What is the adequate daily weight gain in grams per day for a child with failure to thrive?

Adequate Daily Weight Gain for Children with Failure to Thrive

For children with failure to thrive, the recommended weight gain target is 17-20 grams/kg/day, which is the standard used to prevent growth failure in very low birth weight infants and approximates intrauterine growth rates. 1

Age-Specific Weight Gain Targets

Weight gain expectations vary by age:

• Premature infants: 17-20 g/kg/day 1
• 0-6 months: Approximately 190 ± 152 g/month (or ~6.3 g/day) 1
• 6-12 months: Approximately 110 ± 111 g/month (or ~3.7 g/day) 1
• 12-24 months: Approximately 71 ± 58 g/month (or ~2.4 g/day) 1

Diagnostic Criteria for Failure to Thrive

Failure to thrive is diagnosed when:

• Weight falls below the 10th percentile for age 2
• Weight crosses two or more major percentile lines downward on growth charts 2
• Weight-for-height falls below the 10th percentile 2

Nutritional Requirements for Catch-Up Growth

To achieve catch-up growth in children with failure to thrive, consider:

1. Energy requirements:

   • Infants (0-1 year): 75-85 kcal/kg/day during recovery phase 1
   • Children (1-7 years): 65-75 kcal/kg/day during recovery phase 1
   • Children (7-12 years): 55-65 kcal/kg/day during recovery phase 1

2. Calculation method:

   • Use Schofield's equation to calculate resting energy expenditure (REE) 1
   • For total energy requirements, either:
     • Add factors for physical activity and catch-up growth to REE, or
     • Double the REE 1

Monitoring and Assessment

For optimal monitoring of weight gain in children with failure to thrive:

• Infants: Assess at every clinic visit 1
• Older children and adolescents: Assess every 3 months 1
• Adults: Assess every 6 months 1

Nutritional Interventions

For Breastfed Infants

• Increase frequency of feedings
• Consider fortifying expressed breast milk 1

For Formula-Fed Infants

• Use high-energy/protein infant formula
• Consider more concentrated feeds under supervision of a physician or dietitian 1

For Children and Adults

• Increase meal frequency
• Fortify foods with extra fats/oils
• Consume more calorie-dense foods 1

Common Pitfalls to Avoid

1. Inadequate assessment: Relying on a single growth parameter rather than evaluating weight, length/height, and head circumference together 3

2. Missing underlying conditions: Failure to evaluate for conditions that commonly present with failure to thrive:

   • Cystic fibrosis
   • Skeletal dysplasia
   • Congenital conditions 2

3. Delayed intervention: Waiting too long to implement nutritional interventions can lead to long-term consequences affecting growth, behavior, and development 4

4. Insufficient monitoring: Not adjusting nutritional plans based on response to intervention 1

5. Overlooking psychosocial factors: Most cases of failure to thrive involve inadequate caloric intake caused by behavioral or psychosocial issues 3

The key to successful management is early detection and intervention with a targeted nutritional approach that achieves consistent weight gain at rates appropriate for the child's age.