Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Physiological instability or unsafe care
Shock, severe dehydration, hypoglycaemia, hypothermia, altered consciousness, respiratory compromise, electrolyte disturbance or inability to provide safe nutrition requires urgent hospital care.
Action: Stabilise airway, breathing, circulation, temperature and glucose; obtain paediatric review and targeted blood tests. Rehydrate and correct electrolytes cautiously using a weight-appropriate protocol. If neglect, fabricated illness, coercive feeding or food insecurity may leave the child unsafe, follow local safeguarding procedures while meeting immediate nutritional needs.
Synopsis
Identify a clinically important change in growth trajectory, verify measurement and intake, observe feeding, distinguish nutritional, medical and psychosocial causes, intervene proportionately and protect the child without stigmatising or blaming the family.
Use serial accurate measurements, not visual impression. Plot weight and length or height on UK-WHO charts, correct for prematurity when appropriate and review the trajectory from birth.
NICE thresholds for concern are a fall across 1 centile space when birth weight was below the 9th centile, 2 spaces when between the 9th and 91st, or 3 spaces when above the 91st; current weight below the 2nd centile also warrants concern.
Weight loss above 10% of birth weight triggers clinical assessment, feeding history and direct observation, but does not by itself diagnose disease or mandate formula.
Key red flags
Lethargy, reduced urine, prolonged capillary refill, hypothermia, hypoglycaemia or severe wasting requires same-day paediatric assessment.
Investigation priorities
01
First-line: verified anthropometry and observed feedingFirst stepFirst line
Confirm the growth pattern and identify modifiable intake or skill problems.
Management branches
ConfirmVerify before labelling
A measurement or trajectory raises concern.
Repeat accurate weight and length or height and plot all prior reliable measures.
Apply NICE centile-space thresholds and assess current clinical urgency.
SupportOptimise ordinary feeding
The child is stable and intake or interaction can improve.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.