Berkeley Parents Network: Failure To Thrive (Not Gaining Weight)

Berkeley Parents Network

Failure To Thrive (Not Gaining Weight)

Berkeley Parents Network > Advice > Eating > Failure To Thrive

3-year-old not eating enough - gastrostomy tube?
1-year-old not gaining weight
More advice about children not eating

3-year-old not eating enough - gastrostomy tube?

Sept 2005

Hi, I was wondering if any of you parents out there have any experience with gastrostomy tube feeding. We're facing this decision with my 3 yr old son right now because he is not eating enough to grow. I've read a lot on the internet but I'm wondering if anyone has personal experience they can share with me. Thanks

Hi there. I certainly feel for you, it is difficult when your child will not eat- it is hard on you as a parent, as well as your child! Having said that, putting a g-tube in a young child seems pretty extreme unless absolutely, positively nothing else has worked. I work in healthcare daily with adults who mostly all have G-tubes or J-tubes or both, although some have naso- gastric tubes. The insertion of the tube is done as a surgical procedure with anesthesia. Some people recover quickly, while others always have pain at the site. Here is the problem that I see with a young, active child: the g-tube can become infected, or pulled out and then you really have trouble. Even when you are not using it to deliver food directly to the stomach, the tube apparatus is fairly long and dangles around and gets caught in clothing. It also requires maintenance: daily cleaning, and flushing everytime that it is used for food. Sometimes it plugs up for no good reason and requires a physician to look at it.

Sometimes it gets pulled only partway out and needs a physician to look at it. Another problem is that sometimes putting a lot of food directly into the stomach causes bloating, cramping, gassiness and the liquid food itself leads to looser stools.

Also, I have worked with some kids who simply throw up the liquid that you have just put into them. So, it really is not a perfect solution. What has your physician done so far to try and find out why your child is not eating? Does you child gag or cough when eating? Is it certain textures or flavors? Does you child drink liquids alright or seem to have more trouble with those? Has an Ear, Nose, Throat specialist done an exam of your child's mouth, throat, palate? If even one little thing has been identified as questionable, did they do a barium swallow study? Has an x-ray or scan been done of the upper GI tract, especially the esophagus? Has a gastric reflux diagnosis been looked at and ruled out? Does your child complain of pain or any other bad feeling after eating, or throw up often? There are so many things to think about and look at before deciding to put a piece of plastic in a toddler's tummy. And even if this is what you end up needing to do, you still have not gotten to the root of why the child is not eating. At the very least, if you have looked at all of these things and more, they could try a naso- gastric tube for a trial to see if the child tolerates the feedings. That will only work though if your child leaves the tube in (same actually goes for the g-tube which is lightly tacked into the body with stitches.) As the parent, you have to do what you feel will best help your child. But please speak up and ask the Dr. to exhaust all means before turning to this, it is not a perfect solution by any means! My heart goes out to you, this is not an easy decision you are dealing with. healthcare mom

sounds really fishy unless this child has some other problem that is contributing to her not eating. she may just be small for her age. she may be a picky eater, many toddlers eat very little or eat very sporadically infact its the norm for this age group to eat very little several days in a row and then have a decent eating day. unless there is more to this than you actually wrote in the original post I'd at least get another opinion. before you subject this child to surgery and tube feedings. anon

1-year-old not gaining weight

July 2003

My baby is now a year old and still only weighs 17 lbs. She was 16 pounds at 6 months, and has only gained a pound 6 months later. I've been having a lot of difficulty feeding her. When I first started her out on solids (at 5 months), she was a good eater until she hit the 6 month age mark. Since then, she doesn't want to eat no matter what I do or put in front of her. I try to distract her with toys, videos, whatever and slip food into her mouth. The only thing she really likes is oatios and rice chex. I should also mention that she has a ton of food allergies too (that's another topic). She's allergic to dairy, eggs, wheat and nuts. I try to feed her fatty items, such as soy margarine, avocado...sometimes she'll take it, sometimes she just won't open her mouth. Her pediatrician has run about 9 blood tests on her and everything came back normal. He also checked her stools for blood and that came back negative. We're waiting for more tests on whether there may be parasites found in her stool. I'm not sure what else I can do to get food into her. I started feeding her soy formula recently (whatever, to get calories into her). Since she doesn't take the bottle, this has been a slow process as well. Today I managed to get 4 oz of formula into her by giving it to her in a cup. Does any parent out there have any advice you can give me on this. It's been very frustrating, and I'm starting to get really worried. She's very thin and continues to not gain weight. In fact, she's now off the charts in terms of weight for her age. Thanks very much, I really appreciate any help you can prvodice. may

I know it can be frustrating to see your baby slip off the chart. I hate those charts- they should do away with them! 17 pounds does not seem that small for her age.

My son is 17 months old and has been off the chart since he was 10 months old. He now weighs a mere 20 lbs, however, he is very bright and active and he has been hitting all of his developmental milestones right on track. My son is half Filipino and half American (my husband is 6'' where I am only 4'11)I am very petite so part of being small could be in the genes. As long as your daughter is plotting her own chart- it might not be as rapid as you would like but perhaps she might be small by nature (if you and/or your husband are small, also she could just be a small baby but grow to be a bigger person. If your daughter is alert and active and happy then I think this should be your measurement for her.

Still putting genes aside, good nutrition and eating well are very important to a growing baby.My son although not a picky eater, does not eat that much and has no interest in anthing but bread, fruit and yogert. He too did not take to formula from a bottle (he was bf until 13 months) but he does like milk now from a sippy cup. Our doctor recommended putting formula in his foods for more calories. I understand your daugther has food allergies so perhaps the soy formula added into her food might help.

As one small baby mommie once told me, we should be so lucky our babies are easy on our backs and that we can use the Baby Bjorn for awhile while other big babies have busted out! Good luck!
Proud Small Baby Mama

I suggest going to zerotothree.org (professional publication of the National Center for Infants, Toddlers and Families). They have fantastic advice on feeding, (among many other things), such as

Let the child touch the food & eat with fingers.
Talk in a quiet and engaging manner.
Be engaging, but not overwhelming; take care not to overwhelm the 
child with talking or behavior.
When the child is self-feeding, remain present in the situation, 
but don't take over.
Let the child decide how fast to eat.
Let the child decide how much to eat.
Respect the child's food preferences.
Respect the child's caution about new foods.
Remember, all children learn to eat eventually.

this obviously does not address any medical issues your child may have (e.g. allergies), but I hope it helps.

my daughter also weighed 17 pounds at her one year checkup and she has no known food allergies. our doctor said she looked very healthy and attributed it to our being ''petite'' people. I am half chinese on my mother's side and that seems to have dominated her size gene. she is now 2 3/4 and weighes 24 pounds. sometimes I worry when I see the kids she has been around since she was just a wee thing because she is quite tiny in comparison. as long as she remains vivacious and eats decently (many days a frustrating task as she is a very selective diner) I'll just adore her skinny little arms and legs. at least ''uppies'' is still manageable! gael

My kiddo went through a similar phase (no weight gain at ALL from 6-9 months) although he didn't have allergies. I found that the key to improvement was to not get emotional about it, offer frequently, NEVER to force food, and to give him as much finger food as he could eat (ie meatballs, soft apples, etc.). Part of it was a fierce independence. Distraction also helped. I hope some of that helps. He's now a 2 year old and healthy as can be although he'll never be huge (25% ht and 5% wt).
another mom

Have you or your pediatrician thought about oral-motor issues with your child? It is possible that there is something 'mechanical' or sensory going on that makes eating/swallowing, etc. complicated. Sometimes medical doctors don't think of this right away or wait until they have exhausted and out-ruled all medical avenues before they make referrals for this. Pediatric occupational therapists would be the ones to consult about eating and oral-motor issues. Feel free to contact me if you have further questions. Good luck.
Abby

What a challenge you are facing. It really helps to do this with support and I would recommend seeing a pediatric dietitian who can guide you and offer some advice. For example, many young children like waffles and pancakes, they are soft, you can top them with butter. Offer food every 2-3 hours, let the child be in control of the amount, the more you fuss, the less they eat. Read books by Ellen Satter, dietitian and therapist.
R.D.

I can totally relate to your experience. My 21-daughter has been an extremely fussy feeder from the beginning. She refused the bottle from very early on, despite all of my efforts. I had to return to work at month 4, so I started her on solids very early and used the pumped milk in other foods (see below). Even now that we are on a toddler diet, she continues to be extremely picky about her food. She even dislikes the more common kid favorites such as macaroni and cheese and peanut butter and jelly sandwiches. Fortunately, she has no known allergies (though we are vegetarians and our diet may be more restricted in other ways).

Some principles that have helped us survive

1) Make as much of the pureed foods at home as possible, using fresh veggies/fruits. From the beginning, she refused to eat any of the bottled foods but would manage to eat some of the home cooked food.

2) Spice everything. I found that my daughter really likes strongly flavored foods, and through trial and error, I have found her favorite flavors.

3) Keep her on a routine. I found that she would prefer to do anything but eat. (I found it wasn't true that ''she would eat when she was hungry.'') But, with a little vigilance on my part about routines, she has come to expect eating certain things in certain orders at certain times during the day (e.g., breakfast, then fruit, then snack, then milk, etc. all within roughly same time periods each day).

4) Distract her throughout the feeding (I always put her in a highchair so I can control her) with lots of animated discussion, related to either her toys, books, or tv shows on hand. I also make sure no one else is in the room during feeding and that I am not distracted by anything else (such as phone, spouse, etc) b/c she will quickly stop eating.

5) Use sippy cups and glasses for beverage items and mix as much formula/milk into solid foods as possible - b/c my daughter refused the bottle, I trained her to use a sippy cup and then a glass for drinking very early on. Also, while I was at work, all foods served to her (including the fruit purees) until she was regularly drinking soymilk from a glass (see below) would be mixed with some breastmilk so she would get at least a few ounces with the solid feedings.

And, here are some quirky foods that seem to work for her (and are not on your list of allergic foods)

1) Instant oatmeal and quinoa flakes hot cereal (I buy both buld at Whole Foods). I put a sweetener (such as Molasses), spices (cinnamon,nutmeg and cloves) and cook it with a combo of whole milk and water. You can also make it with soymilk.

2) Baby cereal, formula (My daughter likes a particular organic dairy formula I use) and a large banana, all blended together. The consistency is pretty thin and I spoon feed her. Even though she has outgrown these foods, I still feed this to her everyday because she still likes it.

5) Soymilk to drink in glass (she refuses any cow's milk and she only likes Silk Soy, which is fortunately readily available)

6) Superfood Juice from Odwalla (curiously, she seems to really like this and b/c it is very nutritious I try to give her some every day, usually after a vegetable serving).

6) Tofu-based products- She likes tofu products quite a bit, such as baked tofu and veggie dogs . She has been eating thin slices of baked tofu since she was a year old.

7) Dried beans of all kinds (boiled and seasoned with different spices). When she was young, I would puree some boiled rice and different beans together with spices and some breastmilk.

Hope this helps. Good luck and hang in there. While your daughter may not ''grow out of'' her fussiness anytime soon, it will get marginally easier as she grows older b/c there will be a wider variety of foods and food preparation methods available to you. And, while I always worry about my daughter's weight (she too is really low in the charts), the pediatrician has never been worried and says that she is an extremely healthy, curious and physically active child.

mom of an extremely fussy eater

The opinions and statements expressed on this website are those of parents who subscribe to the Berkeley Parents Network. Please see Disclaimer & Usage for information about using content on this website.