FFinalistSouthampton · 2027
Child health
AKT · Child health/Growth, GI & MSK

Faltering growth

Inadequate weight gain (multifactorial)

Overview

Failure to gain weight at the expected rate — a sustained drop across centiles. Causes span inadequate intake, malabsorption, increased requirement and psychosocial factors; most cases are non-organic.

Recognise

  • Sustained fall across weight centiles (≥2 spaces depending on birthweight centile)
  • Assess intake, feeding technique, stooling, development
  • Look for organic clues and psychosocial/neglect factors

Red flags

  • Signs of neglect/abuse; severe malnutrition; organic red flags (chronic diarrhoea, recurrent infection, dysmorphism)

Differentials & how to tell them apart

Coeliac diseaseintroduction of gluten, anaemia, positive TTG
Cystic fibrosissteatorrhoea, chest infections, positive newborn screen/sweat test
Cow milk protein allergyallergic features, responds to elimination
Non-organic/feeding difficultymost common; psychosocial assessment

Investigations

Detailed feeding/growth history, plot on growth chart, observe a feed. Targeted tests only if organic features: FBC, U&E, coeliac serology, CRP, TFTs, urine, stool.

Management

Multidisciplinary feeding support; treat any identified organic cause

  1. 1Multidisciplinary assessment: feeding history, observe a feed, plot growth, support intake. Most cases are non-organic.
  2. 2Investigate only if organic features; involve dietitian, health visitor, safeguarding if concern.
Optimise calorie intake / feeding support — dietitian-led; treat any organic cause

Key points

Most faltering growth is NOT organic — investigations are guided by red flags, not done routinely.

Monitor & prognosis

Serial weights/growth; feeding; development; safeguarding.

Good when intake optimised; depends on cause.

Source: NICE NG75 (faltering growth)