Poor Growth

Poor growth in early childhood may have important long-term consequences through its influence on adult body size and composition and is associated with increased morbidity and perhaps mortality.

There is no consensus on a definition of failure to thrive (FTT).

The most common definition in practice is:

  • weight decline on centile lines or
  • weight falling below the lowest centile.

Assessment and monitoring of a child with poor weight gain requires:

  • ensure that the child is assessed and reviewed by a doctor
  • more frequent weight and growth monitoring as advised by a doctor and/or dietitian
  • consider genetics particularly for short-stature children
  • follow-up assessment for illness or organic disease
  • ensure illness, or underlying clinical conditions are excluded or well managed
  • accurate assessment of feeding and intake
  • nutritional interventions for 'catch-up' growth or maintenance of current growth trajectory are implemented by a doctor and/or dietitian, with follow-up by Maternal and Child Health (MCH)
  • sensitivity and partnership approach − if a child has been under medical investigation because of poor growth and no physical problem has been identified, parents are likely to feel blamed, inadequate and under suspicion of neglecting their child.

Activities

Growth assessment depends on precise measurements and careful plotting and interpretation of these findings.

Activity G

Phoebe is an eight-month girl weighing 6.5 kg. Her previous weights were:

  • birth weight − 2.8 kg
  • two months − 4.3 kg
  • four months − 5.5 kg

Figure G.1 shows Phoebe's weight for age plotted on a WHO growth chart. Overall, her weight is tracking along the 5th centile, but this example shows a normal variation in month-to-month weight gain. In context with assessment of her overall health and development, review her weight gain as per MCH practice guidelines, or in one to two months time if concerned

Figure G.1 WHO birth to 24 month weight for age, girl
Figure G.1 WHO birth to 24 month weight for age, girl
Source: World Health Organisation Child Growth Standards

Activity H

Mia is 12 months old and her weight is 8250 g. She was born at term; her previous weights were:

  • birth weight − 3830 g
  • two months − 5780 g
  • four months − 6750 g
  • eight months − 8050 g

Figure H.1 shows Mia's weights plotted on the WHO growth chart. Her weight has dropped from the 75th centile at birth, to the 25th centile at 12 months. In context with assessment of her overall health and development, refer for medical assessment or review in one month.

Figure H.1 WHO birth to 24 months weight for age, girl
Figure H.1 WHO birth to 24 months weight for age, girl
Source: World Health Organisation Child Growth Standards

For further information, see: Poor Growth (pdf - 79.19kb)