Failure to thrive

Question

Dear expert team,
our daughter (6-years old, CF) refuses any high-caloric additonal food. She has a normal lung function, is stable without infections and very active.
Unfortunately, she is often estimated to be 2 years younger, as she is only 106cm high and weighs only 15 kg. She is going to school next year and we ask ourselves, what else can we do, in order to finally achieve a good height and weight (if possible without PEG). Or is it acceptable (in case of stable general condition) to let it go as it is? Gaining weight was difficult from the beginning on in spite of quite normal eating behaviour and appetite. We enrich the food. Can there be other reasons for the failure to thrive?
Best regards,

Answer

Hello.
at the age of 6 years the weight is below the 3rd percentile, as well as the length.
Therefore a very tiny child.
Are the parents also tiny? How is the stool? Frequency of bowel movements?
In any case a celiac disease has to be ruled out (antibodies against transglutaminase and gluten in the serum). How is the ph value of the stool?
A trial with acid inhibitors (omeprazole 20 mg/d) can be tried. Then the pancreatic enzymes are more effective. Sufficient amount of enzymes?
Nutritional advice and getting the pressure off your child, to be forced to eat more.
A psychosomatic counselling will be helpful for sure.
At the moment not a PEG at all! The child has obviously no consuming illness with weight loss and failure to thrive.
Therefore quite a few things have still to be clarified.
This can for sure be discussed with the CF center in charge.

Best regards,
Dr. H.-E. Heuer

03.12.2014