When and where should children with growth problems be referred?

If failure to gain weight adequately does not respond to management at a primary care clinic, the child must be referred for further assessment and management. This is particularly important in children with a weight that falls or crosses centiles.

Usually these children are referred to a special nutritional clinic where the following steps should be followed:

  1. Exclude any chronic illness such as tuberculosis or HIV infection.
  2. A dietician or nutritional counselor should educate the mother or caregiver.
  3. A social worker should interview the mother or caregiver and assist where help is needed.
  4. If the child is still not improving, refer to a paediatrician.

Important medical problems such as malabsorption, hypothyroidism, diabetes, urinary tract infection and chronic heart disease must be excluded.

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