Clinical update

Faltering growth: signs, symptoms and guidance on improving care

NICE guidance sets out four quality standards covering slower rate of weight gain for babies and preschool children

NICE guidance sets out four quality standards covering slower rate of weight gain for babies and preschool children

Essential information

Faltering growth refers to a slower rate of weight gain in childhood than expected for their age and sex. Concerns about faltering growth may be raised by healthcare professionals or parents about a child they feel is not feeding or eating, not growing as expected or is thin or seems unwell. Faltering growth in early childhood may be associated with persistent problems with appetite and feeding.

Whats new?

Taking a detailed feeding or eating history and plotting measurements on a growth chart are among the key elements to improve the recognition and management of faltering growth, according

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NICE guidance sets out four quality standards covering slower rate of weight gain for babies and preschool children

Picture shows My personal child health record folder
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Essential information

Faltering growth refers to a slower rate of weight gain in childhood than expected for their age and sex. Concerns about faltering growth may be raised by healthcare professionals or parents about a child they feel is not feeding or eating, not growing as expected or is thin or seems unwell. Faltering growth in early childhood may be associated with persistent problems with appetite and feeding.

What’s new?

Taking a detailed feeding or eating history and plotting measurements on a growth chart are among the key elements to improve the recognition and management of faltering growth, according to new guidance from the National Institute for Health and Care Excellence (NICE).

NICE sets out four quality standards to improve care in this area for babies and preschool children.

The standards, which draw on NICE clinical guidance from 2017, call for all children to have a management plan with specific goals if there are concerns about faltering growth.

Signs or symptoms

Healthcare professionals may have concerns about faltering growth in babies and preschool children if they lose more than 10% of their birth weight in the early days of life or they do not return to their birth weight by three weeks of age, NICE says. There may also be concerns if a child drops centile spaces on a growth chart, with the number of spaces causing concern dictated by a child’s birth weight.

Concerns can also be prompted if current weight is below the second centile for age, whatever the birth weight.

Causes or risk factors

Certain health conditions predispose children to faltering growth, but when these are not present the cause is likely to be complex and multifactorial.

In children with no specific cause, simple interventions to increase nutritional intake may be effective in improving weight gain.

How you can help your patient

Early identification of faltering growth in a baby or preschool child enables a management plan to be developed promptly to improve their growth.

It is important that all babies and preschool children have their measurements plotted on a growth chart.

If concerns are raised about the growth of a baby or preschool child, regular measurement and plotting of their weight and length or height on the UK–WHO growth charts (based on World Health Organization child growth standards) in their personal child health record or 'red book', or an electronic equivalent, can confirm if growth is faltering.

Mothers should be supported to continue breastfeeding if their baby is given supplementation with formula because of concerns about faltering growth.

Developing any management plan in collaboration with parents or carers provides them with clarity and reassurance about the actions that need to be taken and may help to reduce their anxiety about faltering growth in their child.

Expert Comment

Alison SpiroAlison Spiro is a retired specialist health visitor, an adviser to the Institute of Health Visiting and honorary lecturer at Brunel University, London

‘These quality standards emphasise that practical, sympathetic, non-judgemental support should be provided quickly to reduce the risk of mothers stopping breastfeeding, and mothers should be told that it is not their fault that their babies have lost excessive weight. It also states that commissioners of community services fund the employment of enough staff to offer mothers this vital, individual support.

‘It is very important that midwives, nurses and health visitors pick up faltering growth in the early weeks after birth because babies' feeding techniques are sometimes not efficient enough to obtain good milk transfer from the breast or bottle, or they have some underlying disorder. Their weights should be plotted on the UK-WHO growth chart in the parent-held child health record. Linear growth will indicate that the child is healthy, receiving adequate nutrition and not suffering from any underlying illness such as cardiac, digestive, metabolic disorders or an underlying safeguarding issue.’


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