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Failure to Thrive: Causes, Signs, and Natural Treatments
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We mamas want what’s best for our babies and worry if their height and weight aren’t jiving with the growth chart at regular checkups. Hearing the words failure to thrive can be scary, to say the least. But there is good news: With prompt attention, the condition is usually quickly resolved, and baby can get back to being his/her healthiest.

Read on to find out: 

What is failure to thrive?
What causes failure to thrive?
What are the signs of failure to thrive?
How dangerous is failure to thrive?
What treatments options exist?

What is Failure to Thrive?

There is no universal consensus on what the definition of failure to thrive is. However, a baby is usually given a failure to thrive (also known as FTT, weight faltering, and faltering weight) diagnosis when his/her weight drops two deviations on the growth chart, or below the third percentile.

Failure to thrive should be taken seriously, as it can be fatal or cause lifelong problems due to stunted development, but it’s very treatable. The sooner FTT is addressed, the better, and most cases are easily resolved. Read on to learn more.

The Difference Between Organic and Inorganic Failure to Thrive

There can be many different reasons behind a failure to thrive diagnosis, but the majority of cases are due to inadequate nutrition. This can be caused by either two things:

Baby isn’t getting enough food
Baby isn’t digesting and absorbing the food properly

Failure to thrive is usually divided into organic FTT (underlying medical condition) or inorganic FTT (not caused by an underlying medical condition). However, medical professionals recognize that the causes for failure to thrive are often intertwined, and some say separating the classifications is outdated.

Causes of Failure to Thrive in Breastfed and Formula-Fed Babies
1. Underlying health conditions

Medical causes of FTT include:

Renal disease
Congenital defects
Pulmonary disorders
Down syndrome
Blood disorders
Brain and central nervous system damage
Cystic fibrosis
Iron deficiency anemia
Severe allergies
Metabolic conditions that prevent baby from absorbing nutrients
B12 deficiency due to a deficiency in breastmilk or gut absorption

2. Food allergies and sensitivities

If you breastfeed, certain foods—namely cow’s milk, soy, eggs, gluten, and shellfish—in your diet can give baby digestive issues. Acid reflux and other allergic reactions can prevent nutrient absorption.

This study found that the vast majority of failure to thrive diagnosis were due to digestive issues, like reflux and enterocolitis caused by milk allergies.

Certain formula ingredients can also cause reflux and allergic reactions for some infants. Conventional formula that’s labeled allergy-friendly still has milk protein and often soy in it, which are some of the most common allergens for infants. Switching to a new formula, like this homemade goat milk formula, can be a better option.

3. Socio-economic status

Some experts advise that lower socio-economic status can also contribute to higher rates of failure to thrive. However, this UK study found no link between a mother’s education status and income levels with her child’s FTT. And in a similar study conducted in Japan, researchers found low income and education status in the UK and Denmark did not contribute to FTT, but in Japan they did. Income levels and socio-economic status can play a part in areas where women and their infants don’t get the support they need to thrive.

Causes of Failure to Thrive in Breastfed Babies

Breastfeeding is the healthiest food for baby, but it can be tough sometimes! Mama’s diet not only affects the nutrition of breastmilk, but it can also cause tummy troubles for sensitive babies. Gluten, dairy, and soy are some of the most common allergens in breast milk. In more severe cases, these issues can cause failure to thrive.

1. Tongue and lip tie

Tongue tie and lip tie can prevent a proper latch when breastfeeding. Ties can start a cascade of feeding issues, sometimes resulting in failure to thrive (and a frustrated baby and mama). Formula-fed babies can also have feeding issues with tongue and lip ties.

2. Vegetarian and vegan breastfeeding mamas

While plenty of vegetarians and vegans get enough of the right nutrients, they do have to take extra care to ensure they get certain vitamins and minerals predominantly found in animal sources, including B12. (sourceIn this case study, the 12-month-old breastfed baby of a vegetarian mother had B12 deficiency that caused his brain to shrink and not develop properly. In another case, an 8-month-old refused solid foods, but after B12 supplements for both him and mama, his food aversions disappeared. Infants with a B12 deficiency may experience weakness, fatigue, permanent brain damage, and failure to thrive, among other symptoms. 

Vegetarian and vegan mothers who plan to breastfeed should consult with their healthcare provider and a lactation consultant to determine whether or not their diet contains enough B12 from non-animal sources. If mama may not be getting enough B12, a supplement may be prescribed for either the mother or the infant. (source)

3. Mama’s Gut Health Causing FTT

Even if you are getting plenty of healthy fats, grass-fed protein, and fresh produce, baby still may not get adequate nutrition. Intestinal permeability, aka leaky gut, prevents nutrient absorption for mama, causing inadequate amounts in breastmilk. Researchers found that this breastfed baby’s failure to thrive was due to his mother’s undiagnosed Crohn’s disease. The mother wasn’t able to properly absorb vitamin B12, so adequate amounts weren’t in the breast milk.

It’s important to note that antibiotics given for a C-section or Group B Strep infections during delivery can impact gut health for both mama and baby, too. This study found that babies exposed to antibiotics during birth had much lower counts of good bacteria and higher counts of bad bacteria compared to babies without antibiotic exposure. All infants were breastfed to some degree, and the differences between the two groups had evened out by 3 months. Yet another reason why breast milk is magical! Probiotic supplements and fermented food for mama can also help.

4. Other health conditions

There are a number of other health conditions that can affect the quantity and quality of breast milk, including:

Thyroid issues in mama can cause a lack of breastmilk production.
Certain forms of hormonal birth control, like the pill and IUDs, can cause a negative change in milk fat and protein content.
C-section births can lead to inadequate milk supply, since baby may not be placed skin-to-skin right away. Talk to your provider about keeping baby skin-to-skin until baby latches for the first time. (source)
Although rare, retained placenta or postpartum hemorrhage within 6 weeks of birth can cause low weight gain in baby. These issues are also life threatening for mama if not addressed immediately.
PCOS or ovarian cysts can prevent breast milk from coming in. (source)

5. Postpartum depression

Mama’s with postpartum depression have an increased risk of failure to thrive when baby is breastfed. A study of nearly 800 infants in the United Kingdom found a strong correlation between mama’s depression and baby’s health. Infants of depressed mothers had slower weight gain and faltering weight, but they were no longer behind their peers by their first birthday.

The Importance (and Confusion) of Growth Charts

It can be normal for baby to flatline a bit on the growth charts, but there’s cause for concern if their weight percentiles continue to fall.

Weight may naturally drop once baby becomes more active, but it should then stabilize. In 2006 the World Health Organization (WHO), published new growth charts that included a more accurate standard for breastfed infants. After 3-4 months breastfed babies naturally grow at a slower rate than formula-fed babies. Rather than focus on percentiles, growing steadily on a curve and/or maintaining percentile is what you really want to see on the growth charts.

When my son was born, he was in the 50th percentile in weight, but fell to the 5th percentile by 4 months. I was a bit freaked, but my doctor wasn’t, because Griffin was meeting all of his milestones, was a happy baby, and my husband was a very slender child. He maintained this percentile (5%) until he was 1 year old, which was another good sign. Once he embraced eating solids, his weight shot back up to the 35%-50% range.

What are the Signs of Failure to Thrive?

Since you’re with your baby every day, it can be difficult to notice little changes in her weight. Here are infant growth charts, so you can easily track baby’s growth yourself.

The most obvious ways to tell that baby is failing to thrive is if they aren’t gaining weight and don’t have adequate diaper output.

Other signs of failure to thrive can include:

Excessive fussiness
Excessive sleepiness
Easily tired
Not meeting milestones, learning delays
Dark urine
Fewer than 8 wet or poopy diapers a day
Constipation
Getting frustrated or exhausted at the breast and falling asleep without an adequate feeding
Delayed motor development
Doesn’t display age appropriate social responses, like smiling

How is Failure to Thrive Diagnosed?

Some failure to thrive symptoms can be mistaken as other conditions, like colic. Assessing baby’s weight is the most accurate way to diagnose failure to thrive. If they’ve dropped two deviations or dip below the third percentile, the doctor will most likely give a FTT diagnosis.

Researchers that observed children at a pediatric hospital for failure to thrive found that immediately putting the children through a battery of diagnostic tests was often unhelpful and unnecessarily invasive. Instead, they recommend the child be observed for weight gain before diagnostic investigation (source).

If your baby’s doctor suspects an underlying health issue, then diagnostic testing may be needed. Identifying and correcting the root cause will help your baby be healthy and thriving. (source)

Tests for Failure to Thrive

Complete blood count to check for anemia
Checking electrolyte balance
Hemoglobin electrophoresis to check for blood diseases, like sickle cell disease
Hormone functioning tests, like a thyroid panel
Urine testing

Is Failure to Thrive Fatal?

If not corrected, yes, since baby is malnourished. Even if death doesn’t occur, FTT can cause long term physical and cognitive damage. Growth occurs very rapidly in infants, and 80 percent of brain growth happens by age 3. The sooner failure to thrive is corrected, the better, so early diagnosis is key.

Treatment for Failure to Thrive

As long as weight is regularly monitored, failure to thrive can be caught and treated at home before serious issues arise. In severe cases, the baby will need hospitalized to receive IV or tube nutrition to correct major deficiencies. Here are the most common at-home treatments for faltering weight:

1. Addressing breastfeeding problems

Treatment will depend on what’s causing the issue. If baby is having issues breastfeeding, then a visit with a lactation consultant is in order. An IBLC lactation consultant experienced in recognizing tongue ties and lip ties is important. If a tie is suspected, then you’ll be referred to a holistic dentist for diagnosis and revision.

2. Let baby lead with breastfeeding

Having baby on too strict of a schedule or letting baby sleep through the night too early can cause dehydration, bonding issues, and insufficient weight gain. Babies like to cluster feed at times, like during growth spurts, when they need increased nutrition. Some babies are slow eaters, or mama’s flow is slower, and it takes more time to feed. Take cues from your baby and let them decide how much they need and when they’re done.
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3. Switching formula

Formula-fed babies may need to switch to a different bottle or change formula. Keep in mind that dairy and soy commonly cause digestive issues in infants and can be found even in many allergy-friendly conventional formula options. Here are recipes for homemade formula, including a goat milk and liver (yes, liver, which used to be the main ingredient in some of the original formulas on the market) version for infant’s with cow milk sensitivities.

Natural Ways to Help Baby

This will depend on what’s causing your baby’s failure to thrive, but here are some suggestions to correct the most common underlying reasons for a failure to thrive diagnosis.

1. Increase baby’s time at breast

In studies, underweight babies gain weight by frequency of feedings versus the fat content of the breast milk. 

Feeding baby more often will also increase your breast milk output since its based on a supply/demand feedback loop. Babywearing, cosleeping, and napping with baby will help baby have easy and frequent access to the breast.

2. Boost breast milk production

If you’re worried you have low milk supply, meet with a lactation consultant to get to root of issue. Here are other things you can do to increase your breast milk production.

Compress the breast during feeds. (Learn how to do that here.) Interesting to note: Breast compression also increases the fat content in breast milk, which can help with baby’s satiety levels.
Feed more frequently, or cluster feed.
Babywear and nap/sleep close to baby to signal the breasts to produce more milk.
Pump directly after a feeding and in between feeds to tell the body to increase milk production. (You can also try power pumping.)
Drink breastmilk tea and eat galactagogues, foods that increase milk production, like oatmeal, flax seeds, and fennel.
Avoid peppermint and parsley in amounts larger than culinary use, since they can decrease milk production.

I highly recommend the book Mother Food—it’s brimming with excellent dietary and herbal tips to boost milk production and enhance the quality of your milk.

3. Try baby massage and chiropractic care

Massage is soothing and a great way to bond with your baby.

In a 2005 study, premature infants who were given massage had shorter hospital stays and 21-48% greater weight gain than the non-massaged group.

Other researchers have noted that certain brain chemicals released by touch, or others released in its absence, may account for these infants’ failure to thrive.

Similarly, subluxations, or nerve compressions, in baby’s spine can cause a whole host of issues. Chiropractic care can fix these subluxations to ease reflux, constipation, digestive issues, and other stressors that cause failure to thrive. Chiropractors can even help correct palate and jaw issues affecting breastfeeding. (source)

3. Enrich mama’s diet

Breastfeeding mama’s need adequate nutrition with plenty of healthy fats, grass-fed animal products, and fresh produce. A breastfeeding mama should aim to drink an extra 32 ounces of water and consume an extra 300-500 calories  per day. A pre-natal supplement is also helpful to fill in any nutritional gaps.

Let’s breakdown top nutrients a breastfeeding mama needs:

Vitamin B12: Some of the best sources of B12 are clams, liver, trout, salmon, grass-fed beef, and eggs.

Vitamin D: Some of the best sources of vitamin D are salmon, sardines, cod liver oil, oysters, and egg yolks.

Vitamin C: Some of the best sources of vitamin C are citrus fruits, broccoli, tomatoes, and cabbage.

Folate: Some of the best sources of folate are spinach, collard greens, asparagus, broccoli, and citrus fruits.

Iron: Some of the best sources of iron are shellfish, spinach, liver, beens, and grass-fed beef.

Magnesium: Some of the best sources of magnesium are spinach, kale, almonds, black beans, and salmon.

If a breastfeeding mama is eating a well-balanced diet and taking prenatal vitamins, additional supplements aren’t usually necessary. Mamas with underlying health conditions, like thyroid issues or Crohn’s disease, and those with dietary restrictions should talk to their healthcare provider about whether additional supplementation is necessary. 

4. Take probiotics and give some to babies too.

Give probiotics to balance gut bacteria and ease reflux symptoms.

B. Infantis is the predominant bacteria in baby’s colon that crowds out pathogenic bacteria. Unfortunately, it’s becoming extinct in the Western baby’s gut. You can supplement with this strain to help baby significantly. Add one drop of this supplement to each breast nipple before feeding. Get your doctor’s approval before trying this regimen.
This strain has been shown to reduce colic crying by 50 percent!
Other moms swear by this probiotic, which is one of the “cleanest” on the marketplace.

Natrum Phos cell salts can also help correct digestive issues, particularly acid reflux. Unlike some reflux remedies, this substance is naturally produced by baby’s body.

A Note to Parents

Failure to thrive is scary. All you want is to see your baby happy and healthy. In most cases, babies diagnosed with failure to thrive go on to be perfectly healthy and may even exceed their peers in height and weight later! See a lactation consultant, work with your doctor, pay extra attention to taking care of yourself and your baby, and you’ll make it through.

What About You?

Has your baby experienced any of the signs of failure to thrive? What are you doing to correct the issue? Anything we missed? Let us know in the comments below!

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