Recommendations for research

The guideline committee has made the following recommendations for research. The committee's full set of research recommendations is detailed in the full guideline.

1 High energy liquid feed supplements

Do high energy liquid feed supplements improve growth in children with faltering growth?

Why this is important

It seems logical to attempt to treat inadequate dietary intake with food of some kind, and high energy liquid dietary supplements appear to be effective when used in older adults. Although they are also widely promoted for use in children, little research on their efficacy has been done. Experimental research suggests that high energy liquid feed supplements may supress appetite and displace normal diet, and one case series found that when high energy liquid feed supplements were withdrawn appetite improved with no impact on weight. Further research is important to establish whether their effectiveness justifies their cost and the suppressant effect on appetite.

2 Feeding interventions for the management of neonatal weight loss

What is the effectiveness of feeding interventions compared with usual care/advice for breastfed neonates (up to 28 days old) with weight loss of greater than 10%?

Why this is important

Weight loss in breastfeeding infants in the first month of life can cause anxiety for parents and healthcare professionals. It can also incur costs to the NHS from admissions of the infant to hospital, with the potential for cessation of exclusive breastfeeding with its associated long-term health benefits.

Practice varies across the UK. Robust evidence about which feeding interventions improve outcomes could inform practice, potentially reducing unnecessary and costly interventions and supporting parent–infant relationships and physical and emotional health.

3 Behavioural interventions

What is the effectiveness of behavioural interventions compared with usual care/advice for children with faltering growth?

Why this is important

Health visitors provide behavioural interventions for faltering growth in community settings. This is carried out with the aim to optimise the Healthy Child Programme and provide support and build relationships with parents and children. Behavioural interventions are time consuming and therefore incur costs. Evidence for the specific components of behavioural interventions are scarce and if found to be effective they could have short-term and longer-term preventative results. A standardised approach to behavioural interventions could both improve clinical practice and save costs.

4 Frequency of monitoring

How frequently should children be measured to identify faltering growth?

Why this is important

It is important to know whether a particular frequency or schedule of measurement of infants and children would identify faltering growth at an earlier age and contribute to an earlier catch‑up in weight. Present practice suggests routine measurements be taken at the time of routine childhood immunisation. Is this schedule of measurement the most likely to confirm whether an infant or child has faltering growth as early as possible? It is unclear whether the present pattern of measurement is most effective for children for whom there are concerns about their growth. If an altered schedule of routine measurement was found to be identifying faltering growth at an earlier age and contribute to an early catch‑up in weight, it would be necessary to consider how best to deliver such a schedule to the entire population of infants and children.

5 Support needs of parents

What are the experiences and concerns of parents of children with faltering growth?

Why this is important

Having a child with faltering growth can be a distressing experience. Parents can feel blamed or unheard. Faltering growth happens when children are young so can have a long-term impact on the child–parent relationship. There are no studies that describe parental experiences or concerns and therefore there is a gap in the evidence. Research on this topic would help to improve understanding of the needs and concerns of parents who have children with faltering growth, which will then enable healthcare professionals to better address them. Understanding the experiences, expectations and needs of parents should inform the design of effective intervention strategies that are tailored to the family.

  • National Institute for Health and Care Excellence (NICE)