Hi, this is Tom, and in this episode I'm going to be going through faltering growth.

And you can find notes at zero to finals.com slash faltering growth or in the zero to finals pediatrics book.

And you can find flashcards and questions to train your knowledge at members.0.0.0.com.

So let's jump straight in. Fultering growth involves a slower than expected gain in weight in a child,

defined in the nice guidelines from 2017 as a weight that plots under the second centile,

regardless of the child's birth weight, or a fall in weight across more than one centile space

if the birth weight was less than the ninth centile, a fall across more than two centile spaces if the birth weight

was from the ninth to the 91st centile, or a fall across more than three centile spaces

if the birth weight was above the 91st centile.

Centile spaces are the distance between two centile lines on a growth chart.

The distance between the 75th and the 50th centile lines is a centile space.

A weight that falls this distance is a drop across one centile space.

For example, if the initial weight of a child is plotted halfway between the 9th and the 25th centile lines,

and several months later it's plotted halfway between the 2nd and the 9 ninth centile lines, they have dropped a full

centile space. Red flags for weight loss in the first weeks of life are losing more than 10%

of their birth weight or not regaining their birth weight by three weeks.

Let's go through the causes of faltering growth.

Anything that leads to inadequate energy and nutrition can lead to faltering growth.

The broad causes can be categorized as inadequate nutritional intake, difficulty feeding,

malabsorption, increased energy requirements, and inability to process nutrition.

Causes of inadequate nutritional intake include inadequate maternal intake during breastfeeding,

reduced availability of food, for example due to poverty, family or parental problems,

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