Essentials of the History for Growth and Weight Faltering

Growth charts

Measurements, including those taken at birth if possible, should be examined to determine the trend in growth rate. Because of wide normal variations, diagnosis of growth and weight faltering should not be based on a single measurement, except when undernutrition is obvious.

Diet history (3 days)

Diet history should be detailed, including eating or feeding schedule, and, in infants, techniques for the preparation and feeding of formula (including volumes) or adequacy of breast milk supply. Plastic nipple type and flow should be evaluated.

As soon as possible, caregivers should be observed feeding the infant to evaluate their technique and the infant’s vigor of sucking. An infant who tires easily during feeding may have underlying cardiac or pulmonary disease. Enthusiastic burping or rapid rocking of the infant during feeding may result in excessive regurgitation or even vomiting. Bottle propping, if identified, should be addressed because this method of feeding is not advised.

A disinterested caregiver may be depressed or apathetic, suggesting a psychosocial environment that is lacking stimulation for and interaction with the child.

In older children, additional history should be obtained including a food log, food allergies/intolerances, symptoms of dysphagia or aspiration, perceived appetite, food or texture selectivity, and medications that may suppress appetite.

Assessment of the child’s elimination pattern

Abnormalities of urine or stool and frequent emesis should trigger an investigation to detect underlying renal disease, malabsorption syndrome, pyloric stenosis, or gastroesophageal reflux.

Medical history and birth history

Of concern is any evidence of intrauterine growth restriction or prematurity with growth delay that has not been compensated; developmental delay; trauma; unusual, prolonged, or chronic infections (eg, tuberculosis, parasitic, HIV); neurologic, cardiac, pulmonary, or renal disease; illness or hospitalization; and possible food intolerance.

A mental health history may be warranted in older children and adolescents to screen for anxiety, depression, or eating disorders.

Family history

Included is information about familial growth patterns, especially in parents and siblings; the occurrence of diseases known to affect growth (eg, cystic fibrosis); and a caregiver’s recent physical or psychiatric illness resulting in inability to provide consistent stimulation and nurturance.

Social history

Attention is focused on family composition; housing stability and access to refrigeration, cooking facilities, and running water; food insecurity; desire for pregnancy with and acceptance of the child; and stresses (eg, job changes, family moves, separation, divorce, deaths, other losses).

Assessment of culturally based or alternative dietary practices should also be assessed.