Faltering Growth

General Symptoms of Cow'S Milk Protein Allergy.

Faltering growth is defined in the 2017 NICE guidelines on faltering growth in children as a fall in weight across:

One or more centile spaces if their birthweight was below the 9th centile.

Two or more centile spaces if their birthweight was between the 9th and 91st centile.

Three or more centile spaces if their birthweight was above the 91st centile.

However, in a recent review they propose that a time frame should be added to ensure children are not falsely categorised with growth faltering, especially following an acute illness such as diarrhoea or vomiting.³

As there are many biological, psychosocial and environmental processes that can lead to malnutrition, faltering growth should never be a diagnosis in itself.⁴

If we consider average growth, then most infants have tripled their birth weight by the first birthday and increased their length by about 24 centimetres.⁵ But all babies are different, and their growth comes in spurts, so it not constant.

What Causes
Faltering
growth in
Infants?

Growth problems can be caused by a number of factors both organic (illness) and non-organic (non-illness related), including genetics, hormonal disorders, illnesses, and poor absorption of food.⁶

Organic causes include a Cow’s Milk Protein Allergy (CMPA), congenital and metabolic disorders, as well as infections, which result in inadequate nutrient uptakes for the infant to achieve optimal growth.^4,7

Could It Be a
Symptom of
Cow’s Milk
Protein Allergy?

In cases of severe CMPA in breastfed infants, faltering growth has been reported, which can have detrimental long-term consequences. Faltering growth is one of the general symptoms of CMPA and may result as a culmination of several other factors.^8,9

It is recommended that infants presenting faltering growth (and sick infants with hematochezia), require urgent referral and full diagnostic work up.