I need a lecture about failure to thrive

Clinical answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Causes of Failure to Thrive (Faltering Growth) in Children

Faltering growth in children can result from a complex interplay of factors including inadequate nutritional intake, feeding difficulties, underlying medical conditions, and psychosocial issues. Common associated factors include preterm birth, neurodevelopmental concerns, maternal postnatal depression or anxiety, and feeding aversion or ineffective feeding techniques (e.g., ineffective suckling or bottle feeding) .
Underlying medical causes may include gastrointestinal disorders such as coeliac disease or inflammatory bowel disease, infections like urinary tract infections, and malabsorption syndromes .
In some cases, failure to thrive may be multifactorial with no single clear cause, and difficulties in parent-child feeding interactions may contribute but not be the primary cause .

Diagnostic Approaches

Diagnosis begins with careful measurement and plotting of weight, length (under 2 years), or height (over 2 years) on UK WHO growth charts to identify faltering growth, defined by specific centile falls depending on birthweight and current weight centiles .
Clinical, developmental, and social assessments are essential, including detailed feeding and eating histories and, where appropriate, direct observation of feeding or mealtimes by trained professionals .
Investigations should be guided by clinical findings; routine extensive investigations are not recommended in well-appearing children without other clinical concerns. Targeted investigations may include screening for urinary tract infection, coeliac disease, and other relevant conditions based on history and examination .
Additional assessments may include calculating BMI centiles in children over 2 years to assess for undernutrition and considering parental heights to evaluate growth potential .
Keeping a food and mealtime diary can help identify feeding patterns, food intake, and behavioural issues contributing to faltering growth .
In cases of suspected malabsorption or inflammatory bowel disease, further specialist investigations and nutritional assessments are warranted, as these conditions can cause growth delay and nutrient deficiencies .

Management Strategies

Management should be multidisciplinary, involving paediatricians, dietitians, infant feeding specialists, speech and language therapists, psychologists, and occupational therapists as needed, coordinated by a lead healthcare professional .
Feeding support is critical, especially in the early weeks of life, with encouragement of relaxed, enjoyable feeding and mealtimes, family eating, self-feeding in young children, and avoidance of coercive or punitive feeding practices .
Parents should be supported with clear, specific information tailored to their child’s needs, including advice on appropriate food types, textures, and nutrient density to optimize energy intake .
Supplementary feeding with infant formula may be considered in breastfed infants with faltering growth but should be accompanied by support to continue breastfeeding and promote milk supply through expressing breast milk .
For children with continuing faltering growth despite dietary advice, short-term dietary fortification with energy-dense foods or oral liquid nutritional supplements prescribed by a paediatric dietitian may be beneficial .
Enteral tube feeding is reserved for severe cases with serious concerns about weight gain after thorough multidisciplinary assessment and failure of other interventions .
Regular monitoring of growth, feeding tolerance, and adherence to interventions is essential to assess progress and adjust management plans accordingly .
In children with underlying inflammatory bowel disease or malabsorption, management includes addressing the primary disease, monitoring for nutritional deficiencies, and supporting growth and pubertal development .

Key References

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