Your infant is a day old and already we are probing them about their weight, concerned about weight loss after birth and regaining birth weight within a specific amount of time. The next comes around and baby’s weight determines if you can go home or not. A couple days after that you return to your pediatrician, mainly for a weight check and to be sure the new parents are adjusting well. Two weeks later, more weight checks - has baby regained birth weight?
This trend maintains throughout the first 2 years of your infants life and beyond, but for good reasons. However, good reasons or intentions are not always taken as such and as healthcare providers we must do a better job about breaking down the barriers of the why and hows of infant care (and overall general health, am I right?).
Inability to regain birth weight or poor length growth with in the first 14 days of life are criteria for neonatal malnutrition which puts infants at an increased risk for infections, complications of infections and developmental delays. These indicators are also alarms for your healthcare providers to assure that there is not a medical diagnosis that had not previously presented itself on sonograms, lab work, etc.
After the two week mark, continued growth velocity and monitoring of percentiles remains important to assure adequate nutrient intake. And while considerations should be made based on each individual infant through assessment of genetics, birth weight, medical diagnoses, etc., we as parents must also understand that adequate growth means adequate calories and when sole calorie source is breastmilk or formula, that means adequate calories correlates to adequate vitamin and mineral intake, which in turn provides our babies the nutrients they needs to do MANY THINGS in their bodies (circulate oxygen, metabolize food, grow hair, strengthen bones, etc., etc.).
So, what happens when our babies are not following the recommend growth curves? Pediatricians will assess for and diagnose failure to thrive or malnutrition based on diagnostic criteria:
WEIGHT FOR LENGTH (0-24MO) OR BMI/A (2-20YO) Z-SCORE
Z-scores correlate to percentiles but give a better understanding of changes from the 50th percentile when children are at the 0th or 99th percentile.
WEIGHT GAIN VELOCITY
The amount of weight gained on average per day over a certain number of days. This weight change is more rapid from 0-4 mo and then slows as infants get older.
BODY STORES
Muscle and body fat stores should be assessed at point and time as well as over time to assure normal changes are happening in a child body composition and if excessive losses are prevalent.
NUTRITIONAL INTAKE
How much is estimated that the patient needs to consume for adequate growth compared to actual intake.
If a patient is weight faltering or meets diagnostics for malnutrition, the pediatrician will have to assess the root cause of the problem. Your pediatrician may utilize other healthcare professionals to rule out root causes (dietitian, lactation consultant, speech pathologist, other specialties such as endocrinology, cardiology, nephrology, etc.). Root causes typically fall into one of three categories:
Inadequate intake This may stem from a variety of problems such as simple mixing errors, fatigue secondary to high bilirubin levels or other complications, inadequate volume offered, feeding issues (suck or swallowing dysfunction), etc.
Increased losses Spit up secondary to excess volume intake/latch and suck or swallow dysfunction/food allergies or intolerance are a typical culprit but this may also include issues with absorption in the gastrointestinal tract.
Increased demands. Typically related to a chronic disease, early life infections, or metabolic disorders; this also becomes a problem the longer a patient is malnourished as nutrient demand are higher to replenish stores.
Once root cause is named, the same team that aided in finding the issue will likely help resolve it through individualized care that addresses the infant’s and family’s specific needs. It is vitally important that a pediatric dietitian is part of this care team to aid in restoring adequate growth velocity while assuring adequate micronutrient are consumed, different regimens and formulas that may be trialed are appropriate, that rapid weight gain ceases once a patient is safely re-nourished, and that breast fed infants can continue to have that bond with mom while optimizing nutritional intake if that is what mom so chooses.
As a mom and a dietitian, this area is very dear to me that parents understand why healthcare professionals want your babies to growth adequately. It is also a mission of mine to assure that each baby is looked as an individual and that growth trends are assessed from a wholistic standpoint. Some babies have different growth curves, and that may be okay, so long as weight and length trends are at least lower end of normal. These babies may have been born smaller, have lesser genetic potential, etc. Some babies may have normal percentiles but lower growth velocity, and that may be okay too. Maybe these babies were born heavier and are adjusting to their genetic growth potential? BUT, sometimes low percentiles or weight gain velocity is not safe and intervention is needed to assure that your child’s potential is optimized.
In the event you find yourself in this scenario, it is important to remember their things that we cannot control. As parents, we can only control our infants genes so much and once their born the only thing we can do is provide an environment where genes are expressed to their best abilities (reasons why your care team does what they do and are wanting to help your babies growth. Also, if you’re interested in talking about optimizing those genes prior to getting pregnant, let me know. I’d love to talk!). Other things that we cannot control are any medical diagnoses or complications you and your child might encounter and we cannot force our children to eat when they do not want to.
What we can control is consistently offering nutritional intake, nourishing ourselves (mind, body and spirit) so we can best provide for our children, and seeking/receiving help from professionals who can find and treat the root cause.
Personalized nutrition care is important for your infant, let us help you and your little find the right groove for you! Https://www.panhandlenutritiontherapy.com.
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