Summary
Faltering growth, previously known as “failure to thrive,” is a condition in which a child’s weight or growth rate is below what is expected for their age. It requires careful monitoring of weight, height, and head circumference over time.
To determine the cause, a comprehensive evaluation is necessary. This includes reviewing medical history, family routines, food availability, meal patterns, and the child’s participation in mealtimes. While medical tests may be performed if needed, they are generally guided by a child’s history and physical examination rather than done routinely.
Faltering growth can be stressful for families, regardless of the cause. It can lead to anxiety and conflicts around feeding, even when there is an underlying medical condition. The condition affects children across all socio-economic backgrounds but may be more common in families with financial hardships or multiple risk factors.
Diagnosis and When to Seek Help
If your child is not gaining weight as expected, appears underweight, or has a slow growth rate, it is important to consult a healthcare provider. Other signs may include:
- Reduced appetite or difficulty eating
- Low energy levels or delayed developmental milestones
- Persistent digestive issues, such as vomiting or diarrhea
A doctor will assess growth patterns using standardized growth charts and evaluate dietary intake, feeding routines, and social factors. Extensive medical tests are usually not necessary unless there are specific concerns based on the child’s history or physical examination.
Management
Addressing faltering growth involves an interdisciplinary approach, which may include:
- Nutritional support: Ensuring adequate calorie and nutrient intake through diet changes or supplements if needed.
- Behavioral and feeding strategies: Encouraging positive mealtime experiences, minimizing stress, and promoting structured meal routines.
- Medical and psychosocial support: Addressing any underlying medical conditions and providing guidance for families experiencing stress or food insecurity.
- Collaboration with specialists: Involving doctors, nutritionists, psychologists, and social workers to develop a tailored plan for the child’s growth and well-being.
Hospitalization is only considered in severe cases when outpatient care is insufficient to support proper growth.
Follow-Up and Monitoring
Regular follow-ups are essential to track progress and adjust interventions as needed. Parents and caregivers should work closely with healthcare professionals to ensure that their child is growing at a healthy rate.
With early intervention and appropriate support, most children with faltering growth can achieve normal development and thrive.
History and Exam
Key diagnostic factors
- presence of risk factors
- faltering growth
- signs of malnutrition
- poor social history
Other diagnostic factors
- family history of faltering growth
- increased caloric loss
- gastrointestinal symptoms
- comorbid medical history
Risk factors
- small for gestational age (SGA)
- gastrointestinal problems (reflux, coeliac disease)
- poor carer knowledge
- poor carer-child interaction
Diagnostic Investigations
1st investigations to order
- according to clinical assessment
- FBC
- iron studies
- chemistry panel
Investigations to consider
- blood lead level
- serological testing for coeliac disease
- stool analysis
- HIV testing or other infectious screen
Book an Appointment
Other Related Conditions
FEEDING PROBLEMS
SLEEP DIFFICULTIES
CHALLENGING BEHAVIOURS
LEARNING DIFFICULTIES
LANGUAGE DISORDERS
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