Excerpt

The term ‘faltering growth’ (previously called ‘failure to thrive’) is widely used to refer to a slower rate of weight gain in childhood than expected for age and sex. The term faltering growth is preferred as periods of slow growth may represent temporary variation from the expected pattern and the word ‘failure’ may be seen as pejorative. Various definitions of faltering growth have been used in the past, meaning estimates of prevalence in the UK vary widely.

This guideline covers recognition, assessment and monitoring of faltering growth in infants and children. It includes a definition of growth thresholds for concern and identifying the risk factors for, and possible causes of, faltering growth. It also covers interventions, when to refer, service design, and information and support.

Contents

• 1. Introduction
  • 1.1. Guideline Committee membership, National Guideline Alliance (NGA) staff and acknowledgements
  • 1.2. Other versions of the guideline
  • 1.3. Schedule for updating the guideline
  • Acknowledgements
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
  • 2.4. What this guideline covers
  • 2.5. What this guideline does not cover
  • 2.6. Relationship between the guideline and other NICE guidance
• 3. Guideline development methodology
  • 3.1. Developing the review questions and protocols
  • 3.2. Searching for evidence
  • 3.3. Reviewing research evidence
  • 3.4. Method of combining clinical studies
  • 3.5. Appraising the quality of evidence
  • 3.6. Evidence of cost effectiveness
  • 3.7. Developing recommendations
• 4. Weight loss in the early days of life
  • 4.1. Normal limits of maximal weight loss
  • 4.2. Percentage birth weight loss associated with adverse outcomes
  • 4.3. Evidence to recommendations (based on evidence from sections 4.1 and 4.2)
  • 4.4. Recommendations
  • 4.5. Research recommendation
• 5. Faltering growth after the early days of life
  • 5.1. Introduction
  • 5.2. Thresholds for concern and measurement of weight, height or length
  • 5.3. Assessment
  • 5.4. Interventions for faltering growth
  • 5.5. Monitoring
  • 5.6. Referral
• 6. Organisation of care
  • 6.1. Introduction
  • 6.2. Description of clinical evidence
  • 6.3. Summary of included studies
  • 6.4. Clinical evidence profile
  • 6.5. Economic evidence
  • 6.6. Clinical evidence statements
  • 6.7. Evidence to recommendations
  • 6.8. Recommendations
• 7. Information and support
  • 7.1. Introduction
  • 7.2. Description of clinical evidence
  • 7.3. Summary of included studies
  • 7.4. Clinical evidence profile
  • 7.5. Economic evidence
  • 7.6. Clinical evidence statements
  • 7.7. Evidence to recommendations
  • 7.8. Recommendations
  • 7.9. Research recommendation
• 8. References
• 9. Glossary and abbreviations
• Appendix A. Scope
• Appendix B. Stakeholders
• Appendix C. Declarations of interest
• Appendix D. Review protocols
• Appendix E. Search strategies
• Appendix F. Summary of identified studies
• Appendix G. Evidence tables
• Appendix H. Excluded studies
• Appendix I. Forest and percentage plots
• Appendix J. Grade Evidence Profiles

Final

Developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.