Visual summary

Faltering Growth
In the early days of life some weight loss is common and is usually a physiological
Weight loss in the early days of life phenomenon associated with fluid shifts. The term ‘faltering growth’ is used to describe a
pattern of slower weight gain than expected for age and sex in infants and preschool children,
Normal weight pattern and it is most often due to inadequate nutritional intake.
Birth Faltering growth is complex and often multifactorial. Parents may feel ‘blamed’ for their
weight child’s slow weight gain. Health care professionals should remain alert to the possibility of a
safeguarding concern, but should be sensitive to the emotional impact of caring for a child
Up to 10% weight Birth weight usually with faltering growth.
loss in early days regained before 3 weeks

0 1 2 3 Faltering growth after the early days of life

Weeks
If more than 10% of birth
All birth Below 9th 9th–91st Above 91st
weight lost in early days If not returned to birth Birth weight weights centile centile centile
weight by 3 weeks

Clinical 1+ 2+ 3+
Further
assessment investigations Thresholds Current weight A fall across A fall across A fall across
Take a detailed history is below the 1 or more 2 or more 3 or more
to assess feeding Only if indicated based for concern
2nd centile weight centile weight centile weight centile
on clinical assessment for age spaces spaces spaces
Look for evidence of:
or concern about
Dehydration amount of weight loss

An illness or disorder
that might account Observation Offer assessments Observations
for weight loss Consider direct Consider direct observation of feeding or meal times
Clinical Social
observation of feeding
Developmental
Further investigations
Consider Refer to paediatric services if there is Take a detailed history Consider investigations for:
evidence of illness, marked weight loss, of feeding or eating
referral or failure to respond to feeding support
Urinary tract infection Coeliac disease

Management strategies
Food and drink choices Feeding and mealtime strategies
If necessary, based on the assessment, advise on food choices that: Discuss possible strategies with parents or carers,
are appropriate to the child's developmental optimise energy based on assessments, history, and observations
stage in terms of quantity, type, and food texture and nutrient density Encouraging relaxed and Eating together as a family
enjoyable feeding and mealtimes or with other children
In infants or children who need a further increase in the nutrient density of
their diet beyond that achieved through advice on food choices, consider: Encouraging young children Allowing young children to
to feed themselves be ‘messy’ with their food
short-term dietary fortification referral to a
using energy-dense foods paediatric dietitian
Making sure feeds and mealtimes Establishing regular eating
are not too brief or too long schedules
Advise the parents or carers of infants or children with faltering growth that
drinking too many energy-dense drinks, including milk, can reduce a child's Setting reasonable boundaries for mealtime Avoiding
appetite for other foods. behaviour while avoiding punitive approaches coercive feeding

Consider referral

Is there any evidence of any of the following? No Consider management strategies,

Symptoms or signs that may
indicate an underlying disorder
Rapid weight loss
Slow linear growth
Unexplained short stature
Safeguarding concerns
and when to reassess
Failure to respond to
interventions in primary care
Yes Discuss with or refer to an appropriate
Severe undernutrition pediatric specialist care service

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