Having a long-term health
condition that affects
appetite or the way the
body absorbs nutrients
NUTRITIONAL MANAGEMENT IN CHILDREN WITH FALTERING GROWTH
The term ‘faltering growth’ (previously called ‘failure to thrive’) refers to slower growth or weight gain in childhood than is typically expected for their age and gender.1
It is normal for newborn infants to lose weight in the early days of their life and for children to grow at different rates, however, persistent or significant weight loss is often a cause for concern for healthcare professionals (HCPs) and parents or carers.1
Whilst there are a variety of causes of faltering growth, insufficient nutritional intake is usually the leading cause.1 Whilst each child grows at different rates and some weight loss can be expected, particularly for newborn infants, significant weight loss is a concern, and it is vital that this is investigated, managed and monitored.1,2
Faltering growth is typically caused by insufficient nutritional intake to meet energy requirements. However, certain health conditions, such as cystic fibrosis or coeliac disease, can also impact growth, as can persistent problems with appetite and feeding.1
It is important to note that in the absence of an underlying health condition, the cause of faltering growth could be multifactorial and may be a result of:1,3
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Socio-economic status
Educational disadvantage
Social/family factors, such
as parental mental health
or neglect
Having a long-term health
condition that affects
appetite or the way the
body absorbs nutrients
Having a condition which
increases energy
requirements
Dysphagia
Taking medicines that
cause symptoms, such as
nausea, reduced appetite
or diarrhoea
Having an eating disorder
or behavioural condition
Gastrointestinal (GI)
conditions that can cause
malabsorption
Faltering growth and undernutrition in children can have significant consequences, including:6,7
Stunting
Impaired cognitive
function
Developmental delay
Persistent problems
with appetite and
feeding
Reduction in IQ that
can continue into
adulthood
Increased risk of
mortality
Faltering growth can also significantly impact the parents/carers of the child, who may often feel blamed or unheard. Understanding parents’ perspectives is an important part of intervention strategies, which should be tailored to the child and their family.1
For infants who lose more than 10% of their birth weight in the early days of life, a clinical assessment should be performed to identify whether there may be evidence of dehydration or an underlying illness.1
For infants who experience faltering growth after the early days of life, the World Health Organisation (WHO) growth charts should be used as part of routine monitoring of a child’s growth and development. These growth charts plot the child’s weight, length (or height), and head circumference to indicate growth over time.1
If faltering growth is indicated:1
A validated nutrition screening tool for use in hospitalised children from 2 weeks to 16 years of age.
A validated, easy-to-use digital nutritional awareness tool that supports HCPs in completing a nutrition-focussed consultation.
MUAC Z-score tapes are a simple, inexpensive and easy way to measure malnutrition risk in children.
Nutritional management for children with faltering growth is usually community-based, with nutritional support and intervention aiming to increase energy intake to support growth. Sometimes, the child may need to be referred to a dietitian or paediatrician.1
For older infants or children, a food-first approach should be taken. Oral nutritional supplements may be required where faltering growth continues despite other interventions. If there are severe concerns about weight and growth, enteral tube feeding may need to be considered.1
Nutritional strategies and interventions should be established with the child’s parents or carers. Specific goals set to meet the child’s individual requirements should be set and monitored regularly.1
PaediaSure® Plus
PaediaSure Plus is suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. PaediaSure Plus provides 1.5 kcal/ml and is available both as a 500 ml Ready to Hang tube feed and as a 200 ml oral nutritional supplement.
PaediaSure® Compact
PaediaSure Compact is a 125 ml oral nutritional supplement suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. It has been specifically developed for children who may benefit from a smaller volume, as an alternative to ready-to-drink supplements which are 200 ml in volume. Each bottle provides 301 kcal (2.4 kcal/ml) and 8.4 g of protein. The milkshake style oral nutritional supplement is ready-to-drink and available in three delicious flavours: banana, strawberry and vanilla.
Similac® High Energy
Similac High Energy is a 1.0 kcal/ml, nutritionally complete, high energy, ready-to-use infant formula for special medical purposes for infants from birth to 8 kg with, or at risk of, faltering growth. It is particularly suitable for infants who may have increased energy requirements or are fluid restricted. Similac High Energy is available in 200 ml bottles, which attach directly to Abbott giving sets
In this course, you’ll define malnutrition, characterise the role of the dietitian and other healthcare professionals in assessing nutrition requirements, describe the impact of specific conditions on nutrition requirements, and discuss expectations for catch-up growth.
In this course, Helen McCarthy will define paediatric malnutrition and its prevalence in the UK, review the role of paediatric malnutrition screening tools in practice, and evaluate the paediatric malnutrition screening tools currently available for identifying malnutrition.
References:
1. NICE, 2017. Faltering growth: recognition and management of faltering growth. Available online: www.nice.org.uk/guidance/ng75 Last accessed March 2024
2. Paediatr Child Health 2004 Mar;9(3):177-90
3. Sheffield Children’s NHS Foundation Trust, 2022. Faltering Growth / Failure to Thrive. Available online: https://www.sheffieldchildrens.nhs.uk/download/628/medicine/9839/1074_faltering_growth_failure_to_thrive.pdf Last accessed February 2024
4. NHS 2023. Malnutrition. Available online: https://www.nhs.uk/conditions/malnutrition Last accessed February 2024
5. Westwood A S. Afr Med J 2015;105(7):606
6. NICE, 2023. Faltering growth: What are the implications. Available online: https://cks.nice.org.uk/topics/faltering-growth/background-information/complications/#:~:text=Potential%20complications%20of%20faltering%20growth,Developmental%20delay. Last accessed March 2024
7. Mertens A et al. Nature 2023;621:568-576
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ENSURE PLUS
1 x 220 ml
Flavor: Apple
1,5 kcal / ml
Nutrition Information
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| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
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