Poor weight gain of children is the most heard complaint in my OPD. Parents are always worried about the weight of their child and complain that it is not increasing adequately. So in this talk I would like to talk about the common causes for the same.

 

 

Causes of poor weight gain in children

 

Pre-natal causes:

Birth weight had an important role in a child’s life. It is called as the first certificate of merit! Birth weight of the baby depends on various maternal factors. Some of them are

• Poor maternal nutrition
• Pregnancy induced hypertension
• Smoking
• Alcohol
• Anemia
• Intrauterine infections- Toxoplasma, CMV, Rubella etc,
• Teenage pregnancy
• Congenital heart diseases of mother
• Other chronic diseases of mother like bronchial asthma, hypothyroidism

Post natal causes:

Other causes are happening after the birth of the child. It can be divided into 5 categories.

• Improper nutrition
• Excess use of energy
• Excess loss of nutrients
• Genetic
• Syndromic

Improper Nutrition:

This is the most common cause seen postnatally. It can be due to following reasons

• Improper initiation and continuation of breastfeeding
• Unnecessary introduction of formula feeds
• Early weaning
• Improper complimentary feeding with insufficient nutrients
• Late weaning
• Excessive use of junk foods
• Improper feeding during illnesses

Excessive use of energy:

In some chronic diseases, the energy provided is used up fast by the children. Though we provide adequate nutrients, it may not be adequate for growth as it is used up fast due to increased metabolism. The common diseases are

• Congenital heart diseases
• Tuberculosis
• Chronic infections like UTI
• Chronic anemia
• Bronchial asthma

Excessive loss of nutrients:

In these cases, the nutrients are not properly absorbed and are lost through the feces. It is seen in malabsorption syndromes like

• Ulceraive colitis
• Crohn’s disease
• Galactosemia
• HFI

Genetic:

In this, genetic potential of the child to grow will be minimal. Parents also will be thin.

Syndromic:

In some syndromes also the growth potential of the child will be less and it will be associated with some other anomalies also.

Approach to poor weight gain in children

Approach to a child with poor weight should be very systematic which should include a detailed history taking, a proper examination of the child, relevant investigations based on this and correction of the cause detected. Parents should understand that there is no drug to increase the weight and the approach needs to be etiology oriented.