Raisingkids.co.uk's paediatric dietitian, David Swain, advises on the problem of faltering growth.

Raisingkids member's problem
Why is my 18 month-old not gaining weight as she should? She was premature and only weighed 4lb - now she just weighs 18lbs.

The doctor put her on 'Paediasure' as well as referring her to a gastroenterologist. I put extra calories in her food but she is a picky eater. Please help.

David's advice
Faltering growth or 'failure to thrive' has been reported to affect up to 5% of under-5s. It can be caused by a number of factors including insufficient nutrient intake, through malabsorbtion and by suck/swallow inco-ordination. Therefore it's often difficult to ascertain why a child isn't gaining weight. Unfortunately I don't have the information to assess your daughter.

However, you did the right thing by going to your doctor and hopefully the gastroenterologist will be able to shed some light on this matter. Whilst you wait for the appointment to see the specialist you should try and maximise energy from ordinary foods.

A good variety of energy-rich foods should be encouraged such as full cream milk, cheese, meat, full cream yoghurts, milk puddings, cake and biscuits. Extra butter or margarine can also be added to bread, potatoes and vegetables. The Paediasure milk drink that was prescribed by your doctor is a commonly used dietary supplement which also provides a useful source of energy when growth is inadequate.

Finally, if you feel that your daughter needs a full dietary assessment I would ask your doctor for a referral to a State Registered Dietician.

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