Faltering growth

Last reviewed: 18 Apr 2022
Last updated: 13 Jan 2021

Summary

Definition

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
More key diagnostic factors

Other diagnostic factors

  • family history of faltering growth
  • increased caloric loss
  • gastrointestinal symptoms
  • comorbid medical history
  • recurrent ear infections
  • recent surgery/burns
  • signs of dehydration
  • cleft lip and/or palate
  • signs of abuse or neglect
Other diagnostic factors

Risk factors

  • small for gestational age
  • gastrointestinal problems (reflux, celiac disease)
  • poor caregiver knowledge
  • poor caregiver-child interaction
  • cerebral palsy
  • prematurity
  • poverty
  • food insecurity
  • lack of family mealtime routine
  • autism
  • other medical problems (e.g., fever, cardiac abnormalities)
  • allergies
  • swallowing disorder or history of choking
  • caregiver depression
More risk factors

Diagnostic investigations

1st investigations to order

  • according to clinical assessment
  • CBC
  • urinalysis
  • serologic testing for celiac disease
More 1st investigations to order

Investigations to consider

  • blood lead level
More investigations to consider

Treatment algorithm

ACUTE

mild faltering growth

moderate faltering growth

severe faltering growth

Contributors

Authors

Howard Dubowitz, MD

Professor

Department of Pediatrics

University of Maryland School of Medicine

Baltimore

MD

Disclosures

HD declares that he has no competing interests.

Maureen Black, PhD

Professor

Department of Pediatrics

University of Maryland School of Medicine

Baltimore

MD

Disclosures

MB declares that she has no competing interests.

Peer reviewers

Randal Rockney, MD

Associate Professor of Pediatrics and Family Medicine

Department of Pediatrics

Hasbro Children's Hospital

Providence

RI

Disclosures

RR declares that he has no competing interests.

Philip Fischer, MD

Professor of Pediatrics

Mayo Clinic

Rochester

MN

Disclosures

PF declares that he has no competing interests.

  • Differentials

    • Small but healthy
    • Small for gestational age
    • Prematurity
    More Differentials
  • Guidelines

    • Essential Nutrition Actions: improving maternal, newborn, infant and young child health and nutrition
    • Faltering growth: recognition and management of faltering growth in children
    More Guidelines
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