Faltering growth

What is faltering growth?

Faltering growth describes children who are not achieving their expected growth potential. It is caused by an inadequate energy intake, usually when food is not available or when a child doesn’t eat enough. With nutrition being one of the most important factors determining growth and development in these early years, an absence or lack of food (for whatever reason) is likely to cause the problem.

Factors contributing to faltering growth

Medical/organic factors	Parental Factors	Child factors
Unable to absorb or utilise nutrients e.g. cystic fibrosis Excessive loss of nutrients e.g. vomiting, diarrhoea Increased nutrient requirements due to medical condition e.g. cardiac or respiratory failure Unable to achieve adequate intake e.g. due to chewing, swallowing difficulties	Parental attitudes and cultural beliefs Family difficulties Poverty Child neglect	Poor appetite Excessive juice drinking Poor dentition Feeding difficulties e.g. sucking, swallowing difficulties

Recognising faltering growth
Identifying children with or at risk of faltering growth is vital. You can usually tell where faltering growth is an issue from their reduced weight, so regular weight reviews every 6 to 8 weeks should reveal any growth issues. Where you have any concerns about a child’s growth, a growth chart on which you can plot their weight, height and head circumference is a useful clinical tool to use.

Managing faltering growth
A multidisciplinary team approach to the management of faltering growth is essential, so you should develop a comprehensive food and feeding plan (giving consideration to contributing medical and psychological aspects).

Nutritional management
You should conduct a full dietary and feeding assessment to understand the child’s dietary intake and any behavioural feeding problems, which may be contributing to a reduced food intake.

Your nutritional management objectives
Your key objectives when implementing a feeding plan to manage faltering growth should be:

• Improve energy intake
• Promote weight gain for catch-up growth and to achieve optimum growth 
• Correct any nutritional deficiencies 
• Encourage adequate oral intake to meet nutritional requirements

Your guide to improving nutritional intake
To encourage catch-up growth and weight gain, you will need to promote a high-energy high protein diet – but because children may have a small appetite it can be difficult to achieve these high intakes.

You can consider the following ways to increase their energy intake:

• Add extra butter, margarine or oil to all vegetables, potatoes, pasta, rice, casseroles
• Spread butter thickly on bread
• Mix full fat cheese, full fat cream cheese or cream into foods e.g. grated cheese can be added to savoury foods such as vegetables, mashed potatoes, scrambled egg, soups, sauces, casseroles and pasta dishes
• Add extra cream, ice cream evaporated or condensed milk to puddings
• Encourage high calorie desserts such as full fat yoghurts, sponge and custard, rice pudding
• Offer high energy snacks such as soft cheese/cheese triangles on crackers, fromage frais or yoghurt, toast with butter and jam or peanut butter*, or cheesy snack biscuits
• Only offer nourishing fluids to drink such as milky drinks, home-made milkshakes or smoothies made with whole milk, full fat yoghurt or ice-cream and fresh fruit
• For children who are unable to take an adequate oral intake of everyday foods and drinks, an oral nutritional supplement may be necessary and can be prescribed – such as Resource Junior or Clinutren Junior

* Whole nuts and seeds should not be given to children under the age of 5 years