Faltering growth

Faltering growth refers to a slower rate of weight gain in childhood than is expected for age and gender. It is a common problem which may be identified through routine growth monitoring, or due to parent/carer or healthcare professional concerns.¹

Faltering growth may be caused by inadequate intake due to a variety of feeding and behavioural difficulties, including medical conditions that are associated with increased requirements or malabsorption.^1,2 In high- and middle-income settings, faltering growth is most commonly associated with non-disease related aspects, such as psychosocial, environmental and socioeconomic factors. Other relevant factors include prematurity and maternal anxiety and depression.³

Infancy marks a period of rapid growth in which nutrient requirements (per kg body weight) are proportionally higher than at any other time of life. Young children are more vulnerable to the short- and long-term effects of malnutrition, so early diagnosis and intervention is vital.⁴ NICE guidance exists to help reduce variation in care provided to infants, children and their families for faltering growth, by providing healthcare professionals with specific recommendations to support recognition, assessment, monitoring, onward referral and appropriate management of faltering growth.⁴

Nutritional management of faltering growth requires a balanced ratio of energy and protein, as well as micronutrients for optimal catch-up growth. Clinicians should assess the adequacy of caloric intake, as well as addressing the underlying causes.

Supporting breastfeeding should be a priority in both disease and non-disease-related faltering growth with an assessment of technique and supply, and only where appropriate consider nutritional supplementation. In formula fed infants, ready to use energy dense feeds with proven efficacy should be used where indicated.⁴