Evaluation and Management of Growth Faltering in Children

Initial Assessment

The American Academy of Pediatrics recommends plotting current weight, height, and BMI on appropriate growth charts to determine severity of weight deviation and growth pattern 2
A comprehensive medical evaluation is strongly recommended for children falling off the growth curve for weight with poor appetite, as this may indicate underlying health conditions requiring immediate attention 1
Review of previous growth measurements is essential to establish growth trajectory and determine if poor weight gain is a new or ongoing issue 1
Assessment for signs of malnutrition or dehydration during physical examination is crucial 1
Evaluation of developmental milestones and screening for developmental delays that may impact feeding is necessary 1

A comprehensive feeding history, including typical daily food intake, appetite changes, mealtime behaviors, and food preferences, should be obtained 3
Review of medical history for gastrointestinal symptoms, chronic illnesses, and medications that may affect appetite is important 1
Mealtime behaviors and environment should be evaluated, including factors such as family dynamics and screen time 4, 5

A comprehensive physical exam, including vital signs, signs of malnutrition, and abdominal examination, should be performed 1, 6
Neurological assessment and oral examination for dental issues or structural abnormalities are also necessary 1

For mild weight faltering with no identified medical cause, a structured feeding schedule with regular meals and snacks, focus on nutrient-dense foods, and limitation of sweetened beverages and excessive juice consumption are recommended 3, 4, 5
For moderate to severe weight faltering, a multidisciplinary team approach, individualized feeding plan, and addressing any identified medical conditions are necessary 1, 3
Close monitoring and follow-up are essential for children with significant weight faltering 1