1.1.3 Failure to Thrive Policy
SCOPE OF THIS CHAPTER
It is important to emphasise that in situations of failure to thrive, effective communication between involved professionals and families is essential if children are to be adequately protected.
In all circumstances where failure to thrive is thought to be due to a lack of appropriate care then safeguarding and child protection procedures must be followed.
RELATED INFORMATIONRecognising Abuse and Neglect Procedure, Neglect
Failure to Thrive occurs when a child fails to achieve their expected growth and development for their age, having regard to their birth weight and medical history.
Although there may be a medical cause, the majority of children who fail to thrive are children who have no organic disorders. This often occurs in the overall context of emotional deprivation and neglect; therefore, the child not only fails to grow but fails to develop intellectually and emotionally.
(Children with medical disorders which affect their growth may also be neglected).
Recognition that a child is failing to thrive depends upon regular monitoring of the child's growth and the alertness of professionals and carers to the realisation that growth is not progressing normally.
In a proportion of cases, this may be associated with other features such as developmental delay.
It is important to remember that older children can also fail to thrive. Health assessments of children of school age, for example by school nurses, may reveal impairment of a child's growth, but medical checks are less frequent for older children and, therefore, professionals need to be very alert to the problem in this age group. (If the weight falls over 1 major percentile, this constitutes a cause for concern and the weight should continue to be checked. If the weight falls over 2 major percentiles on two consecutive occasions - a referral for a medical opinion should be considered).
3. Referral for Medical Assessment
Preschool children who are failing to thrive will initially come to the attention of a health visitor. The health visitor should consider, after discussion with the parents, referring the child to the GP for a medical assessment. The GP will arrange to see the child and assess from a medical point of view, whether there is any obvious cause for the child's failure to thrive. This will include an assessment of the child's growth and development, and may involve a referral for a specialist paediatric assessment.
If a child is referred to, or presents to a Paediatrician with failure to thrive, they should undertake an assessment of the child, including assessment of the child's growth and development, to determine whether there is any obvious cause for the child's failure to thrive.
When failure to thrive comes to the attention of staff working with children, for example, in a Children's Centre, nursery or school, after discussion with the parents, the child should be referred to the GP for a medical assessment. The health visitor/school nurse should also be informed of the referral.
If at any stage there is significant concern on the part of any staff working with children about a particulars child growth or development, then early referral for a medical assessment should take place.
In addition, if, at any time, there are concerns that the child has suffered or is likely to suffer Significant Harm as a consequence of the failure to thrive, the situation should be discussed with the relevant Children's Social Care Services Team Manager and a referral made in appropriate cases under the Referrals Procedure.
4. Management of Risk
If it is considered that a child's failure to thrive is not severe and that advice to the parents or carers regarding diet and support to the family should result in an improvement in the child's growth, then it is appropriate for this action to be taken. Progress must be monitored within a set timescale. It should be remembered, however, that prolonged monitoring should not take place at primary care level if no significant progress is being made. In this situation the opinion of a Paediatrician should be sought
When continued monitoring of a child's growth and development takes place because of concerns about failure to thrive, there must be effective sharing of information and it must be clear to all professionals concerned and parents/carers what action they are required to take and when. This monitoring will usually take place under the as part of an Early Help / Early Support assessment. For example, a Paediatrician may wish to review the child in 6 weeks time, the Health Visitor will check the weight at intervals in between and the Dietician will advise the family so that they can implement the advice at home.
Close monitoring and regular review should take place and specific timescales should be set. The younger the child, the more critical the timescales - as brain growth is occurring at a significant rate, and therefore, longer timescales may not be adequate to safeguard and promote the child's welfare.
5. Communication and Liaison
It is essential that when children are seen outside the primary care setting and this includes where children are seen by Community Paediatricians, that a letter recording the assessment and discussion with parents and plans for future management is sent to the GP, and copied to the Dietician, other involved professionals and if relevant, Children's Social Care Services and the Designated Nurse.
Effective management of children who are failing to thrive requires timely and effective communication between professionals and family.
6. Child Protection Referral
If at any time there is concern that failure to thrive is, or may become, a child protection issue and that the child is suffering or likely to suffer Significant Harm, then the situation should be discussed with Children's Social Care Services and if appropriate a referral to Children's Social Care Services must be made under the Referrals Procedure.