Clinical update

Faltering growth

The National Institute for Health and Care Excellence is developing new guidelines on how healthcare professionals recognise and monitor faltering growth in infants and children

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Essential facts

Faltering growth, previously called failure to thrive, refers to a slower rate of weight gain in childhood than expected for age and sex. While newborn babies normally lose weight in the first days of life, persisting or large weight losses can cause concern.

The reasons for faltering growth in babies and older children can be complex.

What’s new

Guidance to help healthcare professionals recognise, assess and monitor faltering growth in infants and children is being developed by the National Institute for Health and Care Excellence (NICE). The document has been consulted on and is due to be published in October.

Signs and symptoms

Children with faltering growth may be identified by routine growth monitoring, or by parental or health professional concern. A child’s weight, length or height and head circumference should be plotted on UK-WHO growth charts – based on World Health Organization child growth standards – to monitor development.  Undernutrition presents as a relatively slow weight gain, demonstrated by a fall across weight centiles on the growth chart.

Causes and risk factors

Causes are often multifactorial if not related to a specific clinical condition, and it may not be possible to identify a clear cause. Difficulties in the interaction between a child and their parents may contribute. In babies, preterm birth, neurodevelopmental concerns and maternal postnatal depression or anxiety could increase risk of faltering development. Problems can include ineffective suckling, the feeding environment, feeding aversion and physical disorders.

For older children, mealtime arrangements, types of foods offered, food aversion and avoidance, and appetite, for example a lack of interest in eating, can contribute.

How you can help your patient

Consider asking the parents of children with faltering growth to keep a diary recording food intake, including types and amounts, and any mealtime issues to help inform management strategies and assess progress. Work with parents and carers to establish a management plan with specific goals for every infant or child where there are concerns about faltering growth. Provide feeding support if there is concern about faltering growth in the first weeks of life.

Expert comment
 Carmel Blackie, associate professor in primary health care at Kingston University London and St George’s University of London and fellow of Institute of Health Visiting

'About one in 20 children will go down two centile points on growth charts, and one in 100 will go down three places, so faltering growth is likely to be seen by health visitors, midwives and practice nurses. It is really important that nurses working with young children understand what normal development looks like so that they can refer the child on when there is a problem. Health visitors should be aware of genetic and ethnic inheritance differences which effect growth. 

'Premature babies and children with conditions such as Down's syndrome and Turner syndrome need to be considered using appropriate charts. Faltering growth can be a complex, multifactorial issue, and causes can include a wide range of underlying medical conditions. Safeguarding is important and consideration of maternal and infant bonding and parenting should be born in mind.’


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