Faltering growth in babies

The causes of faltering growth are multifactorial

Infancy marks a period of rapid growth in which nutrient requirements (per kg body weight) are proportionally higher than at any other time during life. Young children are therefore more vulnerable to the effects of malnutrition, and early diagnosis and intervention are key1. Faltering growth may be caused by inadequate intake (undernutrition) due to a variety of feeding difficulties, medical conditions with associated increased requirements (e.g. Cystic Fibrosis or congenital heart disease), or malabsorption2,3.

A commonly used definition of faltering growth is based upon using the 2009 UK-World Health Organisation (WHO) growth charts, where a sustained drop of weight through two or more centiles is not a normal pattern and requires careful assessment3,4.

Early growth faltering may have long-term health implications5,6

Faltering growth in early infancy (before 8 weeks) has been shown to be associated with persisting deficits in IQ at age 8 years5, as well as slower rate of height gain throughout childhood6. Infants with faltering growth in later infancy remain shorter and lighter throughout childhood6. Screening for, and early identification of malnutrition is therefore important to support prompt initiation of nutritional treatment to achieve better outcomes7.

The importance of protein: energy ratio for optimal catch-up growth

The goal of nutritional management in faltering growth is to achieve catch-up growth in order to sustain normal development; through improved protein and energy intake and correction of micronutrient deficiencies. WHO guidelines recommend that 8.9-11.5% of energy should be provided as protein to provide optimal catch-up growth8. Challenges arise as these infants have an increased need for higher calorie intakes, but are unable to manage large fluid volumes. Energy dense, low-volume formulae have been developed to address these needs.

Gastrointestinal tolerance of High Energy formulas is key

Good gastrointestinal tolerance of high energy formulas is important for maximising nutritional intake. Whey dominant formulas, containing partially hydrolysed protein promote a shorter gastric emptying time making the formula easy to digest9. The UK Department of Health and Irish Health Service Executive also recognises that whey protein is easier to digest10,11. An SN-2 enriched fat blend structurally resembles the fat that is found in breast milk and is well absorbed by infants. As the fats are more easily absorbed, formulas containing an SN-2 enriched fat blend have demonstrated improved fat and calcium absorption, and softer stools in both vulnerable and healthy paediatric populations12-15.

New guidelines on the recognition and management of faltering growth in children are due to be released by NICE* in October 2017.

Faltering growth in babies

  1. Agostoni C, Axelson I, Colomb V, Goulet O, Koletzko B, Michaelsen KF et al. (2005). JPGN 41, 8–11.
  2. Sullivan PB and Goulet O. EJCN (2010) 64, S1.
  3. Wright C. Arch Dis Child 2000;82:5–9.
  4. J Pediatr Gastroenterol Nutr 41, 8–11.The Royal College of Paediatrics and Child Health UK - WHO growth charts, 2009. www.growthcharts.rcpch.ac.uk. Accessed January 2017.
  5. Emond A, et al. PEDIATRICS 2007: Volume 120, Number 4.
  6. Din Z et al. PEDIATRICS 2013; Volume 131, Number 3.
  7. Joosten K and Meyer R. EJCN (2010) 64, S22–S24.
  8. WHO/FAO/UNU Report of a Joint Expert Consultation. Protein and Amino Acid Requirements in Human Nutrition. Technical Report Series No. 935. World Health Organisation 2007;185–193.
  9. Billeaud C, Guillet J, Sandler B.. Eur J ClinNutr 1990; 44 (8): 577-83.
  10. NHS Choices. Types of formula milk. (2016). Available here. Accessed January 2017.
  11. HSE, 2007. Available here. Accessed February 2017.
  12. Carnielli VP et al. AJCN (1995b): 62: 776-81.
  13. Carnielli VP et al. JPGN (1996);23(5): 553-60.
  14. Lucas et al. Arch Dis Child Fetal Neonatal Ed (1997);77: F178-184.
  15. Kennedy K et al. Am J ClinNutr 1999;70:920–7.

*National Institute for Heath and Care Excellence

IMPORTANT NOTICE: The World Health Organisation (WHO) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breastfeeding – in particular the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will have a negative effect on breastfeeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breastfeed. Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively bottle-fed, more than one can (400 g) per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast milk is not only the best, but also the most economical food for babies. This product must be used under medical supervision. SMA PRO High Energy is a milk based formula for the dietary management of babies and young children with medically determined high energy requirements as identified by a healthcare professional. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 18 months of age. SMA PRO High Energy is not intended for use with preterm babies, for whom fortified breast milk or a low birthweight formula such as SMA PRO Gold Prem 1 is more appropriate.