Faltering Growth in Children

🔍 When to Suspect

A child's weight or rate of weight gain is significantly below that of their peers, typically defined as a fall across ≥1 centile space (birth weight <9th centile), ≥2 spaces (9th–91st centile), or ≥3 spaces (>91st centile) on a growth chart, or current weight below the 2nd centile for age

From the full topic in The Ocean Library: Faltering Growth in Children

🧭 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.

🧠 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

---