Treatment of children with slow weight gain part 2

Post by Doctor Ho Thi Anh Thu - Neonatologist - Neonatology Department at Vinmec Nha Trang International General Hospital

The goal of treating a child with delayed weight gain is to provide the child with adequate nutrition to "catch up" to a normal weight. To do this, parents need to change the child's diet, feeding schedule or nurturing environment. Carers and doctors work together to develop a plan that meets the needs of both the child and the family.

Most children with mild to moderate malnutrition can be managed at home with the help of the child care team and, in some cases, the coordination of different specialties (e.g. nutritionist) caregivers, speech therapists, social workers, nurses, pediatricians, early behavioral intervention specialists, child care workers, psychiatrists).
Children who are severely malnourished often need to be hospitalized. While in the hospital, a child's diet and weight can be closely monitored.

Nutrition therapy is the mainstay of treatment for children with poor weight gain. The goal of nutrition therapy is to help a child "catch up" with weight gain, which is often two to three times the normal rate of weight gain for the child's age. The best way to calculate servings (measured in calories) depends on the child's age and nutritional status, individual recommendations should be determined by the child's clinician or health care nutritionist . In some cases, a multivitamin supplement may be recommended.
For infants the energy in breast milk can be increased by pumping breast milk, adding a predetermined amount of powdered formula or liquid concentrate. This combination is called fortified breast milk. For infant safety, this treatment should be performed under the supervision of a clinician or healthcare nutritionist.
The number of calories in infant formula can be increased by adding less water to the powder or liquid concentrate or by adding a calorie supplement, such as maltodextrin or corn oil. For the safety of infants, the treatment of children with delayed weight gain should be done under the supervision of a healthcare practitioner or dietitian.
Milk of plant origin (e.g. soy, almond, rice, coconut, etc.) is not suitable for infants. With the exception of soy infant formula, plant-based milk is deficient in protein, calcium, vitamin D, and other nutrients.
Newborns 0 to 4 months need frequent feeds, usually 8 to 12 times a day, older babies usually feed about 4 to 6 times a day. In older children, dietary energy intake (measured in calories) can be increased by adding rice cereal or formula powder to pureed foods.
For older children, dietary calories (in calories) can be increased by adding cheese, butter or sour cream to vegetables, or by using high-calorie milk drinks instead of whole milk.
Milk alternatives for poor weight gainers who cannot tolerate dairy (i.e. milk from animals, usually cows and goats). Dairy colostrum alternatives are not "dairy," but extracts from plant sources. Popular milk alternatives include soy, almond, rice, coconut, and hemp milk. Dairy alternatives include quinoa, oats, potato, and mixed-grain milk. Soy milk has the nutritional composition closest to cow's milk. It is often fortified with calcium and vitamin D. Other plant-based milks are generally lower in protein, calcium, vitamin D and energy than cow's milk or soy milk. They also lack other vitamins, minerals and fatty acids found in cow's milk. If milk replacer is needed for a child with poor weight gain, then an appropriate milk substitute must be selected to provide the missing nutrients.

Yogurt is a nutritious option for treating slow weight gain, but it's important to read the nutrition facts label to make sure it's high in calories, protein, and calcium. More and more yogurt products are available and the nutritional composition is very different. Greek yogurt is a good choice because it can contain twice as much protein and calories as regular yogurt. Low-fat and fat-free yogurt should be avoided.
During catch-up growth, the amount of energy (measured in calories) and protein a child eats is more important than the variety of foods. For example, if a child is willing to eat chicken and pizza, but refuses all vegetables, this is acceptable. At meals and snacks, give your child solid foods before liquid foods. Fruit juices should be limited to less than 120ml of 100% unsweetened fruit juice per day.
Older children should eat often (every two to three hours, but not constantly). Children should eat three meals and three snacks on a consistent schedule. Snacks should be timed so that children don't lose their appetite (e.g. snack time shouldn't take place within an hour of a meal, snacks shouldn't be offered right after the main meal). not finished eating). Examples of healthy snacks include crackers, peanut butter, cheese, hard-boiled eggs, pudding, yogurt, fresh fruit or vegetables, or cookies. In some cases, a multivitamin and mineral supplement may be recommended.

Changes to the area where the child eats can help the child eat more. All members of the child's family should be aware of the importance of these changes.
The child should be placed in a position where the neck is steady and the child is comfortable. Children must be allowed to feed themselves (eg, holding a bottle or eating food with their fingers) but soft foods can be offered with a spoon. There will be some confusion as the child learns to feed himself. Distractions during mealtime should be minimized, such as television, phones, and music. Make mealtimes consistent, no matter who feeds your baby. Mealtimes should be relaxed and social, encouraging eating with other family members and fun conversation (regardless of how much the child eats). Eating with others allows the child to observe how others make food choices, which will hopefully encourage healthy eating habits. Don't be discouraged if your child refuses a new food. New foods may need to be offered several times (even up to 10 or more) before they are accepted. For children with rigid behavior (such as children with autism), new foods may need to be presented up to 30 times before the child accepts them. Mealtimes should not be scrambled to eat, caregivers should encourage, but not force children to eat, food should not be viewed as a punishment. Also, food should not be offered as a reward. You should praise children when they eat well, but not punish them when they don't eat. In some cases, the treatment of children with delayed weight gain may require the use of medication. Children with underlying medical conditions that limit weight gain are usually managed by a clinician (eg, pediatrician, family physician). Occasionally, a specialist may need to be consulted (e.g., allergist/immunologist for children with food allergies, gastroenterologist for children with GERD, or a specialist in gastroesophageal reflux disease). nutritionist for nutritional guidance). These specialists can provide guidance on the need to eliminate certain food allergies. Foods and food groups (eg, dairy products) should not be eliminated without a doctor's advice as this can further increase a child's risk of malnutrition.

Malnourished children are at risk for complications, including an increased risk of common infections. Common infection prevention methods, such as washing hands and avoiding contact with sick friends or family, are recommended. However, it is not usually necessary to take additional precautions (for example, by preventing the child from attending school). Children need to continue to be vaccinated on schedule.

Developmental and behavioral problems can increase a child's risk of low birth weight. For example, children who have difficulty chewing or swallowing food may not consume adequate amounts of food. In the United States, early intervention programs can provide developmental stimulation when needed. Some children also benefit from seeing a developmental behavioral pediatrician or behavioral psychologist for additional support. These clinicians have specialized training in the medical, psychological, and social aspects of behavioral and developmental problems in children.
Psychosocial problems , in some situations, poor weight gain in children is related to problems in the family, such as not having enough food in the home, caregivers' concerns about feeding certain foods (eg, fatty foods), or medical or psychiatric problems in caregivers (eg, alcohol/drug abuse).
In these situations, treatment includes measures to improve the home condition, ensure that there is enough food for all family members, and educate caregivers about the importance of nutrition. full maintenance.
Children with low birth weight are often examined by a doctor periodically after starting treatment, the frequency of visits (weekly to monthly) depends on each child's condition. During these visits, the child will be weighed and measured, and the clinician will talk to the caregiver (and the child, if applicable) about any questions or concerns. These regular visits are usually continued until the baby's weight is near normal and is steadily increasing. If the child is able to absorb enough calories, the catch-up weight gain is usually complete within three to six months.
Many caregivers wonder how poor weight gain affects a child's adult height and weight. The size of a child as an adult depends on several factors, including genetics, the age at which the child was underweight (for example, heavier as a toddler), severity weight and duration of malnutrition, comorbidities and weight gain after intervention.
When you know how to treat slow weight gain, parents can consult and consider to adjust their diet, activities, and lifestyle so that the child can develop to the fullest extent.
Currently, Vinmec International General Hospital is one of the few hospitals with a full range of pediatric specialties, able to perform general examinations in conjunction with a nutritionist to help build a menu for each patient. children, advice on living regimens and treatment directions suitable for each child's condition. All examination procedures at Vinmec are always performed by a team of doctors and experts with many years of experience. Therefore, parents can be assured of the quality of medical care at Vinmec.