Catch Up Growth in Infants and Young Children with Faltering Growth: Expert Opinion to Guide General Clinicians

Overview

"Catch Up Growth in Infants and Young Children With Faltering Growth: Expert Opinion to Guide General Clinicians" provides key insights and practical approaches for general clinicians dealing with infants and young children experiencing faltering growth. This 2023 paper brought together a group of paediatric nutrition and growth experts to develop recommendations based upon the available evidence, the following are the main points summarised from the expert opin-ion paper for faltering growth in low-, middle-, and high-income countries:

Growth is programmed to occur during a critical window of opportunity and comprises a com-plex interaction between nutritional, genetic, hormonal, and environmental factors. During these critical timeframes, such as during infancy, even a temporary deprivation can result in long term negative consequences for growth and development¹.

Faltering growth definition:

Faltering growth (FG) previously referred to as Failure To Thrive, refers to a deceleration or de-viation from the expected growth trajectory in infants and young children. It is characterized by a decline in weight, length, or head circumference, or a failure to regain growth momentum after a period of growth restriction. There are differing definitions for faltering growth, more commonly known being the National Institute for Health and Care Excellence (NICE)² and the World Health Organisation (WHO)³ definitions, although current definitions exclude timeframes for growth faltering, a point ad-dressed by this expert opinion. As well as for faltering growth, the experts also agree on clear definitions for catch up growth, growth acceleration and normal growth.

Importance of early identification:

Early recognition and intervention are crucial in managing faltering growth to prevent long-term consequences. It is essential for general clinicians to regularly monitor growth parameters and identify deviations from expected growth patterns.

Underlying causes of faltering growth:

Faltering growth can be attributed to various factors, including inadequate caloric intake, malabsorption, chronic illness, feeding difficulties, or psychosocial factors such as neglect or poverty. Identifying the underlying cause is essential for appropriate management.

Evaluation and assessment:

Healthcare professionals should be aware of the potential risk of malnutrition in children admitted to hospital and identify those at risk. Clinicians should conduct a thorough evaluation, including a detailed history, physical examination, assessment of feeding practices, and laboratory investigations to identify any medical or psychosocial factors contributing to faltering growth.

Nutritional interventions

Nutritional management of FG requires a balanced ratio of energy and protein, as well as micronutrients for optimal catch-up. Clinicians should assess the adequacy of caloric intake, as well as addressing the underlying causes. Supporting breastfeeding should be a priority in both disease and non-disease-related FG with an assessment of technique and supply, and only where appropriate consider nutritional supplementation. In formula fed infants, ready to use energy dense feeds with proven efficacy should be used where indicated.

Follow-up and monitoring:

Regular monitoring of growth parameters, against an appropriate target for catch up growth is essential to assess the effectiveness of interventions. Clinicians should closely follow up with patients, provide ongoing support, and reassess the need for further interventions as the child's growth progresses.

Multidisciplinary collaboration:

Managing faltering growth often requires a multidisciplinary approach involving healthcare professionals from various disciplines. Collaboration and communication among team members are crucial for comprehensive care.

FG in infants and children under 2 years of age is commonly seen in clinical practice. Overall, this expert opinion highlights the importance of early identification, thorough evaluation, appropriate interventions, and multidisciplinary collaboration in managing catch up growth in infants and young children with faltering growth.