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a result of a chromosomal abnormality, the primary cause for failure to thrive in small babies is poor breastfeeding.

This is due partly to a lack of knowledge and support for breastfeeding mothers in South Africa. “Because of societal disapproval about breastfeeding in public, most women don’t see other women breastfeeding, so they never get shown how to breastfeed successfully,” says Heather. This uncertainty leads to anxiety in the new mother, and this has a negative effect on her milk supply, especially in new mothers who don’t have emotional support and nurturing from those around them.

“Going back to work can also have a negative effect,” says Heather, as women who are separated from their babies suffer emotionally, in addition to being under pressure to express enough milk. “And the crèche environment, with its many bugs and viruses, isn’t an ideal environment for a child under one year old,” she adds. Illness in the infant, such as diarrhoea and/or vomiting, also has a negative effect on his ability to absorb nutrients.

In South Africa, there are additional circumstances that contribute to failure to thrive in infants – poverty being chief among them. “Women who aren’t able to breastfeed successfully, for whatever reason, are forced to put their babies on formula, but because it’s expensive, they often over-dilute the formula, which means their babies don’t get enough nutrients,” says Heather.

More than half of the babies in South Africa are born to single moms, according to Statistics South Africa, and at least half of working moms in South Africa are single, according to the annual Old Mutual Savings and Investment Monitor. This often means that new moms have very limited support, and breastfeeding mothers who are under stress or exhausted often struggle to produce enough milk for their babies.

Epidemic diseases such as HIV and TB may also cause failure to thrive: according to Unicef, about 300 000 babies are born every year in South Africa to Hiv-positive mothers; about 72 000 of these babies are HIV positive at birth and 21 000 more are infected by HIV from their mother.

Poor education, limited access to clean water and sanitation, and overflowing public health clinics are additional South African problems, adds Tanya. “The clinics are often so busy that infants aren’t assessed properly, and the signs of failure to thrive are missed.”

WHAT YOU CAN DO

It’s vitally important that a good milk supply is established in the first six weeks. And for this to happen, the mom needs “support, support, support!” says Heather. New moms need to be educated about breastfeeding, need to have supportive partners and/or help from friends and family, and need to be nurtured. “Take your baby for a weigh-in once a week for the first six weeks, so you can pick up any problems early,” Heather suggests.

“Mothers of young children must have access to good food and healthcare,” says Tanya, and Heather adds, “More compassion and dignity for new moms at local clinics and hospitals would improve these outcomes.”

HOW IS FAILURE TO THRIVE TREATED?

Usually, the health practitioner will get a dietary history, including the feeding schedule and techniques for the preparation and feeding of formula or adequacy of breastmilk supply; and a family and medical history, to ensure there are no underlying problems to do with either genetics or disease. “A nutritious diet containing adequate calories for catch up growth – about 150 percent of normal caloric requirement – and individualised medical and social supports are usually necessary,” says Tanya. “The child’s weight will be monitored frequently, and the mom may need to bring the infant to the clinic for weekly weigh-ins. A child who doesn’t gain weight adequately in spite of this is usually admitted to the hospital, so that all necessary observations can be made and diagnostic tests can be done quickly.” YB