Is My Baby Eating Enough? Falling Off the Growth Curve with @failure.to.thrive.dietitian Kat Mikelaites

Katie Ferraro (0s):

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Katie Ferraro (41s):

If you have one hour to dedicate to learning about Baby-Led Weaning. Come take this free online video training and grab your copy of that original a 100 First Foods list. While you're there, again, head to babyledweaning.co to get signed up and I hope to see you there.

Ezpz (59s):

It is national smoothie day and I don't get too crazy over smoothies. I'm personally kind of a food first person. I would just rather eat my food than drink it, but I get it. A lot of people love smoothies and smoothies can work for your baby as well. Your baby can start learning how to drink out of an open cup around six months of age. I recommend practicing that open cup drinking. Do it five minutes after each meal and then what will happen is your baby will hit that milestone of being able to drink out of an open cup on their own by age one, albeit with a little bit of spillage. Now what do you put in the open cup? Okay, I don't recommend water for earlier eaters. Since water is a thin liquid that can be hard to swallow early on. So you can do thicker liquids that your baby already knows how to drink like breast milk or formula or you can thin out purees and put them in the open cup.

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Ezpz (2m 18s):

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Kat Mikelaites (2m 28s):

The first thing you need to look at is the milk breast milk formula, whatnot. There's people out there that say that food up until one is just for fun. Don't necessarily agree with that. If you've had a baby who's starting solids, they most of it ends up on the floor or in their hair or in the dog's mouth, then it actually ends up in their mouth and it can be really hard for them to actually get the adequate calories at such a young age. You've gotta focus on that formula. You've gotta focus on the breast milk.

Katie Ferraro (2m 53s):

Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in Baby-Led Weaning. Here on the Baby-Led Weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using Baby-Led Weaning.

Kat Mikelaites (3m 22s):

Is my baby eating enough? When your baby starts solid foods, it is so typical to worry, oh my gosh, they're not getting enough or they're not eating enough. And of course you're worried because deep down you are thinking about that future pediatrician appointment or well check and they're gonna weigh your baby and measure them and like, oh my gosh, what if my baby falls off the growth chart? And then God forbid if that happens, the doctors, they're gonna peg my baby as being failure to thrive. And then ultimately as a mom, that is exactly what I'm gonna feel like a total failure. Like I can't get my baby enough nutrition to keep them on their growth path. And to be honest, I personally thought failure to thrive was an outdated term that we don't use anymore. In my area of infant feeding pretty much replaced the term failure to thrive with the more preferable term growth.

Kat Mikelaites (4m 9s):

Faltering, okay, less harsh for sure. But I was surprised when I was scrolling through Instagram one day and I see this account pop up in my feed called Failure to Thrive dietitian like, wait a minute, who is this? I never heard this person to start following look into it, it's a dietitian.

Katie Ferraro (4m 24s):

Her name is Kat Mikelaites. So Kat Mikelaites is a registered dietitian and on Instagram she's the failure.to.thrive.dietitian has dots all in between it failure.to.thrive.dietitian and Kat works with families whose babies are falling off the growth curve or have experienced unintentional weight loss and she works to understand what the underlying cause is and then helps the families develop plans to get them back on track. So a stalker and I like email her like, Kat, we're really interested in your program and what you're doing and I wanna interview you for my podcast. I didn't know her. So we met, we met on Instagram and I was really, really, really impressed by Kat and her work. She's a much younger than me registered dietitian, she's also a young mom, she has two babies and she's had some experience in her own mothering journey about growth faltering and she's gonna share that.

Katie Ferraro (5m 12s):

And I asked her, you know, like why are you calling yourself the failure.to.thrive.dietitian? She's like in the hospital setting where I work and she's an active practicing registered dietitian. That's what the doctors call it and that's what the parents are hearing. So that's what I wanna help with and I just, I really loved her approach and I wanted to have her on the podcast to discuss some of these topics related to the pressure that we feel as parents to you know, keep your baby's weight up and then what do you do with this weird overlapping like gray area where they're like starting to drink a little bit less infant milk but then they're not eating as much food and when should I really worry about my baby's weight and development or should I worry at all? I'm excited to have Kat on the podcast today to talk to you guys a little bit about growth, faltering, failure to thrive, whatever you wanna call it. It's this idea where your baby's not tracking on their growth curves and she does a wonderful job explaining what the different percentiles are.

Katie Ferraro (5m 56s):

'cause I think the idea of percentile can be really confusing. We live in this like hyper competitive parenting world where you're like, oh I want my baby to be first in everything. Like you do not want your baby necessarily to be number one on the wait for length or the wait for age or the head circumference growth chart if they used to be on the hundredth percentile. So she's gonna explain a little bit of some of these nuances and I think provide you with some resources in case you are concerned that your baby's growth is perhaps not where you thought it would be at a time when you're like, oh my gosh, we're starting solid foods and we need to get more nutrition. It's a stressful time, but there are credentialed experts like cat out there to help you. So with note further ado, here is registered dietitian, Kat Mikelaites talking about Is my baby eating enough food falling off the growth curve with the failure.to.thrive.dietitian.

Kat Mikelaites (6m 45s):

So I had a recent client who baby was born around 16th percentile and he had started dropping percentiles a little bit at a time and it was about five months when mom was like, okay, something's not right. He went from 60th to 17th, he had mild eczema and some weird poops but not, and nothing super concerning. But mom still, like her mom radar kicked in and she's saying, okay, something's not right. Like I just, and my mom, my mom gut tells me that something's not right. Then they started solids and very quickly severe eczema, bloody stools, fighting feeding, both breastfeeding as well as solid feeding. Mom went on a super strict elimination diet. She felt very little guidance from her pediatrician who was just saying, oh it's fine, they'll grow out of it.

Kat Mikelaites (7m 27s):

Here's a cream for the eczema. You know, fast forward she tried the the simple elimination diet and then she tried the crazy one and then she's down to only being able to eat six foods herself and then the baby's only able to eat six foods. I got him at eight months, six percentile. Mom is talking about how she wakes up stressing about the baby. She goes to bed stressing about the baby. She's showing up differently in her marriage because she's just so anxious about her child's health. The fact that she feels so unheard by her provider, she's showing up differently for her other toddler who is getting an angry mom, a stressed out mom. And so I was able to sit down and say, okay, let's look at, let's look at what baby can eat. Let's look at what you can eat. Did a super deep dive in her, what she's eating.

Kat Mikelaites (8m 7s):

I was able to find that she's eating bacon. Okay, perfect. Obviously she's not feeding bacon to her eight month old yet. But that to me means bacon grease. We can give this baby bacon grease because the first thing I look for is fat. How can we get this baby more fat? And so mom was then able to take bacon grease, mix it with rice, which is one of the only things he could eat. Mix it with the ground perky, the only thing that he could eat, feed it to him on a spoon. And sure enough, we just finished working together and he was at the 15th percentile and continuing to gain these families. They're just, they're so anxious, you know, they're so stressed out, they are concerned and a lot of times they feel very unheard by their providers. They get the let's wait and see, you know, it's not that bad. This is normal. And being able to work with a, a practitioner, a provider who really listens to them and is able to give them advice was just phenomenal for this mom.

Katie Ferraro (8m 55s):

And I think that's such an important story because as the registered dietitian, a lot of times you have a lot more time to do that deep dive which like, God bless pediatricians but they don't have time to sit there for 45 minutes and do a thorough food recall. I'm curious if you referred to pediatric allergist because of the severe eczema, was there a pediatric GI doc involved because of the blood in the stool? Like you know, we as a dietitian, our scope of practice is wide, but you know, we have to work with our other providers and in that case it sounds like there was definitely something going on. Did you ever get to the root cause of what the baby's diagnosis might have been?

Kat Mikelaites (9m 28s):

So, no. The mom had talked with a pediatrician about an allergist who told her that allergist isn't gonna do anything before the baby's a year. And then GI we just assumed that it was, it was an allergy, that's why they're having bloody stools, that's why they're having the eczema. And it was very, it was correlated to when the baby ate X, they had bloody stools, you took away X, they were fine.

Katie Ferraro (9m 49s):

So then in that case with the baby then go for a follow-up with the pediatric allergist at one. Was the pediatrician on board with that? Because I mean you'd hate, you know, we want diagnostic confirmation of these conditions if they exist so that parents aren't unnecessarily restricting foods from their babies. Like what would you advise in that case for the next course for that baby?

Kat Mikelaites (10m 6s):

So I advise mom to continue pushing for the things she's very mom gut, you know, following her intuition. Push for the things that you want when baby turns a year, if they're still unable to eat this large list of things that they haven't been able to push for an allergist, push for a little bit more than just, well we're gonna wait and see hold off on that food. Let's see what's actually going on.

Katie Ferraro (10m 26s):

And I feel so bad for parents when they do get brushed off by their provider, things like, you know, blood in the stool is, you know, unless it's the baby just date beets and it's clearly just the pigmentation from the beets. Like if you see blood in the stool, like that's something else is going on. And so I really like what you're saying about kind of trusting your mom gut and I love that Dr. Spock quote, you know, trust yourself, you know more than you think and it is important that you, you get second and third and fourth opinions and it's wonderful that you are able to go so deep with these parents to kind of help to get the baby's weight back on track. I wanted to ask you, when you're telling the story about the baby with the blood in the stool and the eczema and you mentioned the percentile, so it went from, you know, 60th down to sixth or back up to 17th percentile. What are we talking weight for age here?

Katie Ferraro (11m 6s):

Because there's a variety of different growth charts and I think parents get confused.

Kat Mikelaites (11m 9s):

Yeah, yeah, yeah, yeah. This is a great question. First I wanna explain what a percentile is 'cause I feel like it's just, it's such a confusing topic for people and the easiest way that I explain it is when you think about percentiles, it's typically a number, you know, zero to a hundred. What I want you to do is imagine your child, let's say your child's at the 75th percentile. Your child is six months old. Exactly. I want you to imagine a hundred kids that are six months old lined up from lightest to heaviest. If your child for weight is at the 75th percentile, that means they're number 75. They've got 25 kids above them who weigh a little bit more than them. They've got 74 kids behind them who weigh less than them. So they're right there at 75 in that span of a hundred people. I think that really helps people understand that, oh okay, so 75 just means that there's, you know, this many kids who weigh more and this many kids who weigh less.

Kat Mikelaites (11m 56s):

Okay, same thing, 25, this many kids who weigh more, this many kids weigh less and it takes it a little less than, because I think some many, so many parents look at it and think, oh I want my kid to be a hundred, I want my kid to, you know, get an a I want. And so by explaining it like that it it makes a little bit more sense.

Katie Ferraro (12m 10s):

And you're talking about their weight for age though, correct. In that case.

Kat Mikelaites (12m 15s):

In that circumtance, but it applies across all of the growth charts. So you've got your weight growth growth chart, you've got your length, you've got your weight for length, and then you have your head circumference. Weight is how much they weigh, you know, length is how long they are. Weight for length is looking at how much they weigh compared to how long they are. And then head circumference is obviously how big their head is. A lot of practitioners look at weight mostly, you know, they'll glance at length and make sure they're, you know, on the chart. There's nothing too drastic but they really focus in on weight. Whereas I think weight for length can be the most telling measurement that we get typically. So there's no definitive diagnosis when it comes to failure to thrive. But usually what practitioners are looking at would be a, a weight at the third or fifth percentile depending on which growth chart you're looking at.

Kat Mikelaites (13m 3s):

Which is hard because when I give that example of you've got a hundred kids lined up, right, somebody's gotta be number one, somebody's gotta be number two, somebody's gotta be number three. Somebody's got, somebody's gotta fit on all of these, right? Or it wouldn't make sense you, what's the point in a percentile if you don't want anybody at the first percentile? So yes, you may have a kid who's at the first percentile for weight, but then you look at their weight for length and their 75th percentile, which means that they weigh the perfect amount for how long they are.

Katie Ferraro (13m 27s):

Hey, we're gonna take a quick break, but I'll be right back.

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Katie Ferraro (14m 8s):

And I think it's important that we also reinforce here, and parents need to keep this in mind too, that we're tracking trends over time. So if your child was always 75th in line out of a hundred kids and now all of a sudden they're 99th, whoa, hang on, what happened there? But if they're always 75th, there's always fifth sometimes parents, oh my god, my baby's so small, they're fifth percentile. Have they always been fifth percentile in their way for age? If they continue to stay on that path, that's fine. That means they're tracking according to them. And we do have this tendency, especially in today's area, you know, people say, you know, how much is your baby weigh? Well how much is your baby eat? Well what is your baby doing right now? And like again, you know, that's part of the beauty the world is that everybody is different and not everybody's gonna be 75th in line, but again, if your baby was normally 75th and now they're second or they're 99th, we sometimes will talk a little bit about measurement error in a second.

Katie Ferraro (14m 54s):

But I wanna go back and just ask how did you get involved in this area of nutrition? I think it's wonderful that you, you know, have such a niche in an area that's really confusing to parents. And I know in other countries, a lot of times providers are actually much more adept at explaining growth charts. And here in the United States I feel like, you know, your MA and your pediatrician might spend like two seconds pointing something out and like, wow, a registered dietitian will sit down with me if I'm concerned about weight and explain what all of this means. How did you come to arrive at the type of work that you do, Kat?

Kat Mikelaites (15m 23s):

Yeah, great question. So I started out and as a dietitian, a new dietitian doing, seeing everything, which is, you know what most dietitians do. I was in a pediatric clinic and I saw everything from seizure kids to poor growth kids to kids with tube feeding to just a variety of things. And then I also was in a children's hospital also seeing a variety of things, right? I just fell in love with this population because I could make such an impact in these families' lives so quickly, especially the younger the kid was, the easier it was to make any type of progress. And I knew that I could change these parents' lives and part of why I created my program, I started my business was because I was seeing these families who have been through all of this stress, all of this trauma and are in the hospital and looking at all of these medical bills for simple nutrition fix sometimes.

Kat Mikelaites (16m 12s):

Sometimes it was super crazy and it was a lot more medical things and they needed to be there. But so many families that I saw, it's a simple nutrition fix was all I needed to do. And so I fell in love with being able to help these families and make such a huge impact in their life with their, you know, their new baby or their young toddler.

Katie Ferraro (16m 29s):

Did you have kids of your own when you got interested in pediatric nutrition?

Kat Mikelaites (16m 33s):

I did not. I have been a pediatric dietitian for over five years now and I only have a 3-year-old and a 15 month old. So I was working in peds prior to having children, which has been a a fun journey.

Katie Ferraro (16m 46s):

Let's talk a little bit about the methods for obtaining the data points that go on the different growth charts. So I know there's a lot of measurement error. I, I love my pediatrician's office to death, but like the medical assistants are super busy. If the baby's cold as they are, you know, when they don't have clothes on and the doctor's office and they're fussy and then they kick or they squirm. I mean the way they obtain length in my doctor's office is they just put the piece of paper on the examination bed, put the baby's head down, put their feet down, mark it with a pencil on each end and measure in between. It's highly inaccurate. So you go and plot a wrong length and then all of a sudden, oh my gosh my baby fell off the length grow chart or or wait for length looks all off. How often do you see errors in measurement causing unnecessary strife? Like we'll talk about the point of like, yes you definitely should be worried, but like do you sometimes think that what parents are freaking out about is really just inaccurate measurements?

Kat Mikelaites (17m 31s):

Oh, all the time. All the time with length weight is easier, you know you have an infant scale, you place them on infants.

Katie Ferraro (17m 36s):

Oh unless the diaper's full of pee or poop. That's true.

Kat Mikelaites (17m 39s):

True. If they, you know, a good pediatrician will do them either naked or clean a clean diaper. But it's, it tends to be a little bit easier. It's less hard to get an inaccurate weight. But the length, the the paper one, ooh it drives me crazy and you got little bumps in the table and it's just the baby squirming, the paper's bunching up, very frustrating. But I see in the length part airs all the time, which then cause the weight for length to be all wonky, which to me that's the most important measurement out of all of them. But all the time.

Katie Ferraro (18m 5s):

And talk about length. So shouldn't they be, is it up till age two that they should length should be measured lying down, is that correct or until they can stand?

Kat Mikelaites (18m 14s):

I forget either one. It really varies from pediatrician's office what they wanna do. Some kids, I know my daughter, as soon as she could stand, she didn't fight the standing up straight so that would be more accurate than her sitting there kicking on the, the length board or the piece of paper or whatnot. But it should be up until age two it should be the recumbent, recumbent length on a length board.

Katie Ferraro (18m 33s):

When you're tracking the families that you're working with in their, their growth charts, are you using any apps or using paper like I'm obsessed with data and I love, I love looking at the paper charts but then when I think like the CDC came out with an app or something and one of my interns I was, like hey this is a weird project but like I got seven kids and here's all their growth chart stuff, can you plug it in? 'cause I wanted to like see the way that they were tracking and it was really cool to see, you know, what's going on with your own kids. Do you do it electronically or are you using paper charts for everything?

Kat Mikelaites (18m 57s):

I use an app called Baby Growth. I'm also keeping track of 20, 30 kids at a time and so I, I wanna have all of my growth charts super easily accessible. So baby growth is the app that I use for visual tracking when it comes to actually looking at numbers, I use PD tools, which is just a website where I plug things in using kilograms and centimeters and that gives me the most data and the way that it makes the most sense for me. I've never used the CDC growth charts like the app. I obviously use the growth charts themselves because I can't save anything there. You know, I wanna be able to interesting save friends, I wanna be able to see the child over the span of their, their life or when I'm working with them.

Katie Ferraro (19m 34s):

I could see that like you, you're following them for a long course of time because we're also continuing growth even, you know, when you move beyond infancy you're still tracking your child's growth or your growth path. We talked about that. Sometimes it can be measurement error but that's not all of the time. Like what are some of the underlying conditions or what are things, you know, you mentioned food allergies earlier, but what are some of the clinical conditions that can lead to growth faltering or failure to thrive?

Kat Mikelaites (19m 56s):

The big one is calorie intake, which is, you know, hints at the dietitian part. It's, you know, baby's not consuming enough calories for whatever reason, but that's what it comes down to is inadequate calorie intake. There's some medical conditions that can contribute to failure to thrive. A big one is cardiac anomalies. It can be super difficult for babies who have any type of issue with their heart, number one to breathe while they're eating so they, they don't eat as much. And then number two, their heart's just working so hard to get blood to their body that they need more. So not only do they need more, but they're also not able to get the baseline of what they a standard baby would need anyway. So that's a big one that I see is cardiology babies, you know, baby, any type of baby with any type of neurological issue can sometimes struggle a lot with getting enough calories in children who need, you know, PT, OT multiple times a week.

Kat Mikelaites (20m 44s):

These are other ones, it's like they're doing exercise all the time for whatever their medical condition is. They then you throw on all of the extra therapies. A lot of times with babies there can be, you know, the allergies like the kid I was talking about earlier that are preventing a, you know, their body from being able to absorb things properly. There's, you know, a whole variety of stuff that baby could just not have a great appetite. They could have a a lip tie and so they're not up, they're, they're not transferring things adequately. You know, I've seen families who are aren't mixing formula properly and so they're underfeeding the child the whole slew of things that could be going on. I've seen some babies who just aren't being fed the way that they are as frequently as they should be, which can be some pretty sad, there's super sad instances, you know, mom's milk supply could be struggling, there could be some severe reflux that is then causing the baby some aversion they don't want to feed because it hurts when they feed.

Kat Mikelaites (21m 37s):

Celiac disease is another one that can cause issues with babies, especially once you start getting into solids inborn errors of metabolism or another one that don don't see that frequently. There's dietitians that specialize in that but those can cause a lot of growth issues if the baby's not able to metabolize the food that they're getting.

Katie Ferraro (21m 52s):

And one thing that I wanted to point out, we hear a lot from parents is like, oh well my doctor just told me to start solid foods early. So my baby, especially for premature babies and we've covered that a ton on the podcast with different neonatologists and pediatric dietitians and oftentimes the recommendation coming from the doctor will be like, oh start solid foods early and then they can use food for their catch up weight and we need to remind parents that your baby cannot use a substance like food that they don't know how to safely eat yet to gain weight. And it's so important that you're working with a pediatric dietitian who almost certainly is going to be fortifying the infant milk supply in order to provide those extra calories. I mean you gave the example of like the bacon fat, which I'm sure you're not doing that for every single patient, but like if you're just starting solid foods and you can't use food to meet your nutrition needs, this notion of like feed your baby more food.

Katie Ferraro (22m 35s):

Parents would be like, I wanna do coconut milk and I'm doing all this avocado. And it's like, well your baby doesn't even know how to eat those foods yet. Can you talk a little bit to the importance of working first on the milk supply for a baby who's like just starting solid foods and doesn't know how to eat food yet, like we can't use food to help them gain weight, right?

Kat Mikelaites (22m 51s):

Correct. And that bacon grease baby was eight months, so I, you know, I felt good giving him bacon grease at that point. But yes, the first thing you need to look at is the milk breast milk formula, whatnot. There's people out there that say that food up until one is just for fun. I don't necessarily agree with that, but I think in the beginning, you know, you have a baby, anybody who's listening to this, if you've had a baby who's starting solids, they, most of it ends up on the floor or in their hair or on the, in the dog's mouth, then it actually ends up in their mouth and it can be really hard for them to actually get the adequate calories at such a young age. You've gotta focus on that formula, you've gotta focus on the breast milk and figuring out a way to get either more of that in or increase the nutritional content of the what they've already getting.

Katie Ferraro (23m 34s):

Hey, we're gonna take a quick break but I'll be right back.

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Katie Ferraro (24m 8s):

Can you talk a little bit more the other interventions like let's say you're beyond like you 8, 9, 10 month old babies who are getting a little bit more proficient at feeding themselves. What sort of interventions do you recommend? And of course this is always in the context of like, this is not intended to replace your primary care provider, the listeners, and you're not supposed to use this diagnostically, but just so you know, like what sort of things dietitians like Kat will do, how do you help them increase calories or increase intake? Like what are some of the techniques that you use in your practice?

Kat Mikelaites (24m 36s):

So first thing I do is a super in depth nutrition assessment. I wanna hear what they're already doing. We, you know, I can't tell you what to change if I don't know what you're doing. And just a basic question of what do you feed your baby is not always gonna be adequate. You know, I wanna know are you doing breakfast? Are you doing lunch, are you doing dinner, are you doing snacks? What are you giving them at this point? What are you, are you feeding them solid food first or are you nursing them first? You know, what does your schedule look like? And then typically once you know I can get a good picture of what they're doing, I'll go in and I'll make small changes here. Like okay, you're giving them oatmeal for breakfast, let's add some butter to that oatmeal, you know, I wanna focus on fat. How can we get more fat into what they're eating? Because fat is so much more calories per gram than a protein or a carb is gonna be.

Kat Mikelaites (25m 16s):

So if I can give them half a tablespoon of fat, that right there is 60 extra calories, right? That's the first thing I look at. Let me see how I can add fat into what you're already doing.

Katie Ferraro (25m 27s):

Kat, I'm curious if having your own children has informed the way you counsel other families. I think it's really cool that you were a pediatric dietitian before you had your own kids because you came in it with like a purely clinical viewpoint for most of your cases. Have you had any feeding challenges with your own children or have the experiences that you've had as a mother and starting solid foods with your baby maybe changed some of the ways that you counsel your patients and clients at this point?

Kat Mikelaites (25m 51s):

Oh absolutely. I am able to empathize I think so much more as a mother with other mothers than I was before because before, like you said, I look at things clinically, you know, I was, well we do this and then we follow this guideline and then we do this and then, you know, the AAP recommends doing this. But now that I'm a mom I realize okay, this is what everybody tells you to do, but what do you wanna do? You know, what, how can we tie what we're supposed to do with, you know, what our mom got and what our mom intuition is telling us? So being able to come from that standpoint of this is hard. I know this is hard, let's figure out a way that works best for you and your family. And then with my kids, I, both of my kids actually my daughter had a severe lip tie that I had to push. We had a fantastic pediatrician but he struggled a little bit with some of the feeding stuff.

Kat Mikelaites (26m 35s):

I had to push for a lactation consultant referral, severe lip tie. She had lost weight by four months and so we pushed, we got her lip tie, everything was good after that. And then my son, who is now 15 months, he actually, I, his, his paper growth chart, you asked me about growth charts and I, I keep paper growth chart in my own children and I have his growth chart right here. He is was his four month appointment. He had dipped down, he was, lemme pull up my growth chart, he was just under 50th and then it, his four month appointment, it was 25th. So we went from fifth to 25th in a month and you know, and this was a year ago, so I was, you know, four years into my practice I had started my business. So I was like, okay, we gotta figure this out. And I did a little digging and I figured things out and I, I figured out that his daycare, he had started daycare at, you know, 12 weeks.

Kat Mikelaites (27m 20s):

So I went back to work. His daycare was just propping him up with a bottle and then he was losing half of his bottle out of his mouth. So it was, that was a simple fix for me, but it's still stressful to go in there and I see that, oh my gosh, he's dropped percentile significantly in a short period of time. This is what I do. And this also relating back to what you said is this is what I do for a living and my, my child is falling off their growth chart. Oh my gosh, I can, I'm a terrible mother, I'm a terrible dietitian and, and it's just that spiral that I know so many families go to. You know, you hear failure thrive.

Katie Ferraro (27m 52s):

It literally has the word failure. It's, I think it's why we like phased it out because it's like so mean.

Kat Mikelaites (27m 57s):

My mom hears or is told failure to thrive and what she hears is failure to provide. And my baby obviously didn't get failure to thrive from 50th to 25th on one measurement. But I did feel that oh my god, I'm failing my child and I know what I'm supposed to be doing. So I'm able to relate my experiences to the moms that I'm working with in a way that I never was before I had kids.

Katie Ferraro (28m 19s):

For parents who are listening and who are experiencing in this growth fall during and failure to thrive, Kat, how can they get in touch with you and what services do you provide and how can you help them?

Kat Mikelaites (28m 27s):

Yeah, so they can find me on Instagram. I am at failure.to.thrive.dietitian. That's my primary tool for people to reach out to me. I offer one-to-one work. I do a 12-week program where I work with families, identify why their child's not gaining weight and then implement different, whatever it is. It's so specific to the family and the child that it, it's hard for me to actually say, you know what I'm gonna do because don don't know until I get in there and I do that detailed assessment, but I work with families, figure out what's going on, implement a plan and then I'm there to help them troubleshoot. I worked outpatient for a lot of years working with these families, which was great and I was able to help a lot of people. But it was really hard when you'd see somebody for an hour and then you wouldn't see 'em again for three months because insurance won't cover it for another three months.

Kat Mikelaites (29m 12s):

And so my program is designed to be hands-on super high touch. I talk to my families most almost every day to be able to do that troubleshooting. Typically it's fat. Fat is where I start and how can we sneak more fat into what your kid's already eating? You know, I don't like to completely change what people are doing. It's difficult and I think being a mom is been really helpful for me to know that it, it's very difficult to go on and change everything that somebody's doing. So I like to just make small changes first and then go from there.

Katie Ferraro (29m 39s):

Well thank you so much. I learned a lot and it was great chatting with you. I think you are a total hustler on Instagram. I'm like this girl, like where do you get the time to do all this and raise your kids and work your job? I think you're doing an awesome service for parents. I'm glad I got connected with you. You actually make me feel really lazy because I work with a typically developing population. I run an evergreen program, like it's kind of a one size fits all. Here's how you can eat a hundred different foods before you turn one, but the second there's an abnormality, like I'm so glad I know you now to refer patients to you because what you do, you can't have an evergreen program 'cause there is no one size approach for failure to thrive or growth faltering. You need to work with a licensed feeding professional like yourself. And I just wanna remind parents that even if You don't work directly with Kat, it is important that you are working with a registered dietitian when it comes to getting feeding information if your child has any sort of deviation from typically developing trajectory.

Katie Ferraro (30m 28s):

So keep up the great work, Kat, it was a pleasure speaking with you.

Kat Mikelaites (30m 33s):

Thank you, you too.

Katie Ferraro (30m 33s):

Well, I hope you guys enjoyed that interview with Kat Michaelis. Kat is a registered dietitian. She's on Instagram at failure.to.thrive.dietitian. She has a number of different programs. She works one-on-one with families. So if you have been told your baby has growth faltering or failure to thrive, definitely please consider working with a pediatric registered dietitian. And I am happy that Kat could come here and share her expertise with us. I will put all of the links that we mentioned today, as well as some more resources on how to get in touch with her on the show notes page for this episode, which you can find at blwpodcast.com/442. Thank you so much for listening and a special thank you to our partners at AirWave Media. If you like podcasts that feature food and science and using your brain, check out some of the podcast offerings from AirWave.

Katie Ferraro (31m 16s):

We're online at blwpodcast.com. Take care and I'll see you next time.

What If World (31m 31s):

Parents, did you know there are podcasts for kids? I'm here to tell you about mine. What if world I answer What if questions with wild and funny stories? Tell them how. What if world has a huge cast of magical characters? Okay. And how each story has a positive message. Yeah. Yeah. What if world is great for bedtime car rides or whenever kids just need to unplug? You can find what if World on Apple Podcasts or wherever you listen.