cow’s milk allergy

Failure to Thrive: My child is underweight, what should I do?

As a parent, it’s hard to hear that your child has been diagnosed with Failure to Thrive, often written as “FTT.” I often talk to parents who are confused by the diagnosis and not sure exactly what it means, so I thought I’d take the time today to answer some basic questions.

For those who don’t know, FTT is a medical term and is used to describe poor weight gain over an extended period of time. It is often used when diagnosing infants, children and the elderly.

What’s the background on Failure to Thrive?

FTT has been used for more than a century when diagnosing those who are unable to grow or maintain their weight properly; however, it still lacks concise guidelines because it describes a condition and not a disease.

Most diagnoses of FTT are in infants and children and can be a result of something else that may be going on — such as food allergies. The first few years of life are very important for growth and development; therefore it is important to ensure that your little one is gaining the proper amount of weight and has proper nutrition.  Most babies double their birth weight by 4 months and triple it by age 1; however, children with FTT often don’t meet those milestones and are lagging on their growth charts.

What causes Failure to Thrive?

FTT can be the result of a variety of social and medical factors.

Social Factors. With obesity on the rise, many parents fear that they are “over-feeding” their children, so they may restrict calories.  You will be happy to learn that children (especially young ones) are excellent self-regulators.  They lack the desire to eat simply because food is present or out of boredom, which many of us do not!  They eat out of necessity and because their body needs the nutrients the food will provide.  With that said if you have a young child, follow their hunger cues.  If you feel that they are gaining weight too quickly later in life, you may want to consult your doctor or dietitian.

Medical Factors. Most often FTT is caused by allergies or GI conditions such as:

  • Gastroesophageal Reflux Disease (GERD), which can cause an irritated esophagus which may cause a child to refuse to eat;
  • Chronic Diarrhea which causes the body to rapidly lose important nutrients and calories provided by food;
  • Food Allergies to proteins in things like milk which require a restrictive diet that may lead to the inability to maintain or gain weight; or
  • Illness when the body goes into overdrive trying to fight the infection, using up all of the nutrients it has stored to do so.

How is Failure to Thrive treated in infants and children?

Depending on the cause of FTT, it may be easier than you think to help your little one gain the proper weight he or she needs to get back on the growth charts.  If it’s caused by a disease or condition such as GERD, Short Bowel Syndrome or a milk protein allergy, you may want to introduce an elemental formula such as Neocate. This will not only aid in weight gain, but can also help with the condition itself.  Another option would be to add a product that contains additional fats and carbohydrates like Duocal. It is protein-free and virtually tasteless, allowing you to add it to foods or drinks consumed by the most picky and allergy-ridden eaters.

If you have been told that your child has FTT, make sure that you have your doctor note it on any medical necessity letter or documentation.  This may provide some leverage when applying for reimbursement for elemental formulas.

Have any of your little ones been diagnosed with FTT? How are you helping them to gain weight?

-Nita

References:

http://kidshealth.org/parent/food/weight/failure_thrive.html#

http://www.lpch.org/diseasehealthinfo/healthlibrary/growth/thrive.html

Can Your Child Outgrow a Food or Milk Allergy?

So your little one has just been diagnosed with a milk or food allergy and you’re already wondering when (or even if) he or she will finally outgrow it.  As much as your new elemental formula and allergen-friendly diet is helping, you can’t help but wonder when you can feed your child without anxiety.  Don’t worry, you’re not alone!

Good news – It is possible for children to outgrow their allergies; however, it may depend on what the child is allergic to and the type of allergy.  Most importantly, keep in mind that all children are different! 

Children with cow’s milk allergy (CMA) may be more likely to outgrow their allergies than their peanut or tree nut allergy buddies.  Studies have shown that about 45-50% of children outgrow a CMA at one year, 60-75% at two years and 85-90% at three years.[1],[2]

Now, compare that to the studies which show that about 20% and 10%, respectively, of young patients may outgrow peanut and tree nut allergies and approximately 8% of patients who outgrow a peanut allergy relapse.  Additionally, nut related allergies are typically more severe and can even be fatal, which is quite scary![3]

If your little one has multiple protein allergies, such as both CMA and nut related allergies, he or she may outgrow the CMA while the nut related allergy could still persist.  Still, outgrowing an allergy to cow’s milk will expand their diet and improve the quality of life and available foods for your little one. 

The other factor that may influence your little one’s ability to outgrow an allergy is the levels of allergen-specific IgE detected in their blood.  This means, the lower the allergen-specific IgE detected, the greater the chance of outgrowing the allergy.  Your doctor can monitor this with either blood or skin prick tests. 

As I mentioned before, all children are different.  Your little one may have all the right “ingredients” to overcome their allergy, but they may be doing it at their own pace.  Your doctor may decide to attempt a food trial by introducing some foods that your child is allergic to, in order to see if the allergy still persists.  Be patient, sometimes food trials can be taxing. 

As many of you know, I suffered from CMA growing up and over time, I was finally able to consume milk products.  It happened gradually -first I stopped having a reaction when consuming cheese (most likely because it’s processed, so my immune system didn’t recognize the milk proteins as allergens) and then I could finally add in other foods that were previously not allowed in my diet.

So my advice to all of you new allergy parents is don’t worry, there is a light at the end of the tunnel!  To the more experienced allergy parents, can you shed any advice on food trials and outgrowing allergies?

- Nita


[1] de Boissieu D, Dupont C. Time course of allergy to extensively hydrolyzed cow’s milk proteins in infants. J Pediatr 2000;136:119-20.

 

[2] de Boissieu D, Dupont C. Allergy to extensively hydrolyzed cow’s milk proteins in infants: safety and duration of amino acid-based formula. : J Pediatr. 2002;141:271-3.

[3] The natural history of peanut and tree nut allergy. Fleischer DM. Curr Allergy Asthma Rep. 2007 Jun;7(3):175-81. Review.