Please click the relevant flowchart box to be taken directly to textual information.
The growth of an infant falls below the 0.4th centile or crosses 2 centiles downwards on a growth chart or weight is 2 centiles below length centile.
Look for features of any medical disorder that might explain poor growth. Usually faltering growth is due to undernutrition without an underlying medical disorder. If signs or symptoms suggest an underlying problem (e.g. congenital heart disease or respiratory illness), refer to paediatrics. Consider a dipstick test for urinary tract infection and blood tests for coeliac disease if the diet includes gluten.
Please see the Early Years – UK - WHO growth charts and resources.
Breast fed baby:
Breastfeeding is recognised as best for baby, and the benefits of breastfeeding extend well beyond basic nutrition. Health professionals should encourage breastfeeding and ensure that support is given if needed.
If any difficulties with breastfeeding, refer to the midwife or health visitor for expert advice and support.
If baby is less than 28 days old with exceptional or ongoing feeding problems contact the Specialist Infant Feeding Midwife on 07799341200 (please do not give this number to the patient).
Unresolved feeding concerns for babies more than 28 days old can be discussed with the Health Visiting Infant Feeding Lead on 07798534298 (please do not give this number to the patient).
Please also see Countywide Infant Feeding Pathway.
Well infants with faltering growth should be referred for support and advice from their health visitor initially.If advice and support in the community does not lead to improved growth, consider referral to secondary care (paediatric services).
Unwell children should be referred to paediatric services.
If concerns are urgent contact Paediatric Consultant Advice Line on 0300 4225800.
Alternatively refer to Paediatrics or contact the Paediatricians via Advice and Guidance.
The team to whom the infant is referred should indicate who is responsible for review and discontinuation. If the team hand responsibility back to the GP this should be with an indication of what the goal is at which point discontinuation can occur.