Every parent measures their child against some internal benchmark – the weight chart at the GP surgery, the size of children in their NCT group, the clothes that fit or suddenly don’t. Most of the time, variation is just variation. Children grow at different rates, have weeks where they eat well and weeks where they barely touch a meal, and none of this is cause for alarm.
But when a child is consistently falling below expected growth trajectories – not just having a slow week, but showing a pattern of inadequate weight gain or growth over time – it’s worth understanding what might be happening. Growth faltering, also known as failure to thrive, is a clinical term for exactly this situation. It’s not a diagnosis in itself but a description of a pattern that needs investigating.
What Is Failure To Thrive And How Is It Defined?
Growth faltering describes a pattern of inadequate physical growth in a child that isn’t explained by their constitutional make-up or genetics. Clinically, it’s typically identified when a child’s weight crosses two or more centile lines downward on a growth chart over time, when weight falls below the 2nd centile for age and sex, or when the rate of weight gain is significantly slower than expected for a sustained period.
It’s important to separate this from normal variation. A child who is small but growing consistently along a low centile is likely to be constitutionally small, particularly if their parents are. Growth faltering is about trajectory – a change in the pattern – rather than a single measurement.
What Are The Signs Of Growth Faltering In Children?
The most visible sign is inadequate weight gain over a period of weeks or months. In infants, this may present as failure to regain birth weight within the expected two-week window, or weight that plateaus or decreases after an initial normal gain. In older children, it may be more gradual and easier to miss without regular measurements.
Associated signs can include: missing child development milestones, persistent feeding difficulties or poor appetite; frequent illness suggesting reduced immunity; low energy levels or developmental delays in motor skills; reduced subcutaneous fat (the layer under the skin that gives children their characteristic chubbiness); and clothing or nappy sizes that haven’t changed over a longer period than you’d expect.
What Causes Growth Faltering?
The causes divide broadly into three categories, though in practice they often overlap.
Inadequate caloric intake is the most common cause. This can stem from feeding difficulties, poor appetite, behavioural food refusal, or in some cases parental or caregiver circumstances that affect the amount or quality of food available. It can also result from breastfeeding difficulties in early infancy that reduce milk intake without either parent being aware of the shortfall.
Malabsorption occurs when the child is taking in adequate calories but the gut is not absorbing nutrients effectively. Coeliac disease, cystic fibrosis, cow’s milk protein allergy, and other gastrointestinal conditions can all reduce absorption. These conditions require diagnosis through specific tests rather than dietary intervention alone.
Increased metabolic demand means the child’s body is using more energy than a typical child of the same age. Cardiac conditions, chronic infections, kidney disease, and thyroid problems can all increase the body’s energy requirements in ways that outstrip normal intake.
How Is Growth Faltering Diagnosed?
The process begins with a thorough clinical assessment: detailed feeding history, a complete medical history, physical examination, and careful review of growth chart measurements over time. Blood tests, urine tests, and in some cases stool tests are used to screen for underlying conditions that might explain the pattern. Depending on initial findings, referral to subspecialties – gastroenterology, cardiology, endocrinology – may follow.
The assessment requires time and clinical thoroughness that can be difficult to access through NHS paediatric services, where waiting times for non-urgent referrals can be lengthy. If you’re concerned about your child’s growth and need a prompt assessment, we offer private healthcare for infants and children in London, allowing you to access a paediatric consultant quickly with the diagnostic tests needed to begin answering the question without a prolonged wait.
How Is Growth Faltering Treated?
Treatment depends entirely on the underlying cause. Where the primary issue is inadequate caloric intake, nutritional intervention is the starting point – this may involve working with a paediatric dietitian to increase caloric density of feeds or meals, addressing feeding difficulties, or in some cases using supplemental nutrition. Where an underlying medical condition is identified, treating that condition is the priority.
Regular monitoring of weight and growth is an integral part of management regardless of the cause. Progress needs to be tracked closely enough that the treatment plan can be adjusted if the response isn’t adequate.
Why Grosvenor Gardens Healthcare
Grosvenor Gardens Healthcare’s paediatric team in Belgravia and Dulwich provides consultant-led assessments for children across a full range of health concerns, including growth and development. Our consultants trained at leading UK teaching hospitals, and the one-stop clinic model means that initial assessment, blood tests, and follow-up can be managed efficiently in one place rather than across multiple appointments.
If you’re worried about your child’s growth and want answers without a lengthy wait, book a paediatric consultation at Grosvenor Gardens Healthcare and begin the process of finding out what’s actually happening.
FAQs
At what point should I take my child to a doctor about slow weight gain?
If your child’s weight has crossed two or more centile lines downward on their growth chart, if they are consistently below the 2nd centile and showing other signs of poor nutrition, or if you simply feel something isn’t right about their eating or growth pattern, that’s reason enough to seek an assessment. Trust your instinct as a parent. A paediatric consultation will either reassure you or identify something that needs attention, and either outcome is better than continued uncertainty.
Is growth faltering the same as being a small or fussy eater?
Not exactly. Many children go through phases of fussy eating or slow periods of growth without it constituting growth faltering. The distinction lies in the pattern over time: a consistently downward trajectory on a growth chart, particularly when accompanied by other signs like low energy or frequent illness, warrants investigation in a way that ordinary pickiness does not.
Can growth faltering affect my child’s development beyond physical growth?
Yes, particularly when it’s prolonged or severe. Adequate nutrition is essential for brain development, cognitive function, and emotional wellbeing. Children with significant growth faltering sometimes show delays in motor development, speech, or cognitive milestones. This is one of the reasons that early identification and intervention matter – the sooner the underlying cause is found and addressed, the lower the risk of longer-term developmental impact.
Will my child need to be admitted to hospital for growth faltering?
Hospital admission is reserved for cases where growth faltering is severe, where there is a concern about the child’s immediate safety, or where investigations require inpatient monitoring. The majority of cases are managed on an outpatient basis, with a combination of nutritional support, regular monitoring, and where necessary, treatment of an underlying condition.
Can breastfed babies experience growth faltering?
Yes, and this is sometimes harder to detect because breastfed babies can’t have their intake measured directly. Inadequate milk supply, difficulties with latch or feeding position, and feeding too infrequently are all potential contributors. If a breastfed baby is not regaining birth weight within two weeks, is feeding very frequently without seeming satisfied, or is producing fewer wet nappies than expected, a feeding assessment and weight check are warranted.
