Help! My baby is not gaining weight

The words “failure to thrive” can cause parents to panic. Here’s our paediatrician’s advice.


Those weekly weigh-ins are so exciting, aren’t they? Unless your baby just isn’t gaining weight or growing as expected, that is, and then they can be downright scary – especially if you hear the words “failure to thrive”.

But, says paediatrician Dr. Natasha Padayachee-Govender, failure to thrive isn’t a disease or even a diagnosis on its own. Rather, it’s a sign that there may be an underlying problem – one that should be addressed and appropriately managed to bring about improvement.

What are the signs?

“Children who fail to thrive usually have height, weight and head circumferences below the standard growth charts – weight may be lower than the third percentile, and weight may be 20% below the ideal weight for the baby’s height,” explains Dr. Padayachee-Govender.

She says slowed or halted growth may also be a warning sign. “This is often accompanied by delayed skills development, especially for milestones like rolling over, sitting, standing and walking, as well as mental and social skills.”

ALSO SEE: Decoding baby’s growth chart


Failure to thrive is one of those conditions where a bunch of factors come together in a perfect storm – so, the causes may range from medical to social or environmental issues.

Inadequate caloric intake

Dr Padayachee-Govender explains that inadequate caloric intake is often a root cause, but this in itself may come about because of breastfeeding problems, the incorrect preparation of formula, gastroesophageal reflux, or a lack of available nutritious food.


“Babies may pick up on their caregiver’s depression, too, or they may be affected by physical issues like a cleft lip or palate,” says Dr. Padayachee-Govender.

ALSO SEE: How to cope with postnatal depression during COVID-19

Not absorbing calories

“On the other hand, they may be getting all the calories they need – it’s absorbing these calories that’s a problem, and this may be because of food allergies or other medical issues like malabsorption, pyloric stenosis (a narrowing of the stomach’s opening to the small intestine), a malformation of the gastrointestinal tract, or an inborn metabolic error (a rare genetic disorder in which the body cannot properly turn food into energy),” adds Dr. Padayachee-Govender. 

Excessive caloric expenditure

Dr. Padayachee-Govender says failure to thrive can also be caused by excessive caloric expenditure, typically caused by conditions like thyroid disease, chronic infections or immunodeficiency, chronic pulmonary disease, congenital heart disease or heart failure, or malignancy.

Prevention is better than cure

Interestingly, Dr. Padayachee-Govender says that helping your baby thrive starts even before she’s born – with making sure you’re getting the right nutrition. So, take those prenatal vitamins, especially folic acid while you’re pregnant, and keep up with your antenatal checks.

ALSO SEE: 5 common prenatal vitamins concerns all moms-to-be have

Newborn care


Once baby is born, establish a breastfeeding routine as soon as possible or, if you’re not breastfeeding, make sure you’re mixing her formula correctly and using it appropriately.

Keep up those baby checks

They’re a great opportunity to check your little one’s development and get advice around stimulation or nutrition, such as when to introduce solids. More than this, Dr. Padayachee-Govender points out, it’s at these visits that your paed or nurse will be able to identify any issues that may contribute to undernutrition.


Don’t dismiss the impact of stress on your baby, she warns. “Family dynamics are an important part in managing failure to thrive, so a solid support structure is vital.” She also advises taking advantage of bonding opportunities like bath time and nappy changes, and playing games like peek-a-boo.

The way forward

“If your doctor has diagnosed failure to thrive, she’ll also provide guidance for catch-up growth,” Dr. Padayachee-Govender continues. This may entail breastfeeding more often, supplementing with formula or breast milk fortifiers or even getting help from a lactation consultant.

“If your baby is formula-fed, your doctor may advise changing to a specialized, energy dense medical formula that provides higher calories per volume. If there is something else at play, like a deeper underlying condition, additional medical treatment may be necessary.” Either way, says Dr. Padayachee-Govender, it’s vital that you consult your paed regularly so that she can monitor catch-up growth or refer you to another relevant specialist, if necessary.

More about the expert:

Dr Natasha Padayachee-Govender is a specialist paediatrician practising at Life Fourways Hospital.  Her areas of interest are in allergies and asthma, neonatal intensive care and early childhood development. The scope of her practice includes newborn baby attendance in theatre or delivery room, neonatal and paediatric intensive care and general paediatric management – in room consultations and hospitalised children. Learn more about Dr Natasha Padayachee-Govender here.

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