in Spain physically). So if his height and head circumference are continuing to grow this is actually less concerning than if they were affected instead of being "spared".

Jnavits12 :

However his weight started off in the 10-25% on the standard growth chart used in the US http://pediatrics.about.com/cs/growthcharts2/l/blboysbirth.htm

Jnavits12 :

And is now way below the 3%...

Jnavits12 :

He may have been small initially either due to his genetic predisposition small people tend to have smaller babies...or due to the placental insufficiency that Mom was experiencing towards the end of the pregnancy.

Jnavits12 :

The fact that his ht and head circumference are continuing to grow as expected shows that he does have enough calories in for their growth (and also points out why we follow weight so closely in babies as it is directly related to brain growth (head) and development.

Jnavits12 :

Some babies are just small and skinny...but your nephew is quite underweight and probably at the point where I as a pediatrician would make sure I had all bases covered to rule out any physiologic condition causing him to not gain in addition to placing him on an optimal high calorie diet supervised by a nutritionist so that we could have him at least gain weight proportionately well to allow his other growth to continue.

Jnavits12 :

Therein may have been the blood and urine tests that they did in the hospital although when we often do these tests without having any suspicion of a disease due to other symptoms we are in fact "fishing" and rarely come up with a diagnosis.

Jnavits12 :

The broad disease categories include metabolic illnesses (all rare but do happen), genetic conditions that result in a syndrome (usually these make a baby look a certain way with distinct features or other medical problems associated with them), gastrointestinal problems, (again usually have symptoms associated with them), cardiac problems, and even cancer. The CT scan I'm not sure what they were looking for although if his head were small they could be looking at brain anatomy and perhaps they could be looking for any mass if his liver enzymes were high.

Jnavits12 :

The liver enzymes being high (I would want to know which ones and how high), as in babies the scales are often not well developed and a few points above the hospital lab cutoff may not be clinically significant...would make me think about possible metabolic issues....which is as well huge category but has to do with how we process calories we consume and turn them into the energy our cells use.

Jnavits12 :

If he is developing well this is very reassuring as babies with genetic syndromes tend to lag behind in their development right from the start. At 6 months he should he babbling, starting to use his hands to play with objects purposefully (mouthing them most of the time :)! ), moving them from hand to hand, sitting with very little support and rolling all around the floor both ways back to front and front to back.

Jnavits12 :

I have met (many) skinny babies whose weight gain made me break into a sweat every time I saw them...that had skinny parents and ended up really quite normal once the grew into their big heads. These kids after a brief screen and thorough following I would monitor every month or 2 their weight gain. High calorie is much easier to do with solids as you can pack a bunch into a small volume of food harder to do with formula. He should be on a high calorie formula at least 22-24 cal/oz which is basically regular formula concentrated further following a medical recipe. To his solids you can add tsp of extra virgen olive oil,avocado puree, butter (real), melted cheese, cream, (got the picture....healthy fats) in order to increase the calorie content. In addition their are medical "powders" like duocal to add to purees to up the calories.

Jnavits12 :

In the US and most developed countries there is a newborn screening test done on every baby. Not sure what Ireland has on it's roster but I will try to look for you. Usually this rules out horrible metabolic diseases and even more common ones like cystic fibrosis.

Jnavits12 :

In Ireland it is called the bloodspot screening and it is quite limited compared to the extended version used in the US http://www.hse.ie/eng/services/news/newsarchive/2013archive/feb2013/bloospotreport.html

Jnavits12 :

However it does include Cystic fibrosis which is high on the differential in a baby that fails to gain weight, but a negative newborn screen is not definitive for not having it....just makes it less suspicious to me...however if a baby gives me clinical suspicion of having it I do do a sweat test anyway.

Jnavits12 :

A lot for you to read over. Again having a bit more information on any specific symptoms would be helpful unless there are any...which in this case it also helpful. A skinny baby who is otherwise doing great usually doesn't have a medical condition. Let me know by responding how I can help you further thanks!

Customer:

hi we just got word his ct was normal nothing wrong with his brain hes doing all the things you said except rollin from side to side he just goes from back to frount he doesnt seem to have any thing wrong with him so ill suggest calorie increase to her thank you

Jnavits12 :

Hi, are his parents really thin?

Customer:

no and his mum is 6ft and dad 6ft

Jnavits12 :

Wow... well maybe now that he can eat solids his weight gain will be better...he could have had reflux or something like that that limited his bottle drinking.

Jnavits12 :

He still needs formula as much as he will drink as his only drink save for water, serve 3 meals a day and soon around 9-12 mo 2 snacks too

Jnavits12 :

Have them ask about higher calorie formula as well as he really should be getting at least 22 cal/oz (like ex preemies do)

Customer:

he will be going back to the hospital in june so hopefully he will be heavier thanks again

Jnavits12 :

You are welcome best of luck to you and to him!

Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1036
Experience: US Pediatrician licensed in California living abroad.
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