Growth Faltering / undernutrition

Growth faltering (failure to thrive) can occur during childhood. It is defined as a growth rate below that appropriate for a child's age and sex.[1] It can affect height, weight and head circumference with values being lower than expected.[1] Growth faltering accounts for 1–5% of paediatric hospital admissions under 2 years of age, and has been reported to be up to 21% in community in the paediatric population.[2,3]

Growth faltering during childhood is caused by malnutrition/undernutrition(b) , which occurs usually as a consequence to a disease and/or conditions. For example, children with burns, cystic fibrosis, cancer, congenital heart disease, inflammatory bowel disease, liver disease, neurodisability, metabolic stress, short bowel syndrome, etc. are at risk of growth faltering, but it is also acquired during hospital stay. Studies show that around 40% of children who are unwell are at risk of undernutrition, since disease often leads to inadequate nutrient intakes, increased nutrient requirements and/or increased nutrient losses.[4]

Besides growth failure, undernutrition may have further serious short and long-term consequences on children’s development, such as developmental delay, gastrointestinal dysfunction, increased risk of infections, and deficits in cognition and social/emotional competence.[5] Screening for undernutrition is therefore important to ensure children are treated early for optimal growth and development.

There is no single nutritional therapy that is applicable to all paediatric patients. The type of nutritional intervention depends on the age, clinical situation, absorptive and digestive capacity, oral intake, activity level, and tolerance of the child, as well as on feasibility. Possible nutritional therapies include dietary advice, oral supplements, and enteral tube feeding.[5] The goal of nutritional support is to provide adequate amounts of energy and nutrients for optimal growth and development, with preservation of lean tissue mass and body composition, while minimising gastrointestinal symptoms, supporting developmentally appropriate feeding behaviour, and enhancing quality of life.[6-8]

Footnotes

(b)  Malnutrition is defined as the condition that develops when the body does not get the right amount of macro- and micronutrients it needs to maintain healthy tissues and organ function. It occurs in people who are either under- or overnourished. Undernutrition is a consequence of consuming too few essential nutrients or using or excreting them more rapidly than they can be replaced or in case of some defect in metabolism that prevents the body from using its food properly. TheFreeDictionary by Farlex, Inc. (http://www.thefreedictionary.com)