INADEQUATE WEIGHT GAIN

• Inadequate weight gain in children caused by failure to thrive is indicated when a child's weight is consistently lower than the third to fifth percentile for his or her age- or when a child loses weight and remains at or below the third percentile. Another indicator is when a child slows down in two or more major growth parameters.

Organic causes:

• Prenatal: Intrauterine growth retardation, intrauterine infections
• Gastrointestinal: persistent or recurrent vomiting
• Defects in absorption: celiac disease, cystic fibrosis, lactose intolerance
• Cardiovascular: CHD, congestive cardiac failure
• Renal: Chronic renal failure
• Metabolic diseases: in born errors of metabolism
• Infections: TB, UTI
• CNS: Metal retardation, CP

Inorganic causes:

• Poor nutritional intake: poverty, cleft lip, cleft palate
• Emotional deprivation

• Toddlers have a physiological anorexia as they are busy exploring the environment by play activities. As long as the child is well and active one need not worry. Still it is one of the commonest symptom in children.

Assessment of Growth: measurements falling two major percentiles

Calculation of weight: 

• 3-12 months – (age in months + 9)/2
• 1 – 6 years - age (yr) ×2 + 8
• 7 – 12 years -(age (yr) × 7 – 5)/2

Gain in Height:

• 25cm in 1 st year
• 12.5cm in 2 nd year
• Beyond 2 yrs 6cm per year
• Height beyond 1 year of age: (age × 6) + 77

Identify following if any

• Dysmorphic features
• Vital Signs
• Pallor
• Clubbing
• Associated Vitamin Deficiencies
• Skin and Hair Changes
• Lymphadenopathy
• Edema

Systemic Examination of -CVS, CNS

• CBC – To rule out anemia 
• Blood: S. Creatinine, S. sodium, S. potassium, S. Calcium, S. Phosphorus
• Urine Examination: to diagnose urinary tract infection
• Stool examination
• X ray chest: suspected case of tuberculosis, interstitial lung disease
• Karyotyping: detect chromosomal aberrations

Ayurvedic management 

• Treatment is decided according to cause

 GIT causes 

• correct Agni

 Choornas

• Ashtachoorna, Thaleesadi choorna
  • Infant: 2-3 gm
  • Toddler- 5gm
  • School going- 7-10gm
  • Anupana: honey or water or along with food

Arishta (depending on the status of the child)

• Mustarishta, Abhayarishta
  • Upto 2yrs- ½ tsp arishta diluted with 1 tsp water
  • 2-5 years- 2.5ml-5ml diluted with 5 ml boiled water
  • 5-10 years- 10ml
  • 10-15 years- 15ml

Kashayas – various pachana deepana vatanulomana kashayas

• Gandharva hasthadi kashaya,Chiruvilwadi kashaya,Amruthothara kashaya
  • Up to1 year: for mother: 2 tsp sookshma choorna is boiled in 2 glass water, strained and given to mother. If agni bala permits give 1 tsp thrice to the child
  • 1 year to 5 years: ½ tsp powder boiled in 1 glass of water and given as divided doses mixed with sugar or jaggery
  • 5 to 10 years: 1 tsp powder boiled in 1 glass of water and given as divided doses mixed with sugar or jaggery
  • 10-15 years: 1 ½ tsp powder boiled in 1 glass of water and given twice daily mixed with sugar or jaggery

Brimhana therapies after correction of Agni:

Grithas (depending on status of agni)

• Indukanta gritha, Kalyanaka gritha. Shadpala gritha , Vidaryadi gritha
  • Upto 1 years: given as drops: always one should have a proper assessment of agni before administering sneha kalpana -2drops to 5 drops depending on agni
  • Above 1 year: always start with minimum dose - even 2 drops will be sufficient to get the desired effect
  • Properly monitor the status of agni and increase the dose

 Preenanamodaka: Priyalamajjadi modaka

Prashas and lehas: Amrutha prasha, Kusmanda rasayana ¼ tsp to 2 tsp

Infections

• Treat the infection first and then adopt Agni deepana and Brimhana chikitsa