Good nutrition is key in early life,¹ and most infants will gain normal weight without any concerns. Faltering growth, however, is defined as a slower rate of weight gain in childhood than expected. Here, our guest blogger, Hazel Duncan, RD, takes a look at faltering growth in practice.

The focus of research over recent years is to look at the impact of adequate nutrition within the first months of life and the impact this can have in children in both the short and longer term.

Normal weight gain means that the infant has had a nutritional intake that has met the need for growth during the first two years of life. Whilst the majority of infants will gain weight normally, with no concerns regarding inadequate or excessive gains, growth faltering can occur at varying stages. Brain development within the early months uses a large proportion of calorie intake and failure to gain adequate weight can lead to development being delayed.¹

Faltering growth is the term used to describe the deviation of a child’s weight or height from their usual (or expected) centile line. It is reported to affect around 5% of infants and preschool children, depending on the definition used.^2,3 Faltering growth would usually occur in early infancy when growth is rapid and energy and nutrient needs are high.^2,3

MONITORING GROWTH

Growth monitoring in infancy is key to identify infants at risk of growth faltering. In the majority of cases, this will be picked up by the health visiting team or hospital team if an infant has already been identified with growth problems.

• Infants should be measured correctly using naked weights until two years of age on scales that are to two decimal points.
• Whenever possible, scales should be on a solid surface (not a carpet)
• Length should be measured with the infant naked with no nappy and two adults are required to ensure technique and accuracy. An appropriate measuring board should be used.
• OFC or head circumference should be measured.⁴
• All measurements should be plotted on the appropriate growth chart and interpreted by a trained healthcare professional.

WHAT IS FALTERING GROWTH?

Faltering growth is defined as a slower rate of weight gain in childhood than expected for age and sex³ and is a term to describe a weight pattern, as it is not a diagnosis in itself. For the majority of cases faltering growth would be defined as a weight that crosses more than two centiles.

Faltering growth is either caused by inadequate intake or excessive losses and a paediatric dietitian is key in being able to identify the cause and recommend a treatment plan.⁵

WHAT TO DO IF FALTERING GROWTH IS SUSPECTED

Once an infant or young person is identified as faltering to grow, a thorough assessment is required to try to identify the cause. Only once the cause has been identified can an appropriate treatment plan begin.⁶ The assessment should include:

• a thorough history, looking at past measurements, feeding history, associated symptoms, eg, loose stools, vomiting, food refusal, respiratory infections and urine output;³
• any metabolic conditions so they can be ruled out as part of this assessment;
• an examination to be carried out, initially by a health visitor or GP and then a paediatrician at time of referral and this examination should assess for any dysmorphic features, abdominal distension, skeletal wasting and examination of all symptoms to ensure no underlying pathology.^2,3

TREATMENT PLANS

The treatment of faltering growth is determined by the cause. Adequate calories are required to promote catch-up growth and dietitians play a key role in optimising calorie intake and ensuring this can be done in an achievable manner.^3,5 Thickened feeds, calorie-dense formula feeds, or alternative methods of feeding such as nasogastric feeding, may all need to be considered to optimise and improve growth for the infant or child.

Once a treatment strategy is identified, growth measurements should continue until the family and healthcare team are satisfied they have optimised the nutrition. A dietitian should remain a key player in the treatment plan until growth is optimised and the strategies put in place have been withdrawn and the young person is thriving on standard feeding.

Hazel Duncan, RD
Paediatric Dietitian, Kids Nutrition

Hazel is a paediatric dietitian with 19 year’s experience.
Her previous research has been around inflammatory bowel disease.
She currently covers a wide area of specialities.

Instagram: kidsnutritionrd
Website: www.kids-nutrition.com
Facebook: Kids-Nutrition

References

1. Nyaradi A, Li J, Hickling S, Whitehouse AJO, Foster JK, Oddy WH (2013) Diet in the early years of life influences cognitive outcomes at 10 years: a prospective cohort study.  Acta Paediatrica 102 (12) 1165-1173.
2. Gonzalez-Viana E, Dworzynski K, Murphy MS, Peek R.  Faltering growth in children: summary of NICE guidance.  BMJ 2017
3. National Institute for Heath and Care Clinical Excellence (2017) Faltering growth: recognition and management of faltering growth in children
4. Royal College of Paediatrics and Child Health UK-WHO Growth charts
5. Wright, C (2000) Identification and management if failure to thrive: a community perspective.  Archives of Diseases of Childhood 82: 5-9
6. Roche E, Shrestha V (2017) Faltering growth InnoVAIT RCGP 10:12 734-739