In this section
This is a guide for the initial management of a child with poor growth who presents to the emergency department.
In a small number of cases, inadequate nutrition could be due to caregiver neglect or child abuse. This should be carefully considered, especially in the presence of a Red Flag (see below).
In a small number of cases identified by having one or more of the following red flags, involvement of a multidisciplinary team is essential. Admission to hospital should also be considered if any red flag is present.
Inadequate caloric intake/retention
Excessive caloric utilization
Other Medical Causes
Growth charts for Down syndrome and Turner syndrome are available at: http://www.rch.org.au/genmed/clinical_resources/Growth_Resources/
More information on how to interpret child growth can be found at: www.rch.org.au/childgrowth/
Feeding History – this is the most important aspect to elicit.Infants:
Other important points on history:
Does the child appear sick, scrawny, irritable or lethargic?
Evidence of loss of muscle bulk and subcutaneous fat stores; especially upper arm, buttocks and thighs.
Conduct a thorough examination with particular attention to potential underlying diagnoses.
Look for signs of child abuse and neglect.
Observe the child-parent interaction and communication (cues from infant)
In younger infants, consider observing a feed.
For an otherwise healthy and normally developing child with no suggestive features on history or examination, no investigations are necessary at first.
If a particular diagnosis is suggested by the history or examination, investigate according to the features you have elicited.
Simple first line investigations for a child where there is significant concern but no specific pointers to a medical cause:
When to admit and/or consult local paediatric team
If admitted to hospital
When to weigh?
Although the use of a growth chart is the most accurate indication of overall growth the use of average weekly weight gain for children who are followed up at frequent intervals may be required.
The rate of weight gain per week is variable.
The table below is a guide to the expected average weight gain per week (it is not the minimally acceptable weight gain).
3 to 6 months
100 - 150g/week
6 to 12 months