When your child isn’t growing as expected: Could the gut be involved?
By Dr Rohan Malik
Paediatric gastroenterologist in Woolloongabba, Brisbane
Children come in all shapes and sizes, and being smaller than other children of the same age doesn’t necessarily mean there’s a problem.
What can be more important is your child’s own growth pattern.
If they’re gaining weight more slowly than expected, dropping away from their previous growth pattern or not growing as anticipated, your doctor may start looking at why. Sometimes, the answer can be found in the digestive system.
What does the gut have to do with growth?
Growing bodies need a steady supply of energy, protein, vitamins and minerals.
For that to happen, children need to be able to eat enough food, digest it and absorb its nutrients through the gastrointestinal tract.
A problem anywhere along that pathway can potentially affect growth.
Some gastrointestinal conditions make eating uncomfortable, so a child consumes less than they need. Others interfere with digestion or prevent nutrients from being absorbed properly. Persistent vomiting or diarrhoea can also make it difficult for a child to get what they need from their diet.
In these situations, poor weight gain or slower growth can sometimes be one of the first clues that something isn’t quite right.
Which gastrointestinal conditions can affect growth?
There are a number of possibilities.
Coeliac disease, for example, damages the lining of the small intestine and can interfere with nutrient absorption. Inflammatory bowel disease can also affect a child’s nutrition and growth.
Other gastrointestinal problems may affect how much a child is able or willing to eat. Persistent vomiting, swallowing difficulties or pain associated with eating can all reduce intake over time.
This doesn’t mean that a child who is growing slowly necessarily has a gastrointestinal condition. There are many possible reasons for differences in growth, and some perfectly healthy children are simply small.
The aim is to understand what’s normal for the individual child and whether there has been a meaningful change.
What other signs might suggest a gut problem?
Growth concerns can be particularly important when they occur alongside gastrointestinal symptoms such as:
- persistent or recurrent abdominal pain
- ongoing diarrhoea
- frequent vomiting
- difficulty swallowing
- blood in the stool
- persistent bloating
- poor appetite or becoming full very quickly
- changes in bowel habits.
Sometimes, though, gastrointestinal symptoms can be subtle. A child may not complain of significant pain or diarrhoea, which is one reason their growth history can provide useful information.
Looking at the growth chart, not just the number
A child’s weight or height on one particular day only tells us so much.
Doctors are interested in how that measurement compares with previous ones. Has your child generally continued along their established growth pattern, or has something changed?
That’s why regular measurements of weight and height are useful. Looking at them over time can help distinguish a naturally smaller child who is growing consistently from one whose growth may need further investigation.
How is poor growth investigated?
There isn’t one test for poor growth.
Assessment usually starts by looking at the child’s growth history, diet, appetite and overall health, together with any other symptoms.
If a gastrointestinal cause is suspected, your doctor may recommend investigations based on the individual child’s circumstances. These could include blood or stool tests, with further investigations considered depending on the findings.
A paediatric gastroenterologist may become involved when symptoms or test results suggest an underlying gastrointestinal condition, or when poor growth remains unexplained.
Finding out what’s getting in the way of growth
When a child isn’t growing as expected, it’s natural for families to focus on how much they’re eating. But sometimes there’s another question worth asking: what happens to that food once it’s eaten?
The digestive system has an important job to do, breaking food down and making its nutrients available to a growing body.
If something is interfering with that process, identifying and treating the underlying problem can help give a child the nutritional foundation they need to grow and thrive.
