faltering growth
Faltering growth Faltering growth, previously known as failure to thrive (FTT) and also known as weight faltering, is the term used to describe infants and young children who fail to achieve expected growth for their age as measured by their weight and length or height and plotted on a suitable growth chart.
Kate Harrod-Wild Specialist Paediatric Dietitian, Betsi Cadwaladr University Health Board
This can be identified by the weight crossing two centile spaces downwards, or where a difference of more than two centile lines between the weight measurement and length or height persists over several measurements. Sometimes dietitians will see children, particularly infants, in their clinics who have been referred because of a low weight. However, this is meaningless in most cases if not accompanied by a length or weight measurement, as the child may simply be small, and primary healthcare professionals need to ensure that length or height is measured where concerns regarding weight emerge. However, if both weight and length or height is below the 0.4th centile, then this is considered abnormal and investigations should be carried out to try and establish the cause. On the UK 1990 growth charts that were used until the mid-2000s, about five percent of children would have an episode of growth faltering. However, on the newer WHO growth charts, based on the slower pattern of growth of breastfed babies to
six months, only about 0.5% of babies are less than the 2nd centile at 12 months (1). Historically, ‘failure to thrive’ was divided into organic and non-organic. However, this is now considered to be unhelpful, as few children with faltering growth have organic disease. The evidence suggests that organic disease is unlikely in children who are asymptomatic and well on examination, so that investigations should only be used to rule out rare major conditions (see Table 1) rather than to identify a cause of the faltering growth (2). Routine weight monitoring should identify most cases of faltering growth; it is recommended that this should occur during the first week as part of the assessment of feeding and at eight weeks, 12 weeks, 16 weeks, one year (usually around the time of immunisations), and whenever concerns are raised. However, a population study of children with weight faltering found that although children were identified at a mean age of 15.5 months, the slowing of their weight
Table 1: Possible investigations to carry out in secondary care (2)
Kate Harrod-Wild is a paediatric dietitian with over 20 years of experience of working with children in acute and community settings. Kate has also written and spoken extensively on child nutrition.
Investigation
Indications
Possible cause
Full blood count Ferritin
Any persistent weight faltering Any persistent weight faltering
Urea and electrolytes
Any persistent weight faltering
Thyroid function tests Coeliac blood tests Mid-stream urine Chromosome analysis
Any persistent weight faltering Any persistent weight faltering Any persistent weight faltering Girls Infants under three months; history of chest infection History of respiratory infection Solid diet is limited, dark skin
Anaemia, leukaemia Iron deficiency Renal failure, electrolyte abnormalities Thyroid disease Coeliac disease Urinary tract infection Turner’s syndrome Cardiac abnormalities; cystic fibrosis Cystic fibrosis Rickets
Chest radiograph Sweat test Vitamin D levels
NHDmag.com April 2015 - Issue 103
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