Infants and children with “faltering growth” concerns should receive community-based care from a team that includes both a health visitor and a midwife, according to draft guidelines.
This “primary care team” should also include a GP and have access to professionals including an infant feeding specialist, said the Nation Institute for Health and Care Excellence.
“Measure their weight again at appropriate intervals depending on the level of concern”
NICE draft guideline
Faltering growth refers to a child not putting on weight as would normally be expected for their age and sex, noted NICE in its draft guidance on the condition, which was published today.
It stated that normal weight loss usually stopped after about three or four days of life, and most infants had returned to their birth weight by three weeks of age.
The institute highlighted that children with faltering growth may be identified by either routine growth monitoring or by parental or health professional concern.
Where there are concerns, a clinical assessment should be performed, looking for signs of illness such as dehydration, and a detailed feeding history taken if infants lose more than 10% of their birth weight or have not returned to their birth weight by three weeks of age.
NICE said that clinicians should also consider direct observation of feeding but ensure this was done by an individual with “appropriate training and expertise”, for example, in relation to breastfeeding and bottle feeding.
The guideline said: “If an infant loses more than 10% of their birth weight in the early days of life, measure their weight again at appropriate intervals depending on the level of concern, but usually no more frequently than daily.
“Be aware that while supplementary feeding with infant formula in a breastfed infant may help with weight gain, it often results in cessation of breastfeeding,” it added.
The guidance noted that a pathway of care should be in place for infants and children where there are concerns about faltering growth, with clarity on the role of community-based healthcare professionals and the process for referral to specialist care.
The draft guidance added that clinicians should consider referral to paediatric services if there was evidence of illness, marked weight loss, or failure to respond to interventions.
Overall, the NICE draft guideline covers the recognition, assessment and monitoring of faltering growth in infants and children.
It defines growth thresholds for concern, and identifies the risk factors for, and possible causes of, faltering growth. It also covers interventions, when to refer, and the information and support that should be given to parents or carers.
The consultation on the draft guidance runs from 18 April to 1 June. The final guideline is expected to be published in October 2017.