Poor weight gain in children older than two years of age
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
In most cases, poor weight gain in preschool and school-age children is the consequence of inadequate dietary nutrient intake relative to typical needs for metabolism and growth. In other cases, poor weight gain is related to increased metabolic requirements secondary to an underlying disease state, or a combination of these factors. The challenge for the child's clinician is to determine if inadequate dietary intake is the result of an underlying medical problem (organic disease), environmental or psychosocial problems, or a combination of these factors.
This topic will discuss the etiology and approach to poor weight gain in children older than two years. Poor weight gain in children younger than two years and short stature are discussed separately. (See "Failure to thrive (undernutrition) in children younger than two years: Etiology and evaluation" and "Failure to thrive (undernutrition) in children younger than two years: Management" and "Causes of short stature" and "Diagnostic approach to children and adolescents with short stature".)
Weight gain follows a predictable course from infancy through adolescence. Height and weight should be assessed routinely and compared with antecedent measurements.
Whenever significant voluntary or involuntary weight loss occurs as described below, or when the rate of weight gain varies from the previously established pattern, there is cause for concern. Any deviation in the pattern of weight gain, when compared with the standardized growth curves from the National Center for Health Statistics (figure 1A-B) should be evaluated. (See "Measurement of growth in children".)
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- Limited or inappropriate intake
- Increased needs
- Increased losses
- Energy cost of growth
- DIAGNOSTIC APPROACH
- - Present illness
- - Diet history
- - Past history
- - Social history
- - Family history
- - Review of systems
- Physical examination
- - Growth parameters
- - General examination
- Diagnostic evaluation
- - Initial tests
- - Additional tests
- - Advanced tests
- Indications for hospitalization
- Dietary intervention
- Indications for referral
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS