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 exam.
Interdisciplinary collaboration, involving medical professionals, psychologists, nutritionists, and social workers, with other specialists as needed is recommended.
Hospitalization should be reserved for severe or recalcitrant cases.
Growth faltering is often a major concern for families regardless of the etiology and can cause stress, anxiety, and caregiver-child conflict, even in the presence of an organic etiology.
Growth faltering can occur at all socioeconomic 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. As the definition varies between different healthcare providers, the criteria used to diagnose the condition must be specified.
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.”
History and exam
Key diagnostic factors
- faltering growth
- signs of malnutrition
- poor social history
- poor quantity or quality of food or fluid intake
- lack of clarity in communication between parent and child
- abnormal feeding/eating behavior
- perinatal complications
Other diagnostic factors
- family history of faltering growth
- increased caloric loss
- gastrointestinal symptoms
- comorbid medical history
- recurrent ear infections
- recent surgery/burns
- cleft lip and/or palate
- small for gestational age (SGA)
- gastrointestinal problems (reflux, celiac disease)
- poor caregiver knowledge
- poor caregiver-child interaction
- cerebral palsy
- lack of family mealtime routine
- chronic medical problems
- swallowing disorder or history of choking
- caregiver depression
1st investigations to order
- according to clinical assessment
- iron studies
- chemistry panel
Investigations to consider
- blood lead level
- serologic testing for celiac disease
- stool analysis
- HIV testing or other infectious screen
- Small but healthy
- Small for gestational age
- Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition
- Faltering growth: recognition and management of faltering growth in children
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