GPAtlas🧭 When to suspect
Faltering growth (the modern term for what was called ‘failure to thrive’) describes a slower rate of weight gain than expected for an infant or preschool child’s age and sex. It is a descriptive pattern, not a diagnosis – most cases are nutritional and non-organic, but an underlying cause must always be considered. It is common, with concerns arising in up to ~5% of infants and preschool children.
Recognition rests on plotting growth on the UK-WHO growth chart (World Health Organization reference charts used across the UK) and applying the NICE thresholds for concern. A centile space is the gap between two adjacent printed centile lines on the chart. Suspect faltering growth when the fall in weight centiles meets the birth-weight-dependent threshold below, or when current weight is below the 2nd centile for age.
| Scenario | Threshold for concern |
|---|---|
| Birth weight below the 9th centile | A fall across 1 or more weight centile spaces |
| Birth weight 9th–91st centile | A fall across 2 or more weight centile spaces |
| Birth weight above the 91st centile | A fall across 3 or more weight centile spaces |
| Any birth weight | Current weight below the 2nd centile for age |
Two definitions of terms used throughout: an infant is a baby up to 1 year of age, and a child here means a preschool child from 1 year onwards.
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🧠 Clinical pearl The pattern of centile fall hints at the cause. In the common nutritional picture, weight falls first while length and head circumference are relatively preserved. If weight and length fall together, think a more significant problem – an endocrine or genetic cause. If head circumference falls early too, be more concerned about a serious systemic or neurological disorder. |
Source: NICE NG75
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