Last reviewed: 7 Jan 2023
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 DifferentialsGuidelines
- 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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