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Faltering Growth 117
In breastfed infants the mother may need to
exclude foods from her diet and take a calcium
supplement to ensure nutritional adequacy.
Formula-fed infants can usually be changed to an
appropriate specialized feed if necessary.
Advice from a registered dietitian is needed to
ensure the infant’s milk and weaning food intake
continues to provide all the necessary nutrients for
optimizing growth and development.
Excluding cow’s milk protein
The infant formula of choice is an extensively
hydrolysed infant formula. In some cases, if an
improvement in symptoms is not seen, an amino
acid infant formula can be trialled.
Some mothers choose to try a soya formula, but
these are not recommended for infants under 6
months of age (see Chapter 4.1, page 94).
Faltering Growth
Infants who are not drinking enough milk for their
needs will not grow as expected. The Avon
Longitudinal Study of Parents and Children
(Emond et al. 2007) showed the following feeding
problems to be associated with poor growth:
●● sucking problems and slow feeding in the first
few weeks
●● difficulties in weaning onto solids at around 6
months.
Oromotor dysfunction may be the cause of both
these feeding problems.
Faltering growth is defined as weight falling
through 2 centile spaces. However, interpreting
growth charts of infants requires training as
various factors impact on growth rates:
●● Infants lose weight in the first few days of life but
should have regained it by 2 weeks of age.
●● Over the first 6 weeks of life infants with a weight
above the 50th centile may cross centile lines
downwards and small infants with a birthweight
below the 50th centile may cross centile lines
upwards, moving closer to the 50th centile line.
●● Breastfed and formula-fed infants have slightly
different growth patterns during the first year of
life. Breastfed infants grow more quickly in the
first 3–4 months and then grow more slowly
from about 5 months when compared to
formula-fed infants. Infants should all be
plotted on the UK WHO growth charts based
on breastfed infants.
●● Infants should not be weighed more frequently
than every two weeks as shorter intervals are
not necessarily indicative of accurate weight
gain or loss.
Other indications of inadequate milk intake are:
●● apathetic or weakly crying infant
●● poor muscle tone and skin turgor
●● concentrated urine, a few times/day
●● infrequent, scanty stools
●● fewer than 8 short breastfeeds/day.
The management of faltering growth is different
for breast- and formula-fed infants.
Management of faltering growth
in breastfed infants
A person skilled in breastfeeding management
should assess mother and infant feeding.
●● The infant should feed at least eight times in 24
hours (including at night).
●● Infants should be fed until they come off the
breast spontaneously. If sleepy, a nappy change
may help to rouse them and the infant can then
be fed on the second breast.
●● The mother and infant should be in skin-to-skin
contact as often as possible.
●● The mother should be encouraged to express
milk from her breasts after the infant has
finished feeding as after completely emptying
the breast more milk will be produced for the
next feed.
●● Different positioning for feeding (e.g. under-
arm, or especially with mother lying down)
may help the infant to feed more efficiently.