Faltering growth (failure to thrive) in infants

Specialty: Children's medicine
Age group: Children

Direct to an emergency department

• Hyperglycaemia or hypoglycaemia
• Infants younger than 6 months with weight loss greater than 10 percent of body weight who continue to lose weight despite an adequate feeding plan
• Postural heart rate changes
• Significant dehydration
• Significant malnutrition or illness
• Temperature instability.

Criteria for referral to public hospital service

• Infants (younger than 12 months) with unexplained or unexpected weight loss or faltering growth
  • despite adequate energy intake or
  • where the child continues to cross weight-for-age percentile curves.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Findings on physical examination including head circumference
• If there is blood or mucous in the child’s stool
• Growth charts, including current height and weight
• Onset of symptoms
• Any signs of abuse or neglect
• Summary of oral intake, food behaviour and dietary practices (e.g. dietary restrictions, acceptance of food, trauma or neglect, food insecurity)
• Details of previous management including the course of treatment(s) and outcome of treatment(s)
• Developmental history and relevant medical history
• Any relevant weight gain or growth family history including comment on genetic weight for height proportions

Provide if available

• If available
  • coeliac serology (if the child has commenced solid food)
  • faecal pancreatic elastase results
  • faecal reducing substances results
  • full blood examination
  • iron studies or serum ferritin (if the child is older than 6 months)
  • liver function tests
  • stool microscopy, culture and sensitivity (MCS), polymerase chain reaction (PCR) and microscopic examination
  • urea and electrolytes results
  • urinalysis results
  • vitamin B12 results
• Report from an assessment by a credentialed lactation consultant
• Details of any previous assessments or opinions
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is neurodiverse
• If the child is gender diverse
• If the child has a disability
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is a refugee, seeking asylum or has a bridging visa while waiting for an immigration outcome.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

Note there are statewide referral criteria for height concerns in children.

Referrals should be made to suitable community-based services wherever possible.

Do not exclude gluten from the patient’s diet before positive coeliac serology results or a diagnosis of coeliac disease.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Infants with faltering growth linked to maternal gestational diabetes
• Faltering growth linked to inadequate energy intake.