The diagnosis of faltering growth requires a careful assessment of growth parameters (weight, length/height, and head circumference) over time.
The condition requires a comprehensive evaluation as both medical and psychosocial problems may contribute.
Extensive medical tests are, however, generally not indicated, unless suggested by the history or exam.
Interdisciplinary collaboration is ideal in evaluation and treatment.
Hospitalization should be reserved for severe or recalcitrant cases.
The presence of an organic etiology does not rule out the possibility of psychosocial contributing factors.
Can occur at all socioeconomic levels. Although occurrence may be highest among children from low income families, evidence from the UK reported no association between socioeconomic status and growth at age 12 months.
Faltering growth refers to less than expected growth over time during the first 3 years of life when tracked on appropriate growth charts for children of the same age and sex. However, the definition varies between different healthcare providers, and the criteria used to diagnose the condition must be specified.
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
- signs of dehydration
- cleft lip and/or palate
- signs of abuse or neglect
- small for gestational age
- gastrointestinal problems (reflux, celiac disease)
- poor caregiver knowledge
- poor caregiver-child interaction
- cerebral palsy
- food insecurity
- lack of family mealtime routine
- other medical problems (e.g., fever, cardiac abnormalities)
- swallowing disorder or history of choking
- caregiver depression
1st investigations to order
- according to clinical assessment
- serologic testing for celiac disease
Investigations to consider
- blood lead level
mild faltering growth
moderate faltering growth
severe faltering growth
- 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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