Growth faltering is the term used to describe the deviation of a child’s weight or height from their usual (or expected) centile line found in child growth charts (in the red book or community child record). It can be intensely worrying for parents if a child is not gaining the expected amount of weight in infancy or is either tall for weight (and consequently very thin) or smaller than their peers.  Growth faltering is also referred to as failure to thrive, poor growth or weight faltering. Normal weight gain is a reflection of nutritional intake that meets the needs for growth during the first 2 years of life, and height is considered to be a more important marker of this after two years of age. The term stunted is often used when referring to small height for age.

Measuring growth

Weight faltering affects around 10% of children in the UK and is more common in children with medical and social problems. It usually happens during infancy when growth is rapid and energy and nutrient needs are high.   Nutrient needs in the early years can be 4 – 5 times greater than an adult.  It may be detected using the growth chart and centile lines in your child’s red book; when weight falls below the bottom line or crosses more than two centile lines downwards on the growth chart. Growth measurements are typically taken and plotted on growth charts at birth, 6 weeks, 6 months, one year and age 2. There is no need to have weight checked more regularly that this unless a problem is suspected. Children with severe growth faltering should see their Doctor, and may be referred to a Paediatrician, to ensure there is no underlying medical cause for the poor growth. For children who are thin (weight centile more than two lines below height centile) or smaller than average (2nd – 25th centile) but continue to follow their “usual” centile line there is unlikely to be a problem. Small fluctuations in the weight centile are common due to short-term illness that affects food intake.

Causes of growth faltering

The most common cause of growth faltering is insufficient energy and nutrient intake to meet needs for growth during infancy. During the early years, children with gastrointestinal, food allergic or feeding problems, including extreme food refusal, growth may be affected or limited by these conditions. Determining the reason for insufficient nutritional intake is a first step to finding the right solution. Strategies to improve intake, education about foods and nutrients, food fortification and taking account of individual and family circumstances are discussed to find the right nutritional approach to help optimise growth and wellbeing. Paediatric Dietitians are the recognised experts in this field.