Failure to Thrive

Kids grow on their own, and in their own size, I can't believe the NP would say that, but if you know she's health, happy and eating, that's all that's to it, some kids are just skinny, just like some kids are plump!
I say, you just keep doing what you're doing, she's still alive, so you're doing something well! ;-)

Hi Stephanie,

I've been through precisely what you're describing here. At just about the same age, weighing also about the same as your daughter, my (no-longer seen) nurse practioner said all the same things about my daughter. From birth she had been in the 85th percentile for height & between 17 & 25 percent for weight, so I never did figure out why at 18 months they decided it was a problem.

The told me to basically force feed her what I felt was junk (hot dogs, macaroni & cheese, ice cream, etc.) to make her gain weight & bring her back once a month for weigh-ins for 3 months. I did exactly what the told me for the next very expensive & time-consuming months spent on buying, preparing & begging my daughter to eat way more than she wanted or needed. At the end of the 3 months, she had gained 3 ounces so then they decided that she was just skinny.

She's almost 7 years old now & is still tall & skinny for her age though she's beginning to fill out a little bit these days. I'm assuming that your doctor is just taking some precautions in your daughter's case, as they did in mine. While I understand that you must feel almost insulted that anyone would ever treat you like you might be starving your own child, the fact of the matter is that there are actually people like that out there & they need to make sure for your daughter that you (or your day-care provider) aren't one of them.

I wouldn't worry too much about it, you know your child & if you feel like she's developing normally & isn't tired or groggy from being hungry & seems to eat a normal amount of food at set times during the day, then she's probably just got a really high metabolism. I wish I had that problem! Did the NP tell you to make the appointment with a nutrionist? If not, that might be a little premature as when you go in for your follow-up appointment, the pediatrician will probably tell you not to worry about it. Keep your head up & be thankful that your daughter has such a nice fast metabolism!

Dear Stephanie,
I have been raising my Grandson for 8 years and 7 months now and he has been diagnoised with Non-Organic Failure to Thrive...
He only weighed 19 pounds when I went to court and got Legal Guardianship of him at 20 months of age... I had to take him to the doctors for weight checks weekly and had to keep a log of everything ate or drank plus his diaper changes... It was a nightmare ...
See if your Doctor will prescribe Pediasure for your child to help with the problem...
Don't be upset hon, sometimes children just need a little help... My grandson is now 10 yrears and 2 months old and he is doing really good, he's a lil small for his age but, he runs circles around everyone...
Good Luck Kid,
H. W.

Hi Stephanie- PLEASE don't let that NP bother you! Would your daughter be able to count and play if she were starving?? No. Just go to your regular pediatrician and see what they have to say. Some babies are just smaller!
I can totally see why that upset you though!!

Hey Stephanie,
I think I met your husband in the prescription line at Wal-Mart today. No joke. If not, then there is someone else out there with the same problem you have. I was a tiny little person my whole life (now, average, but I'm all "grown up" with two kids so that's to be expected). Maybe they weren't so concerned back when we were kids, but I can't imagine I would have been tagged for "failure to thrive". It sounds like you are taking great care of your little girl and looking into all possible options for her little weight gain. I too have a little girl who was very verbal and smart (but plenty large) so I completely believe that yours does all the things you say she does. I say if she's growing on some kind of consisten scale and acting/developing properly, then she's just little right now. (a layperson's opinion) I did go to high school with someone who was as skinny as anyone I've ever seen and not anorexic or bulemic or anything. She was tall, but her brother fairly average height, and they both had crazy fast metabolisms. She played on the girl's basketball team and certainly ate her fair share, but, at the end of every day, she was hardly more than skin, muscle and bones. This may not be the case with your little girl, but I think a cautious, measured approach to her size is the best - and it sounds like you're doing it. Let us all know what you find out along the way, and good luck!

Some kids are naturally thin. My son was maybe 21 pounds at that age and in the 75th percentile for height. He kept growing and thinning out. He also gained muscle. Looking at him, it was obvious he was thriving, he was just thin. His father was also very thin growing up. I wasn't that big myself.

I wouldn't worry about it.

We also had the diagnosis of failure to thrive for our now 22 month old son. He only gained 4 oz from age 6 months to 9 months and grew only 1/4". They tested him from here to UVA (we saw a pediatric endocrinologist). All the tests determined that absolutely nothing was wrong with him. His height is now on the chart and he's right on the line to be on the chart for his weight. I'm nervous about his 2 yr appt, but hopeful that he will show weight and height gain. He was and is a great eater and developmentally he is fine.

My advice is to find a pediatrician that will LISTEN to you. My son had very obvious stomach issues (very frequent poppy diapers and excessive gas) but no one attributed that to his growth issues.

At this point they think that one of the nurses in the pediatrician's office measured his hieght incorrectly.

Also, if your daughter is exclusively breastfed then there is a growth chart online specfically for breastfed babies since they tend to be smaller.

I know that it is scary when something isn't right with your child. And, yes, failure to thrive gives an implication of negligence on our part, at least I too felt that way. Bottom line for me....my son is happy, developmentally his is great, he eats, he drinks, he has wet and dirty diapers consistenly so, I'm not concerned. He's simply a little guy.

He's been poked and proded and nothing is medically wrong. I do reccommend testing just in case there is an issue, but DON'T LET ANYONE MAKE YOU FEEL THAT YOU ARE AT FAULT!! Find a pediatrician that is your PARTNER!!! not someone that is blaming you for things that you cannot control!! It took us 4 doctors until we found one that listens and actually looks us in the eye and is committed to our child's health and well being.

Hang in there!!! Good luck!

OH...also, I kept a food journal of everything & how much of it that my son ate every day for 2 weeks. That should help with the gastro appt & it may show an allergy, if one exists.

Actually. no. However, I have a 5 year old son that doesn't eat very well and is very thin> I've had concerns about him and his pediatrician says that as long as he is active, not sickly, learning in school, and not complaining about not feelin well, then I shouuld not worry. He will eventually eat. My opinion, maybe your little girl is just going to be on the petite side. I have even bought my son some pedia-sure. He loves it. I believe that she will be fine. Keep you appointment at Hopkins though. The best to you and your family and let me know what they say a Hopkins, it may help me also. Have a blessed Holiday season and prosperous new year.

I am a nurse (not in Peds, but in L&D) and I just want to assure you that I believe everything I have learned about "failure to thrive" does not reflect parenting skills - it is just a reason to figure out if there is anything going on physically to impede growth. Certainly if there are any suspicions about the home environment that would be taken into consideration, but personally I know a couple of people whose children have had that and they were perfectly capable and caring parents. My one friend had to supplement with Ensure for a while and that helped (not sure for the reason ofr his not gaining weight) and I think the other one had Celiac disease?? I am sorry I can't recall.

If you are uncomfortable with that NP than there are plenty of other people to see and you are doing the right thing with your follow ups. It is hard not to take things personally when it involves our children, but medical terminology is somewhat abrasive (so many patients I have labelled "failure to progress" making them feel like there is something wrong with their bodies!), so if something upsets you just ask questions - to more than one person because some bedside manners are also abrasive! :)

My daughter had some problems gaining weight as well. She wasn't quite as small. She was about a year when she weighed in at about 18 pounds but she had fallen off of her growth curve. I hated going to the dr to get her weighed. I wanted her to gain weight so badly. She was happy and active as well. I don't think you have anything to worry about. My daughter is 6 now and still small but very healthy. If you feel uncomfortable with the nurse practitioner, I would not see her anymore. You might want to try a different dr's office even. Your daughter is obviously thriving!!! Good luck!

Doctors need to put a "diagnosis" so that the INSURANCE company will pay for your childs tests. Failure to Thrive is a code the insurance company will accept. We had that with my breatfeed daughter, and I agree it annoyed me as well. But I would agree to see your doctor if you are not happy with the NP. You should nmot have to deal with any health professional who is not treating you well or being condesending. Go in with a list of questions, and don't leave the office to you have them answered!!
Best of luck,
K.

I can certainly understand where your anger is coming from. I don't know you but I am sure from your posting that you do your best and that is the best anyone can do. I myself would be upset if I were in your shoes. My advice is go with your instinct. If she eats, plays, is very smart, then she may just have a very high metabolism. To be honest I wouldn't worry. I have had many friends with children older than yours that weigh less, and are not as smart as she is. She sounds to me like she is probably ok. If she wasn't eating and at least growing in height then you should really worry. At least she is growing in height, it could be the other way around. You are right to take her to the specialists but just remember she was only a NP not a Dr. So don't take it to heart. You're probably fine.

Hi Stephanie, I know exactly what you are going through. My son had just turned 1, recently started walking and had also just switched to strictly table food. So there was a lot of changes in a short period. At his check up the nurse practioner was very rude and very vocal about how she thought I was not feeding him enough. She told me I "had" to go and see a nutrionalist. So we saw the nutrionalist. She was very nice and said his weight was concern, but not a big one and she gave us tips to get his weight up. One of the things that I think really helped, was adding Carnation powdered milk to his sippy cups of milk. It is all about the calorie intake. She also said adding extra butter to things that you cook for them. We did little tricks like that, and within 2 months he was at a "normal" weight! Good luck, and try not to take your NP comments to heart. She needs to be on the lookout for stuff like this. Continue being a caring, good mommy and everything will work itself out.

Sorry, clicked "Send" twice by mistake.

Is the nurse practitioner Jeanne Miller at TCA in NOrfolk? She did that to my daughter as well. She just turned two and is barely 30 lbs! If she is eating and is happy and healthy so be it. If there was a problem you would know it.

A very similar situation happened with my daughter at the same age. My Pediatrician recommended that I give her Pediasure. At her 3 year checkup the Dr. said to wean her off of it. And she is now a 4 1/2 year old who is growing like a weed. Just remember that you can bring a horse to water, but you can't make them drink. Never once was I accused or insinuations made that I was neglecting my daughter. Just make sure to make every effort to help your daughter get back on track. Making an appointment with the pediatrician and the Hopkins doctor is great because you can get a second opinion, plus it shows that you are a very caring mother. Please don't worry to much about it, obviously she is very happy and that is a good thing.

I would have been very annoyed, but after working in a pediatric clinic, you realize you never know what to think or believe. I actually had some issues with my son when he younger, he was getting very tall and not gaining weight to keep up with that, my pediatrician told me to try to feed him more snacks throughout the day, ones with a lot of protein and they followed-up, as long as he didn't show any other signs of malnutrition they weren't concerned. I would mention your concerns with the NP to the pediatrician. Tell him/her that you know your daughter is eating and is otherwise healthy, so you're wondering why you were given a failure to thrive diagnosis? Also, realize that sometimes that is just that a diagnosis, they're ordering blood work and urine test to see if there is a problem so your daughter isn't getting the nutrients from the food she's eating, which is a medical condition and not a product of your ability to care for her. I want to reiterate that you should tell your pediatrician that you didn't appreciate how the NP made you feel, you understand there is a problem, that's why you're there, but that you're doing everything that you can and are willing to do whatever they think is necessary to make sure your daughter is thriving. Good luck and I hope your doctor can make you feel better about the great job your doing!!

Hi

I understand what you are going through too.-- My middle son, from 6 to 9 months, didn't gain any weight or grow at all. In addition to the things you mentioned, my son's Dr ordered a complete set of xrays to check ALL of his growth plates too. Everything came back normal and although he is still small compared to the other boys, in every other way he is a normal, healthy and very active 13 yr old.

Go ahead and get all the tests they recommend and make sure that all the of the results of these tests are included in your child's record. This will give you peace of mind in the long run and show that you have you child's best interests at heart.

Look into the option of changing your Dr or at least use a different NP and tell the Dr why you don't want that NP to see your child again. He/She may not be fully aware of the NP's behavior and deserves a chance to correct staff problems as it will cost his practice in the long run. While the NP's questions were appropriate as they need to assess all possibilities, her demeanor was totally unprofessional.

Stephanie,
Don't worry. If your daughter is eating healthy and is active (she's obviously not lethargic) I wouldn't worry about it. I have often seen my children go through growth spurts, sometimes in length, sometimes in width. People who make a big issue of what is "standard" size are causing anxiety and guilt which is unneccesary. Don't coax or bribe your child to eat any more that she feels she needs or that could cause more problems (e.g. eating disorders).

I would say don't worry about it! Find a new Dr. even! My children are 2 and 3 and JUST hit 20lbs... Both Dh and I were very small children are small enough as adults... My Dh's older daughter is 10 and she just barely is at 50Lbs!!! All the kids are very thin and quite tall.... My two have been following their own curves, but no where near the ones on the charts!!! I say long as you know your child is eating well, is active, and learning then she is fine!
As for teh failure to thrive... Its just a label marked for ins. purposes! I know it sounds harsh, but if you want your ins. to pay then thats what you have to deal with... I know because I felt the exact same way!!

Thats unbelievable. She should have discussed her "diagnoses" with you first. I would suggest trying to get that off her medical record because you never know with insurance companies if that would ever limit her care. I know that seems crazy but you never know. I also have a little boy who has always been tall and skinny, not thin but skinny. He has been the same weight for about the past year but has grown many inches. Also be aware that the leading cause for obesity and diabetes in children today is over eating. If you force feed your kid there stomach get used to that feeling and there brains start not being able to tell them when there full. Trust your instincts, you know best if she's healthy or not. Don't let anyone, even the almighty doctors tell you differently.

I have never heard that term given to a child of that age. I truly disagree with that term regarding your daughter, especially one that is active. It doesn't make sense. I am 8 months pregnant with my 4th child. I have a 7 yr. old son, a 5 yr old son, and a 2 1/2 yr old daughter. My middle child, Grant, is 5 and weighs 32 lbs. My daughter is 2 1/2 and weighs 32 lbs. Grant has some height above her, but is wearing the same size clothes as his sister (she's going to be an amazon!). He has always been low on the charts. At one point he was NEGATIVE! They put him at 1% so I wouldn't cry! He and his baby sister were born at the same weight (6lb. 5 oz), he's just little. He has always had a great appetite and I was always very careful about what he ate so that it was all good fat and carbs, used PediaSure once a day, and made sure he was eating snacks as well as his 3 square meals. Grant didn't make it to 10% on the chart until he was 3 1/2..... and he's FINE. As long as your daughter is thriving in all other aspects of life (learning, laughing, moving) she is fine. She is just "lite" - we refer to Grant as bird bones. :-) If you were to pick up Grant and his sister (even though they weigh the same)you would swear she weighs more!

When your daughter eats, make sure there are very few empty carbs (potato chips, too many cookies, etc). My pediatricians used to joke saying "give him cake!". However, Grant - actually none of my kids - liked foods like cake, or ice cream or doughnuts or potato chips, etc. until just very recently. When she has meats let her dip it in Ranch dressing. When she has spaghetti/pasta but a pat of butter on to melt before you put anything else on it. Good fats everywhere. If there isn't a peanut allergy when she's old enough peanut butter on everything. Breads (banana/pumpkin/etc) for snacks with cream cheese on it or spread margarine (or make the breads into muffins). She doesn't have to eat badly (cakes, candy, etc) just pad the food when you can with foods/dressings here and there. The PediaSure I highly recommend - 240 calories in a can!

I would request that you don't see the NP again. She sounds overractive. If it puts your mind and heart at ease then follow through the Gast. specialist.

I spent the first 2 years of Grant's life worrying there was something seriously wrong. However, the pediatricians never saw anything "wrong" (he's incredibly bright, very active, ec) so they would just keep encouraging how I was feeding him. We have a new set of ped's because we moved last week and I was ready at his 5 yr. check up for a whole new round of "he's small - does he eat." Instead, the Dr. looked at him, asked him questions, looked at his small hands and feet looked at me and said "you know he'll be small? He'll grow in his own time. He's fine."

She'll be fine. Just like all little birds are. :-)

The same thing happened with my daughter who will be 3 in two weeks. She weighed about 16 pounds at one year. I can't remember exactly what she weighed at 18 months, but she has been 24 pounds for almost a year now. (I am wondering what they will say at her 3 year check-up.) Like you said about yours, she is smart, healthy, a good eater, and very active. She has always been in the less than 5th percentile for weight and average in height and head. I would NOT worry! Some people are just petite. If you are uncomfortable with your pediatrician group, you can always switch practices. That's what I did when the NP made me feel awful about my daughter's weight. I have a feeling you are seeing the same doctors that I was. I have been very happy with the change.

Hi Stephanie, Don't be upset, the medical profession looks for problems sometimes. They get all bent if your baby is too chunky or gains too much then they go the opposite way if they don't gain enough. Take this for what it is, if she's eating well and pooping/peeing well (input is output) and the stool isn't runny or like concrete, if she's keeping it all down and can burp and pass gas and she appears happy and not complaining of tummy aches or the like or lethargy, why couldn't your daughter just be burning off as much calories as she's consuming? Afterall, she's 18 months! This begins the stage of what I call "high octane" where you can't keep a baby down. I'd get all the tests and stuff done just to rule it out but no one knows their baby better than the mommy. She may be a tall and skinny girl.
D.

Hi Stephanie,

I wouldn't worry too much, since it was only since August that she gained 3 ounces. However, one of the most common causes of failure to thrive in children is malabsorption due to pancreatic insufficiency from Cystic Fibrosis. Your daughter sounds healthy, but if she does not show some progress, they will probably want to test her. I have a daughter with CF, and that is how she was diagnosed. You can read more here:

http://www.cff.org/AboutCF/

Hi! My son, too, has always struggled with weight gain. He is 4 now and finally made it onto the growth curve (at 5%)...he's always been way below the curve. Anyway, we did a ton of tests, too, under the diagnosis of failure to thrive (FTT). FTT is NOT an implication for neglect...it's a diagnosis that implies a child is unable to gain adequate weight...whether it's due to lack of intake or inability to retain or utilize calories...it is also necessary to write a diagnosis on the lab work in order for insurances to cover the tests. You are definitely on the right track seeing a gastroenterologist and nutritionist. Good Luck with everything.

Hi Stephanie,

I am sorry you are going through this. I went through this when my dd was 6 months old. She too was marked "failure to thrive." I couldn't understand why. We got blood tests done twice and they revealed nothing. I kept a food journal for 3 weeks and my doctor couldn't believe how much my daughter ate. He said she actually ate more than other children, yet they never figure out what was wrong. They mark kids failure to thrive when there is no other medical reason for weight loss or lack of weight gain. It does not mean you are neglecting your daughter by any means. It sounds like that Nurse practioner has some bedside manner issues. I wouldn't schedule my appts. with her anymore either. Just to let you know, my dd is now 3 1/2 yrs old and is perfectly healthy. Also, I have known at least 2 other moms that have dealt with the same issue with their girls and 1 other mom who has dealt with this with her son. All of the children are now 3 1/2 and all are healthy with nothing wrong with them. Sometimes their metabolism is so fast that they just can't keep weight on, especially at that age when they are so mobile. Anyway, please know that you are doing nothing wrong and that you are not the only person who has ever dealt with this. Maybe you want to keep a food journal just to give the doctor an idea of what she does eat so they will have it for her records. In the meantime, enjoy your healthy daughter!

Take care,
D.

My daughter is now 20 months old and is just now catching up with her weight. She has always been on the thin side. If I were you I would find another Dr or NP. She should have talked to you about her concerns instead of judgeing you. You know your daughter best, and I think you would have realized if something was off with her. She is probably just going to be tiny. But as long as she is eating and acting ok I wouldn't worry too much about it. I would find another Dr and get another professional opionion though just to be safe. Sometimes it takes a little hunting before you find a Dr that you like. Good luck!

Failure to thrive is the medical term for any child that fails to gain the expected amount in the given time-frame and does not always imply neglect. It sounds like the NP is doing a work-up to make sure there is nothing wrong with your daughter metabolically (better safe than sorry). How has her growth been until now? She sounds advanced in terms of development and overall healthy which doesn't happen when you've been neglected. It's important to ensure that intake is adequate when someone isn't meeting growth milestones before looking for more ominous problems (celiac disease being something that strikes once solids are introduced for example), so I wouldn't take that question personally about the caretaker. It would be helpful to try to quantify exactly how much she is eating over about 3 days (make a list of everything she puts in her mouth whether it's food or drink and the amount she actually swallows) to take with you when you return to the doctor.

If you live in the Richmond area, there is a great pediatric gastro specialist, Dr. Ted Williams, at St. Mary's Hospital. Try to ask your pediatrician to push for an appointment since he is very busy. I would try this first since JH is so far away and follow up medical care at a distant hospital is difficult ( we have been there). Good luck! W.

Just thought I might give a quick response, that I was very underweight all growing up...really until I got pregnant with my first daughter! We would have those fat check tests where they pinch the extra skin on your arms in school, and would always be sent home with notes of urgency that I was too underweight. I was made to quite any sports I wanted to join because after the first two weeks I lost too much weight, and according to doc and mom, I couldn't afford to do so. Every appointment I ever had, my mom was always asked if I was skinny because I wanted to be...or if that is how I was. Even though everyone around me was always concerned I was too skinny, I felt fine. I ate when I was hungry, and probably even ate more junk food than I needed! I just had a good metabolism I think. So just keep that in mind, that if your child is underweight, I think it would be good if your doc does perscribe something that would aide your child if needed, but most likely your child is doing fine. I am now almost 30, have a little more weight on me now after having 2 kids...and am about average now. I have never felt like I was deprived of any kind of food...was never hungry or starving. I even went to college! Like someone else mentioned...people are just different. There are people, and kids, on both ends of the spectrum.
K.

Go with your instinct! I once had another mom suggest to other moms (behind my back) that my son was autistic. Because, at two, he would not sit on her cute little rug and read flash cards!!!! He is completely normal. I have two daughters. One is tall and thin, the other shorter and "rounder". Each child is different. Yes, make sure she is getting appropriate care during the day but it doesn't sound as though she is "failure to thrive". My son is three and weighs approx. 33 pounds. Good luck and find a new pediatric practice.

Stephanie, I think you may want to consider a new Dr. or Ped's office. It sounds like your NP is showing no compassion towards you and your concerns. By no means, does this mean that you are a bad mother. Your little one sounds very active and may be expending a lot more calories than her little body can take in. I think that Hopkins can give you a better understanding and insight as to what to feed her in order to get some more calories in her. My philosophy is go with your gut....if you feel she is thriving, happy, meeting milestones and seems to be a healthy and content baby, then try not to worry too much. Just the fact that you are concerned over this makes you an awesome mom! Best wishes to you and your beautiful baby girl. You'll look back when she's 10 and wonder what the worry was all about..:-)

Don't let what the NP wrote get to you. She may have had a bad attitude, but "failure to thrive" has nothing to do with neglect, it simply means that your daughter is not gaining weight at a rate that is expected. She may simply have a high metabolism. It's good that you are getting a gastroenterologist involved though to be safe, there are some disorders that kids have that don't allow their body to absorb the nutrients or fats that they need. It may take some tests, but you will see that the doctors will figure out what is wrong, and the last thing that they will suspect is neglect!

Failure to thrive is a medical term that means the child is not gaining weight and is low on the growth chart curve or has a sudden drop on the curve and they don't know why. It is not meant as a reflection of your parenting or to imply any neglect. Whenever you have to have lab work done, you need a diagnosis code to explain why you are having it done. If your NP put down a routine well child diagnosis, your insurance company would probably not pay for the tests (mine wouldn't even pay for a routine CBC with a well child diagnosis code).

Some kids are just smaller than others and if she is eating well, I wouldn't be that concerned. But if you are concerned, I think that Kennedy Kreiger Institute in this area has a clinic that deals with kids that need to put on weight. They had an article in the paper recently, and it talked about things like pediasure, using butter for extra calories, etc.

Good luck, and find a new MD/NP. It sounds like this one just isn't meeting your needs.

I can totally understand you frustration. I can't say this has ever happened to me because my 19 month old weighs 25 lbs and my son has always been hefty. But I am a pediatric occupational therapist that has often worked with kids and families that get this diagnosis. First I want you to say even though you might think it implies neglect that is NOT what it means!!! Yes, it can happen from neglect, but on MANY cases does not. I also have to say sorry that the NP did not explain this to you before handing you the paperwork!!! That was not right! But many healthy kids that are feed well sometimes get this diagnosis. She is probably getting this diagnosis because her growth curve is not appropriately going up. This does NOT mean it is your fault! Kids can also get this diagnosis if their hight for weight is not proportionate, so if she is in the 95% for height and the 15% for weight she could get this diagnosis. Again, doesn't mean neglect. I hope this is easing your mind a little. The NP I am sure just wants to make sure that your daughter is okay. Like you said it is very possible she is very busy and works off all the calories. They just need to cover all basis. Sounds like developmentally she is right on track. They might have you meet with a nutritionist to see if she is getting enough calories. Again she may be getting enough for a normal 19 month old, but she may need more because she is active. Please feel free to contact me if you have more questions about this. Again, I am very sorry this was not explained to you by the NP.

Edited to say: The site didn't give me an option of looking at what other advice you already had, so my info is basically redundant, but I'll leave it anyway.

~~~~~~

Having worked for doctors for 20 years, I would say you need a little info to help you understand the NP's side of things.

In medical billing, they have specific phrases that do not necessarily match what you'd say in regular English. When a child is not gaining weight as they should, there isn't a code that says "not growing much" - so they have to use a technical term - which is "failure to thrive." That does not in any way mean you are doing anything wrong, it is just the lingo docs, other providers, and insurance companies use to understand each other. There is another code, I believe it is inadequate weight gain? But I can't remember right this minute. It is not a judgement, it is a description, and it is required for the provider and the lab to bill your insurance company.

As for her asking whether she is sure the babysitter is feeding her - I would consider that a completely appropriate question. The NP is not there to tickle your ears with only the most polite of questions - she is using any idea she can come up with for why your daughter is not doing as well as she could. Once my daughter was having a problem, I can't even remember what it was now since it was at least 10 years ago, but the pediatrician asked whether I thought someone might be getting to her - it was clear he meant is there any possibility she was being molested or something. I said no, there was no chance of that. I was not offended - it was his job to consider every possibility. Me saying no was good enough for him.

If you take a defensive posture, it will be noticed and possibly documented in the baby's record. If you don't get along with a provider, that's not a big deal, happens all the time. Its not a problem to request a new provider at the practice, just say something like "I think her style is just not clicking with mine."

We are the momma bears, protecting our cubs for anyone or anything that might hurt them - but in this particular case, I think a little understanding of the NP's frame of mind might help you feel more at ease. I would definitely suggest changing providers so things don't get worse, but try not to be angry at her for asking important questions, and using lingo that providers need to use.

Oh you poor thing! Failure to thrive does not mean neglect. It just means that your child does not fit into the standard growth chart. I had the same problem with my daughter. She is almost 4 and weighs a whopping 25 pounds. She is about 35 inches tall. She has met--or exceeded--all developmental milestones. The pediatrician we had when she was younger struggled at every appointment trying to decide if he should test her to determine why she was so small. But, he ultimately just decided not to since both my husband and I are "small" (I'm 4'11" and he's 5'8"...but his mom is 4'10")

We had a different pediatrician with our son...who was also not on the growth chart. Our son was meeting the developmental milestones--barely--but was a fussy baby. He was bigger than our daughter...but still not on the chart. This pediatrician diagnosed him with Failure to Thrive and sent us to all kinds of specialists (endocrinologist, GI, etc.)....I didn't think there was anything wrong, but I went anyway. It turns out he has a minor endocrine issue. I mentioned on more than a few occassions that I thought he had allergies. I was told that he probably didn't--but when he was finally tested, he had significant food and environmental allergies. Once we began to address those issues, he began to really "thrive.

Don't stress about the diagnosis. It's just a generic term when they can't figure out why a child isn't on the growth chart. I was irritated with the doctor when he diagnosed my son...and now that he's two years and two pounds under my daughter...I'm starting to wonder if maybe I should've had her evaluated too!

It sounds like your NP might need a little work on her bedside manner. I'm sure if she'd explained what that meant, it wouldn't have upset you so much. Just remember, if there is a problem and it's caught early, it will be easier to handle. My son was diagnosed with food allergies at one year and one week. So he doesn't know about all the great food he is missing. He just eats! Because of my son's allergies, I've adjusted the entire menu in our home. It's hard to explain to my daughter why she can't have goldfish! (My son is allergice to Peanuts, Wheat, Eggs, Milk and Bananas!)

Good luck to you! And, if you have any other questions or concerns, feel free to contact me!@ :-)

Stephanie-
Although I do not know your exact circumstances. I did go through this myself with my 4 yr old who was then only 3 months. I was nursing at the time and they were trying to force me to formula feed. Alissa hadn't gained a single ounce in 3 months time and they were concerned. Although she nursed constantly from birth. I realized that part of the problem was that I was stressed and not perfoming nutritiously for my daughter. I also moved and changed back to my old pediatrician that i adored.
Although your case is a bit different check out these few things:
1 is she near the curve on the average child chart that most dr.s fill out with height and weight etc.
(alissa was below the curve, but following her own-this counts for ALOT-the new/old pediatrician said as long as she was following a curve, that indicated a healthy baby)
2 is she nutritiously eating ie: vegies fruits, yogurts, dairys etc. if so, then she is getting proper nutrition and the only recommendation they make is to use a multivitimin.
if not, you can try the nutrient suppliment formulas (such as pedia sure)for big kids-although they had me try this instead of her milk in a bottle at 2yrs and she threw it up every time, thus not doing her any good, because then she was keeping nothing down.
Rest assured that between 3-9months of life, alissa gained about 9 ounces and she is currently a healthy, happy 4 year old who is petite, but vigourous!!! Trust me, she holds her own!! Plus, she is more adventurous than most kids her age, because of her size, she can do what most cant. (climb in around over and through things) She currently weighs barely 30lbs and will be 5 next month. She is still following well below the curve, but still has her own curve to follow.
I think that the lab work is a good idea for a few reasons....we did that as well, but it came after a 105* fever at 3 months. At least everything was ruled out and we now rest assured that she is healthy. So go ahead with the lab work, and don't let the "label" offend you. It's just a medical term!!!
GOOD LUCK
V.

Hello Stephanie! I'm not a doctor, and not where near it, however I believe "failure to thrive" is a medical term and is in no way an insult to you or anyone who cares for your daughter. Of course no one wants to hear their child described with those words. My friend's daughter was in a similar situation and they started doing some tests to see if her intestines were working 100% (as well as other organs) because there was no explanation why her weight was so low considering the fact that everyone else was right where it should be (height, head circ, eating habits...) Just be patient and know that for whatever reason this is just medical terminology to help everyone involved understand what the concern is. Hopefully there isn't anything to worry about!