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NICE recommends 'messy' eating for underweight children

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Health visitors should encourage parents of underweight young children to be relaxed about “messy” eating, according to new guidance published by the National Institute for Health and Care Excellence about how to support children who are growing too slowly.

NICE has published the guideline to help healthcare workers identify and manage slow weight gain in infants and children, a condition that is known as faltering growth.

According to data collected in the National Child Measurement Programme in 2015-16, 1% of children aged four to five were underweight.

The NICE guideline, which covers an age range of newborn babies up to children aged five, aims to help GPs and health visitors support parents and carers to develop a management plan for their child or infant together.

The guidance, published last week, lays out what checks health visitors and GPs should do to help identify the underlying problem.

The “clear cause” behind faltering growth may not be possible to establish as there may be a range of contributing factors, states the guidance.

Premature birth, neurodevelopmental concerns and maternal postnatal depression or anxiety may be among the factors, it says.

The guidance also recommends how parents and carers can be helped to tackle difficulties like feeding, weaning or mealtime behaviour, which could be causing slower growth.

In relation to babies, healthcare professionals should consider whether breastfeed infants are able to suckle effectively, or potential problems with bottle feeding.

Clinicians concerned about a child’s weight should discuss a number of strategies with parents and carers, states the guidance.

These include allowing young children to be messy, encouraging relaxed and enjoyable mealtimes, eating with other children and not making feeds too long or short.

It goes on to suggest how regularly the child’s weight should be measured and at what point healthcare professionals should refer on to paediatric specialist care services.

In addition, it states that children with faltering growth should not be admitted to hospital unless they are acutely unwell or there is a specific indication requiring inpatient care, such as a plan to begin tube feeding.

NICE guidelines are not mandatory but health professionals are expected to take guidelines into account when exercising their judgement, alongside the individual needs of patients.

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