Faltering growth

The diagnosis of faltering growth requires a careful assessment of growth parameters (weight, length/height, and head circumference) - over time.

The condition requires comprehensive medical and psychosocial evaluation, including an evaluation of home and family conditions, food security and the availability of food, family routines and the regularity of meals, and meals served in a nurturant context as well as children’s participation and involvement.

Extensive medical tests are, however, generally not indicated. Rather, one should be guided by the history or examination.

Interdisciplinary collaboration, involving medical professionals, psychologists, nutritionists, and social workers, with other specialists as needed is recommended.

Hospitalisation should be reserved for severe or recalcitrant cases.

Growth faltering is often a major concern for families regardless of the aetiology and can cause stress, anxiety, and carer-child conflict, even in the presence of an organic aetiology.

Growth faltering can occur at all socio-economic levels. Occurrence may be highest among children from low-income families and families with multiple risk factors.

Faltering growth (previously known as failure to thrive) is a descriptive term used for children with below-expected weight-for-age, weight-for-length, or BMI-for-age. It can also be used to describe a depressed rate of growth for age.[1]Tang MN, Adolphe S, Rogers SR, et al. Failure to thrive or growth faltering: medical, developmental/behavioral, nutritional, and social dimensions. Pediatr Rev. 2021 Nov;42(11):590-603. http://www.ncbi.nlm.nih.gov/pubmed/34725219?tool=bestpractice.com As the definition varies between different healthcare providers, the criteria used to diagnose the condition must be specified.[2]Hojsak I, Chourdakis M, Gerasimidis K, et al. What are the new guidelines and position papers in pediatric nutrition: a 2015-2020 overview. Clin Nutr ESPEN. 2021 Jun;43:49-63. http://www.ncbi.nlm.nih.gov/pubmed/34024560?tool=bestpractice.com [3]National Institute for Health and Care Excellence. Faltering growth. NICE guideline QS197 intervention evidence review. Aug 2020 [internet publication]. https://www.nice.org.uk/guidance/qs197

Faltering growth usually results from malnutrition, or undernutrition. This is defined by the American Society for Parenteral and Enteral Nutrition (ASPEN) as 'imbalance between nutrient requirements and intake that results in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes'.[4]Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):460-81. https://aspenjournals.onlinelibrary.wiley.com/doi/full/10.1177/0148607113479972 http://www.ncbi.nlm.nih.gov/pubmed/23528324?tool=bestpractice.com