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Poor growth - what every parent should know

Children and babies can fail to grow for many different reasons. Sometimes the causes are medical, sometimes behavioural, such as fussy eaters refusing food, and sometimes inexplicable. Poor growth can be diagnosed only by having your child regularly measured and weighed, and the results plotted on the growth chart in his child health care record book. Depending on the severity of the poor growth, medical and or dietary action may be required.

What is poor growth?

When a child grows less well than the averages established on the growth charts, he is said to be suffering from poor growth. It is not unusual for children to go through periods of poor growth, perhaps because of illness or fussy eating, and most quickly bounce back. For some, however, poor growth can lead to a more serious condition known as faltering growth, which requires medical intervention. Both poor growth and faltering growth can only be diagnosed by having your child's weight and height measured regularly by health professionals. You should be concerned in the following situations and seek medical advice:

  • If your child's weight and height measurements start flattening out on the growth chart and crossing the centile lines downwards
  • If there is a difference of more than two centiles (lines) between his height and weight
  • If your child's weight or height falls below the bottom line on the centile chart

What causes poor growth?

There are many reasons for poor growth, including the following:

  • Behavioural problems, such as refusing to eat enough food or the right types of food
  • Inadequate parenting skills can lead to poor growth. Young parents may not have learnt to cook for themselves, let alone for a young child.
  • Lack of cooking facilities, such as stoves, microwaves and kettles, make it difficult to prepare nutritious food for babies.
  • Inadequate surfaces and poor hygiene can lead to the baby suffering from increased infections, which can cause poor growth.

Poor growth and faltering growth are symptoms of illness rather than illnesses themselves. When children are unwell, especially with a high temperature, they lose their appetite, which, over prolonged periods, can lead to weight loss and poor growth. Other medical problems, such as constipation and reflux can also lead to poor growth. Any child not growing well should have a thorough medical examination to determine the underlying cause. If none can be discovered, use the advice below to boost your child's energy intake and promote better growth.

What can you do?

If your child is growing poorly, use the following tips (devised by dietitians at Great Ormond Street Hospital for Children) to increase the energy in his diet and promote better growth. Note that this advice is only for children who are growing poorly. It is not suitable for any other children, as it could cause excessive weight gain, leading to obesity.

  • Encourage your child to eat a variety of foods and try increasing the calories in his food and drinks
  • Increase the amount of food your child is eating, but do not force him or make a big issue of it. Try offering more frequent snacks or puddings after meal
  • Use full-fat milk at breakfast time, and when making soups, sauces, mashed potato and drinks
  • Encourage milky drinks made with full-fat milk and flavoured with drinking chocolate, milkshake powder or syrup
  • Offer dessert pots, such as full-fat yoghurt, rice pudding or fromage frais, after meals or as a snack in between
  • Serve full-fat yoghurt with chopped-up fruit, or blend together to make a smoothie
  • Use full-fat cheeses and spreads; hard cheeses, such as Cheddar, are usually higher in fat than soft ones
  • Add grated cheese to sauces, omelettes, scrambled eggs and pasta dishes. Also sprinkle cheese on to vegetables, baked beans, soups, pizzas and potatoes
  • Offer snacks such as cheese on toast or cheese sandwiches
  • Increase the fat in your child's diet by frying or roasting foods such as meat or fish
  • Do not remove fat from meat, and leave the skin on chicken
  • Choose tuna or sardines in oil rather than brine or spring water
  • Use hummus as a dip or as a spread on bread or crackers
  • Spread butter or margarine on bread or crackers, and add to jacket and mashed potatoes
  • Melt butter or margarine over foods such as vegetables and rice
  • Add oil dressings or mayonnaise to salad vegetables
  • Add cream to breakfast cereals, porridge, pasta sauces, mashed potato and soup; serve with fruit, jelly, pancakes, scones or cakes; mix into milk and add to milkshakes
  • Offer sugary squash and fizzy drinks (not the diet varieties)
  • Spread honey, jam and syrup on bread, or pour over puddings
  • Add sugar to foods such as breakfast cereals, drinks, puddings and hot drinks (remember to brush teeth twice a day). Note that, it is better for teeth to have sugary drinks at mealtimes rather than between meals
  • Use full-fat and sweetened foods rather low-fat or reduced-sugar products

High-energy meals should improve growth, but if your child cannot eat large amounts at mealtimes, offer frequent high-energy snacks instead, such as:

  • Chocolate
  • Crisps and savoury snacks
  • Biscuits, especially chocolate, cream-filled or jam-filled varieties
  • Crackers with cheese or dips
  • Buttered popcorn (a choking hazard, so watch carefully)
  • Ice cream
  • Dairy dessert snacks, such as chocolate mousse and full-fat yoghurt
  • Milkshakes
  • Cereal with full-fat milk and cream
  • Chocolate spread
  • Dried fruit, canned fruit in syrup and fruit bars

Taken from The Contented Child's Food Bible by Gina Ford


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