Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Related articles

Poor weight gain in children older than two years of age

INTRODUCTION

In most cases, poor weight gain in preschool and school-age children is the consequence of inadequate dietary nutrient intake relative to metabolic and growth needs. 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".)

Nutritional requirements for adolescents and vegetarian children and adolescents are discussed separately. (See "Dietary energy requirements in adolescents" and "Vegetarian diets for children".)

BACKGROUND

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 (NCHS) (figure 1A-B) should be evaluated.

                             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2014. | This topic last updated: Jan 7, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Gahagan S. Failure to thrive: a consequence of undernutrition. Pediatr Rev 2006; 27:e1.
  2. Motil KJ, Phillips SM, Conkin CA. Nutritional Assessment. In: Pediatric Gastrointestinal and Liver Disease. Pathophysiology, Diagnosis, Management, 3rd, Wyllie R, Hyams JS, Kay M (Eds), Elsevier, London 2006. p.1095.
  3. Hassall E. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr 2005; 146:S3.
  4. Rudolph CD, Mazur LJ, Liptak GS, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 2001; 32 Suppl 2:S1.
  5. Acs G, Shulman R, Ng MW, Chussid S. The effect of dental rehabilitation on the body weight of children with early childhood caries. Pediatr Dent 1999; 21:109.
  6. Rogers B. Feeding method and health outcomes of children with cerebral palsy. J Pediatr 2004; 145:S28.
  7. Smith AM, Roux S, Naidoo NT, Venter DJ. Food choice of tactile defensive children. Nutrition 2005; 21:14.
  8. Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food. J Am Diet Assoc 2004; 104:s57.
  9. Slupik RI. Managing adolescents with eating disorders. Int J Fertil Womens Med 1999; 44:125.
  10. Valois S, Rising R, Duro D, et al. Carbohydrate malabsorption may increase daily energy requirements in infants. Nutrition 2003; 19:832.
  11. Chelimsky G, Czinn SJ. Techniques for the evaluation of dyspepsia in children. J Clin Gastroenterol 2001; 33:11.
  12. Kothare SV, Kaleyias J, Mostofi N, et al. Efficacy and safety of zonisamide monotherapy in a cohort of children with epilepsy. Pediatr Neurol 2006; 34:351.
  13. Grosso S, Franzoni E, Iannetti P, et al. Efficacy and safety of topiramate in refractory epilepsy of childhood: long-term follow-up study. J Child Neurol 2005; 20:893.
  14. Swenne I, Thurfjell B. Clinical onset and diagnosis of eating disorders in premenarcheal girls is preceded by inadequate weight gain and growth retardation. Acta Paediatr 2003; 92:1133.
  15. Mofidi S. Nutritional management of pediatric food hypersensitivity. Pediatrics 2003; 111:1645.
  16. Fortunato JE, Scheimann AO. Protein-energy malnutrition and feeding refusal secondary to food allergies. Clin Pediatr (Phila) 2008; 47:496.
  17. Alvares M, Kao L, Mittal V, et al. Misdiagnosed food allergy resulting in severe malnutrition in an infant. Pediatrics 2013; 132:e229.
  18. Moilanen BC. Vegan diets in infants, children, and adolescents. Pediatr Rev 2004; 25:174.
  19. Dunham L, Kollar LM. Vegetarian eating for children and adolescents. J Pediatr Health Care 2006; 20:27.
  20. Block RW, Krebs NF, American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatrics Committee on Nutrition. Failure to thrive as a manifestation of child neglect. Pediatrics 2005; 116:1234.
  21. van der Kuip M, Hoos MB, Forget PP, et al. Energy expenditure in infants with congenital heart disease, including a meta-analysis. Acta Paediatr 2003; 92:921.
  22. Ackerman IL, Karn CA, Denne SC, et al. Total but not resting energy expenditure is increased in infants with ventricular septal defects. Pediatrics 1998; 102:1172.
  23. Bauer J, Maier K, Muehlbauer B, et al. Energy expenditure and plasma catecholamines in preterm infants with mild chronic lung disease. Early Hum Dev 2003; 72:147.
  24. Lin YJ, Lee PC, Meng CC, Hwang B. Cor triatriatum with repeated episodes of syncope in an eighteen month-old girl: a rare cause of cardiogenic syncope. Int Heart J 2005; 46:915.
  25. Mantzoros CS, Rosen HN, Greenspan SL, et al. Short-term hyperthyroidism has no effect on leptin levels in man. J Clin Endocrinol Metab 1997; 82:497.
  26. Marcus CL, Carroll JL, Koerner CB, et al. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr 1994; 125:556.
  27. Bonuck KA, Freeman K, Henderson J. Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis. Arch Dis Child 2009; 94:83.
  28. Pillai MG, Unnikrishnan AG, Nair V, et al. Diencephalic cachexia: a rare cause for failure to thrive. J Pediatr 2005; 147:713.
  29. Fleischman A, Brue C, Poussaint TY, et al. Diencephalic syndrome: a cause of failure to thrive and a model of partial growth hormone resistance. Pediatrics 2005; 115:e742.
  30. Vlachopapadopoulou E, Tracey KJ, Capella M, et al. Increased energy expenditure in a patient with diencephalic syndrome. J Pediatr 1993; 122:922.
  31. Ahme ML, Ong KK, Thomson AH, Dunger DB. Reduced gains in fat and fat-free mass, and elevated leptin levels in children and adolescents with cystic fibrosis. Acta Paediatr 2004; 93:1185.
  32. Kumahara H, Tanaka H, Schutz Y. Daily physical activity assessment: what is the importance of upper limb movements vs whole body movements? Int J Obes Relat Metab Disord 2004; 28:1105.
  33. Spady DW, Payne PR, Picou D, Waterlow JC. Energy balance during recovery from malnutrition. Am J Clin Nutr 1976; 29:1073.
  34. Zangen T, Ciarla C, Zangen S, et al. Gastrointestinal motility and sensory abnormalities may contribute to food refusal in medically fragile toddlers. J Pediatr Gastroenterol Nutr 2003; 37:287.
  35. Reilly S, Skuse D, Poblete X. Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey. J Pediatr 1996; 129:877.
  36. Levy Y, Levy A, Zangen T, et al. Diagnostic clues for identification of nonorganic vs organic causes of food refusal and poor feeding. J Pediatr Gastroenterol Nutr 2009; 48:355.
  37. Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics 2010; 126:e26.
  38. Kleinman RE, Murphy JM, Wieneke KM, et al. Use of a single-question screening tool to detect hunger in families attending a neighborhood health center. Ambul Pediatr 2007; 7:278.
  39. Hardin DS, Rice J, Ahn C, et al. Growth hormone treatment enhances nutrition and growth in children with cystic fibrosis receiving enteral nutrition. J Pediatr 2005; 146:324.
  40. Moy L, Levine J. Capsule endoscopy in the evaluation of patients with unexplained growth failure. J Pediatr Gastroenterol Nutr 2009; 48:647.
  41. Pelletier DL, Low JW, Johnson FC, Msukwa LA. Child anthropometry and mortality in Malawi: testing for effect modification by age and length of follow-up and confounding by socioeconomic factors. J Nutr 1994; 124:2082S.
  42. Collins S. The limit of human adaptation to starvation. Nat Med 1995; 1:810.