NICE's guidance on faltering growth provides advice for GPs on recognising and managing slow weight gain in infants and children.
In 2015 1% of children aged 4-5 were underweight, according to data collected in the National Child Measurement Programme. The guidance says that the cause of faltering growth can be difficult to determine because there may be a range of contributing factors.
NICE says that where there are concerns about faltering growth parents should be advised to make mealtimes enjoyable, encourage children to feed themselves, allow children to be messy with food, avoid coercive feeding and establish a regular eating schedule.
Supplementary feeding a breastfed baby with infant formula may help with weight gain but often results in cessation of breastfeeding, the guidance says. It recommends that if formula is used the mother should be supported to continue breastfeeding and advised to express breast milk to promote supply and feed her baby with breast milk before giving formula.
In infants or children who need a further increase in the nutrient density of their diet, short-term dietary fortification using energy-dense foods should be considered.
When to refer
Children should be referred to specialist services if they fail to respond to intervention in primary care or if there is slow linear growth, unexplained short stature, rapid weight loss, severe undernutrition or any sign of an underlying disorder or safeguarding concerns.
GPs should also refer infants who lose more than 10% of their birth weight in the early days of life or have not returned to their birth weight by three weeks of age to paediatric services if there is evidence of illness or they have failed to respond to feeding support.