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Faltering growth

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What is covered

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

Updates

Updates to this NICE Pathway

28 August 2020 Faltering growth (NICE quality standard 197) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services 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 complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do 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.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so 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.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on faltering growth in infants and children in an interactive flowchart

What is covered

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

Updates

Updates to this NICE Pathway

28 August 2020 Faltering growth (NICE quality standard 197) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Faltering growth (2020) NICE quality standard 197

Quality standards

Faltering growth

These quality statements are taken from the faltering growth quality standard. The quality standard defines best practice for faltering growth and should be read in full.

Quality statements

Measurement of growth

This quality statement is taken from the faltering growth standard. The quality standard defines best practice for faltering growth and should be read in full.

Quality statement

Babies and preschool children have their measurements plotted on a growth chart if there are concerns about faltering growth.

Rationale

It is important that all babies and preschool children have their measurements plotted on a growth chart. If concerns are raised about the growth of a baby or preschool child, regular measurement and plotting of their weight and length or height on the UK–WHO growth chart in their personal child health record (‘red book’), or electronic equivalent, can confirm whether their growth is faltering. Early identification of faltering growth in a baby or preschool child enables a management plan to be developed promptly to improve their growth.

Quality measures

Structure
a) Evidence of local arrangements to ensure that primary and community healthcare professionals are trained to weigh and to measure the length or height of babies and preschool children and plot this information on the UK–WHO growth chart.
Data source: Local data collection, for example training records.
b) Evidence of local arrangements to ensure that calibrated equipment is available for primary and community healthcare professionals to weigh babies and preschool children.
Data source: Local data collection, for example equipment servicing records.
c) Evidence of local arrangements and protocols to ensure that babies and preschool children are weighed and measured at each of the mandated health visiting team contacts.
Data source: Local data collection, for example from service specifications or local protocols.
Process
a) Proportion of babies and preschool children whose weight and height or length measurements are plotted on the UK–WHO growth chart during each of the mandated health visiting team contacts if there are concerns about faltering growth.
Numerator – the number in the denominator whose weight and height or length measurements are plotted on the UK–WHO growth chart at every mandated health visiting contact.
Denominator – the number of babies and preschool children in whom there are concerns about faltering growth.
Data source: Local data collection, for example local audit of patient records.
b) Proportion of babies and preschool children whose weight and height or length measurements are plotted on the UK–WHO growth chart at appropriate intervals if there are concerns about faltering growth.
Numerator – the number in the denominator whose weight and height or length measurements are plotted on the UK–WHO growth chart at appropriate intervals.
Denominator – the number of babies and preschool children in whom there are concerns about faltering growth.
Data source: Local data collection, for example local audit of patient records.

What the quality statement means for different audiences

Service providers (such as community maternity services, GP practices and health visiting services) ensure that calibrated equipment is available for all babies and preschool children to be weighed, and that staff are trained to weigh and measure them. They ensure that processes are in place for babies and preschool children to be weighed and measured at appropriate intervals if there are concerns about faltering growth. Services ensure that community and primary healthcare professionals are trained to plot the measurements on the UK–WHO growth chart and to recognise faltering growth in babies and preschool children.
Healthcare professionals (such as health visitors, community midwives, GPs and practice nurses) weigh and measure babies and preschool children and plot this information on the UK–WHO growth chart. If parents or carers raise concerns about faltering growth, or healthcare professionals have concerns about this, they weigh and measure babies and preschool children at appropriate intervals.
Commissioners (such as clinical commissioning groups and local authorities) ensure that they commission services in which babies and preschool children are weighed and measured, and these measurements are plotted on the UK–WHO growth chart if there are concerns about faltering growth.
Babies and preschool children whose growth raises concerns are weighed and measured regularly by a midwife, health visitor, GP or practice nurse. Their measurements are recorded on their growth chart. If the measurements show that the baby or preschool child is not growing as expected (faltering growth), steps can be taken to help improve their growth.

Source guidance

Definitions of terms used in this quality statement

Measurements
The measurements taken are the weight and the length (under 2 years of age) or height (2 years or older) of babies and preschool children. [Adapted from NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendation 1.2.2 and terms used in this guideline]
Concerns about faltering growth
This can include healthcare professionals being concerned about a baby or preschool child’s growth, for example if they, or the parents or carers, think the baby or preschool child appears to be:
  • not feeding or eating
  • not growing as expected
  • thin or unwell.
Healthcare professionals may also have concerns about faltering growth in babies and preschool children if:
  • they lose more than 10% of their birthweight in the early days of life
  • they do not return to their birthweight by 3 weeks of age
  • there is a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
  • there is a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles
  • there is a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile
  • the current weight is below the 2nd centile for age, whatever the birthweight.
Appropriate intervals
If there are concerns about faltering growth, weight is measured at appropriate intervals taking account of factors such as age and the level of concern, but usually no more often than:
  • daily up to 1 month old
  • weekly between 1 and 6 months old
  • fortnightly between 6 and 12 months old
  • monthly from 1 year old.
If there are concerns about faltering growth, length or height is monitored no more than once every 3 months. [Adapted from NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendations 1.1.5, 1.2.27 and 1.2.30]

Feeding or eating history

This quality statement is taken from the faltering growth standard. The quality standard defines best practice for faltering growth and should be read in full.

Quality statement

Babies and preschool children have a detailed feeding or eating history taken if there are concerns about faltering growth.

Rationale

A detailed feeding or eating history can help to identify any feeding or eating behaviours that might be contributing to faltering growth in a baby or preschool child. These could include, for example, ineffective milk transfer in breastfeeding babies, or food refusal in older babies and preschool children. There are also some physical disorders or developmental issues that can affect feeding or eating. Taking a detailed feeding or eating history also provides information about the calorific value of the baby or child’s diet. Advice and care can then be tailored to their specific needs.

Quality measures

Structure
Evidence of local arrangements to ensure that healthcare professionals are trained to take a detailed feeding or eating history.
Data source: Local data collection, for example training records.
Process
Proportion of babies and preschool children who have a detailed feeding or eating history taken if there are concerns about faltering growth.
Numerator – the number in the denominator who have a detailed eating or feeding history taken.
Denominator –the number of babies and preschool children in whom there are concerns about faltering growth.
Data source: Local data collection, for example local audit of patient records.
Outcome
Proportion of parents or carers who feel supported if there are concerns that their baby or preschool child has faltering growth.
Numerator – the number in the denominator who feel supported.
Denominator – the number of parents or carers of babies or preschool children in whom there are concerns about faltering growth.
Data source: Local data collection, for example patient surveys.

What the quality statement means for different audiences

Service providers (such as maternity services, GP practices and health visiting services) ensure that healthcare professionals are trained, with input from secondary care paediatric services if appropriate, to take a detailed feeding or eating history if there are concerns about faltering growth in a baby or preschool child, and to provide advice based on this history. They ensure that healthcare professionals have enough time with babies or preschool children in whom there are concerns about faltering growth to obtain this history.
Healthcare professionals (such as midwives, GPs and health visitors) take a detailed feeding or eating history if there are concerns about faltering growth and provide tailored advice to the baby or preschool child’s parents or carers based on this history. This advice should be given in a supportive and non-judgemental way. This can be done at the same time as a clinical, developmental and social assessment if one is being carried out.
Commissioners (such as clinical commissioning groups and local authorities) commission services that ensure healthcare professionals have the time and expertise to take detailed eating or feeding histories if there are concerns about faltering growth in babies or preschool children.
Babies and preschool children whose growth raises concerns have information about their feeding or eating habits recorded so that their parents or carers can be given advice on feeding and eating to help the baby or preschool child grow.

Source guidance

Definitions of terms used in this quality statement

Detailed feeding or eating history
In babies under 6 months a feeding history can include:
  • duration and frequency of breast or infant formula feeds per day
  • the numbers of wet and soiled nappies each day
  • in breastfed babies fed with formula, the type of formula given (for example first-stage formula), the amount and how it is being made up
  • any food being given and frequency
  • any behavioural issues such as feeding aversion.
In preschool children and babies over 6 months an eating history can include:
  • types of food being eaten
  • frequency of meals
  • food consumed between meals
  • amount of fluids, including any breast milk or infant formula, being consumed and frequency
  • eating environment, for example at the table with family
  • any behavioural issues, for example food aversion or avoidance.
The detailed feeding or eating history is tailored to the individual baby or child, taking into account a broad range of other factors such as age, severity of weight loss, social circumstances and the family’s food choices. [NICE's full guideline on faltering growth: recognition and management of faltering growth in children and expert opinion]
Concerns about faltering growth
This can include healthcare professionals being concerned about a baby or preschool child’s growth, for example if they, or the parents or carers, think the baby or preschool child appears to be:
  • not feeding or eating
  • not growing as expected
  • thin or unwell.
Healthcare professionals may also have concerns about faltering growth in babies and preschool children if:
  • they lose more than 10% of their birthweight in the early days of life
  • they do not return to their birth weight by 3 weeks of age
  • there is a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
  • there is a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles
  • there is a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile
  • the current weight is below the 2nd centile for age, whatever the birthweight.

Management plan

This quality statement is taken from the faltering growth standard. The quality standard defines best practice for faltering growth and should be read in full.

Quality statement

Babies and preschool children have a management plan with specific goals if there are concerns about faltering growth.

Rationale

A management plan gives parents, carers and healthcare professionals a specific set of actions and goals, with regular reviews to check progress. Developing the management plan in collaboration with parents or carers provides them with clarity and reassurance about the actions that need to be taken and may help to reduce their anxiety about faltering growth in their child.

Quality measures

Structure
a) Evidence of local arrangements and written clinical protocols to ensure that the primary care team are trained to develop a management plan for babies and preschool children if there are concerns about faltering growth.
Data source: Local data collection, for example staff training records.
b) Evidence of local arrangements and written clinical protocols to ensure that the primary care team have access to healthcare professionals with expertise in faltering growth.
Data source: Local data collection, for example local care pathways and joint working agreements with primary and secondary care.
Process
Proportion of babies and preschool children in whom there are concerns about faltering growth who have a management plan that includes specific goals.
Numerator – the number in the denominator who have a management plan that includes specific goals.
Denominator – the number of babies and preschool children in whom there are concerns about faltering growth.
Data source: Local data collection, for example local audit of patient records.
Outcome
Proportion of parents and carers who are satisfied with the way concerns about faltering growth in their baby or preschool child are being managed.
Numerator – the number in the denominator who are satisfied with the way concerns are being managed.
Denominator – the number of parents and carers with babies or preschool children in whom there are concerns about faltering growth.
Data source: Local data collection, for example patient surveys.

What the quality statement means for different audiences

Service providers (such as maternity services, GP practices, health visiting services and paediatric secondary care services) ensure that primary care teams are trained to develop a management plan with parents or carers, tailored to the specific needs of the baby or preschool child. Primary care teams have access to healthcare professionals with expertise in faltering growth to help guide and implement the management plan, for example to agree when referral to secondary care may be needed.
Healthcare professionals (such as midwives, GPs, health visitors and healthcare professionals with expertise in faltering growth) work together to guide the development of management plans if there are concerns about faltering growth in a baby or preschool child. Primary care teams ensure they develop the management plan with the parents or carers, and with healthcare professionals who have expertise in faltering growth if needed. Healthcare professionals with expertise in faltering growth provide advice and support to primary care teams, for example agreeing when referral to secondary care may be necessary. GPs are made aware if a referral to secondary care is being made by another member of the primary care team.
Commissioners (such as clinical commissioning groups and local authorities) commission services that ensure primary and secondary care teams establish local care pathways and joint working agreements to provide planned care for babies and preschool children if there are concerns about faltering growth. They ensure that primary care teams develop management plans for babies or preschool children if there are concerns about faltering growth.
Babies or preschool children whose growth raises concerns have a plan that is decided together by the healthcare team looking after them and their parents or carers. This plan includes specific actions to improve the baby or child’s growth and sets out dates when their growth will be checked again.

Source guidance

Definitions of terms used in this quality statement

Management plan with specific goals
A management plan developed by healthcare professionals working together with parents or carers that includes specific goals. The plan might also include:
  • assessments or investigations, for example serological testing for coeliac disease
  • interventions
  • clinical and growth monitoring
  • when reassessment to review progress and achievement of growth goals should happen
  • plans for referral to paediatric specialist care services if needed.
Concerns about faltering growth
This can include healthcare professionals being concerned about a baby or preschool child’s growth, for example if they, or the parents or carers, think the baby or preschool child appears to be:
  • not feeding or eating
  • not growing as expected
  • thin or unwell.
Healthcare professionals may also have concerns about faltering growth in babies and preschool children if:
  • they lose more than 10% of their birthweight in the early days of life
  • they do not return to their birthweight by 3 weeks of age
  • there is a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
  • there is a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles
  • there is a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile
  • the current weight is below the 2nd centile for age, whatever the birthweight.
Primary care team
This is the team providing community-based care for babies and preschool children where there are concerns about faltering growth or weight loss in the early days of life. This team includes, for example:
  • a midwife
  • a health visitor
  • a GP.
Healthcare professionals with expertise in faltering growth
These are:
  • infant feeding specialists
  • consultant paediatricians
  • paediatric dietitians
  • speech and language therapists with expertise in feeding and eating difficulties
  • clinical psychologists
  • occupational therapists
  • lactation consultants.

Equality and diversity considerations

Healthcare professionals should ensure that the management plan takes into account issues such as cultural background and any particular food choices that are made by families or carers.
Parents or carers should be provided with information about the management plan that they can easily read and understand themselves, or with support, so they can communicate effectively with services. Information about the management plan should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and should be culturally appropriate and age appropriate. Parents or carers should have access to an interpreter or advocate if needed.
For parents or carers with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.

Supporting breastfeeding during supplementation with formula

This quality statement is taken from the faltering growth standard. The quality standard defines best practice for faltering growth and should be read in full.

Quality statement

Mothers are supported to continue breastfeeding if their baby is given supplementation with formula because of concerns about faltering growth.

Rationale

Breastfeeding is recognised as the best way to feed babies under 6 months because it meets their energy and nutrient requirements and provides health benefits for the mother, and immunological and other benefits for the baby. If a breastfeeding baby is given formula to supplement breast milk because of concerns about faltering growth, their mother should be encouraged to breastfeed before giving formula, at every feed, to stimulate her breast milk supply. Mothers should also be encouraged to express breast milk and to give any available breast milk before the formula is given. Supplementation with formula is usually a short-term measure, and providing sympathetic, non-judgemental support and reassurance to mothers will help to ensure that they can resume exclusive breastfeeding whenever possible.

Quality measures

Structure
Evidence of local arrangements to ensure that mothers receive practical support to continue breastfeeding if there are concerns about faltering growth and supplementation with formula is recommended.
Data source: Local data collection, for example local care pathways for midwives, health visitors and lactation consultants to provide support to breastfeeding mothers, breastfeeding support staff numbers and availability.
Process
Proportion of mothers who are supported to continue to breastfeed if their baby is given supplementation with formula because of concerns about faltering growth.
Numerator – the number in the denominator who are supported to continue to breastfeed.
Denominator – the number of breastfeeding mothers whose baby is given supplementation with formula because of concerns about faltering growth.
Data source: Local data collection, for example local audit of patient records.
Outcome
Proportion of mothers who are satisfied with the support they receive to continue breastfeeding if their baby has faltering growth.
Numerator – the number in the denominator who are satisfied with the support they receive to continue breastfeeding.
Denominator – the number of breastfeeding mothers whose babies have faltering growth.
Data source: Local data collection, for example patient surveys.

What the quality statement means for different audiences

Service providers (such as maternity services, GP practices and health visiting services) ensure that practical, sympathetic and non-judgemental breastfeeding support can be provided to mothers when formula is prescribed because of concerns about faltering growth. This includes ensuring that sufficient numbers of staff have the expertise to provide this support and that the support is provided quickly to reduce the risk of the mother stopping breastfeeding. Other support, such as loaning breast pumps, should also be given.
Healthcare professionals (such as midwives, health visitors, GPs, and breastfeeding support workers) provide practical, sympathetic and non-judgemental breastfeeding support to mothers when formula is prescribed because of concerns about faltering growth. This includes, for example, reassuring mothers that they are not at fault for their baby’s faltering growth, encouraging them to feed their baby with any available breast milk before giving the formula, advising them to express breast milk to promote their milk supply and loaning them breast pumps if needed.
Commissioners (such as clinical commissioning groups and local authorities) commission services that ensure sufficient numbers of staff have the expertise to provide practical breastfeeding support quickly to mothers if there are concerns about faltering growth in their babies.
Mothers of babies who are given formula milk to supplement breast milk are encouraged and helped to continue breastfeeding their baby. They are advised to give their baby any available breast milk before giving formula and to express breast milk to prevent their milk supply from stopping. They are loaned breast pumps if needed.

Source guidance

Definitions of terms used in this quality statement

Concerns about faltering growth
This can include healthcare professionals being concerned about a baby or preschool child’s growth, for example if they, or the parents or carers, think the baby or preschool child appears to be:
  • not feeding or eating
  • not growing expected
  • thin or seem unwell.
Healthcare professionals may also have concerns about faltering growth in babies and preschool children if:
  • they lose more than 10% of their birthweight in the early days of life
  • they do not return to their birth weight by 3 weeks of age
  • there is a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile
  • there is a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles
  • there is a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile
  • the current weight is below the 2nd centile for age, whatever the birthweight.

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Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services 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 complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do 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.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so 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.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

In infants or children who need a further increase in the nutrient density of their diet beyond that achieved through advice on food choices, consider:
  • short-term dietary fortification using energy-dense foods
  • referral to a paediatric dietitian.

Glossary

pre-school children from 1 year of age
behaviours sometimes observed in infants or children indicating a persistent unwillingness to eat; such behaviours, depending upon age, might include signs of distress when presented with food, spitting of food or avoidance behaviour
a baby up to 1 year of age
the increase in length (under 2 years of age) or height (2 years or older) over time in infants and children
a high energy liquid feed designed for enteral use, usually selected and prescribed after specialist advice from a paediatric dietitian
this is what happens when nutrition is not sufficient; an infant or child with undernutrition may be abnormally thin, may weigh less than expected for their length or height, and if prolonged undernutrition can lead to stunting (length or height less than expected for age)

Paths in this pathway

Pathway created: September 2017 Last updated: August 2020

© NICE 2020. All rights reserved. Subject to Notice of rights.

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