# Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) for infants who come for immunization, growth monitoring, and feeding counseling. The nurse reviews the growth record of a 6-month-old girl born at term: Age | Weight | Weight-for-age z-score Birth | 3.2 kg | 0.0 2 months | 5.0 kg | -0.2 4 months | 6.3 kg | -0.1 6 months | 6.5 kg | -1.0 The mother reports that the baby has had no illness. How should the nurse interpret this pattern?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629432  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) for infants who come for immunization, growth monitoring, and feeding counseling.

The nurse reviews the growth record of a 6-month-old girl born at term:
Age | Weight | Weight-for-age z-score
Birth | 3.2 kg | 0.0
2 months | 5.0 kg | -0.2
4 months | 6.3 kg | -0.1
6 months | 6.5 kg | -1.0
The mother reports that the baby has had no illness. How should the nurse interpret this pattern?

## 보기

1. Faltering weight gain that calls for a feeding assessment now **✔ 정답**
2. Normal growth, since she has doubled her birth weight by 6 months
3. Underweight that calls for referral to a supplementary feeding program
4. The expected slowing of weight gain once an infant turns 4 months

**정답: 1**

## 해설

The trend matters more than a single value. She gained only 0.2 kg from 4 to 6 months, and her z-score dropped from -0.1 to -1.0, so her curve is flattening even though she is still above -2 z. Without illness, the most common causes are feeding problems, such as early water or foods replacing breast milk, so her feeding must be assessed now.

## 심화 해설

Interpretation of the growth pattern

The most important step in reading a growth chart is to examine the trajectory of the weight-for-age z-score over time, not just the absolute weight at a single visit. In this infant, the z-score moved from 0.0 at birth to -0.2 at 2 months and -0.1 at 4 months, then dropped to -1.0 at 6 months. Although the value remains above the conventional cutoff of -2 for underweight, the downward shift of nearly one full standard deviation between 4 and 6 months signals that the rate of weight gain is slowing. A single z-score above -2 does not rule out growth faltering when the trend is clearly flattening.

The actual weight gain reinforces this concern. From birth to 2 months, the infant gained 1.8 kg; from 2 to 4 months, she gained 1.3 kg; but from 4 to 6 months, she gained only 0.2 kg. This deceleration is consistent with the definition of faltering growth, which refers to a slower rate of weight gain than expected for age and sex [2]. It is not simply the normal physiologic slowing that occurs as an infant becomes more active around 4 months; the magnitude of the drop in z-score is too large to attribute to that alone.

Because the mother reports no illness, the most likely contributors are nutritional or feeding-related. When an infant has no acute or chronic disease, inadequate caloric intake is the leading cause of a flattening weight curve. Common feeding problems at this age include early introduction of water, diluted formula, or low-calorie complementary foods that displace breast milk or formula. These issues can be identified and corrected only through a structured feeding assessment, which should include a detailed history of what the infant is actually consuming, the frequency and duration of feeds, and any recent changes in feeding practices [1][4].

| Age | Weight | Weight-for-age z-score | Interpretation |
| --- | --- | --- | --- |
| Birth | 3.2 kg | 0.0 | Appropriate for gestational age |
| 2 months | 5.0 kg | -0.2 | Normal gain |
| 4 months | 6.3 kg | -0.1 | Stable trajectory |
| 6 months | 6.5 kg | -1.0 | Faltering weight gain |

Key point! Doubling birth weight by 6 months is a rough milestone, but it is not sufficient to declare growth normal when the z-score is falling. This infant has doubled her birth weight, yet the pattern is still concerning because the rate of gain has slowed sharply.

Watch out! Referral to a supplementary feeding program is appropriate when an infant is underweight, typically defined as a weight-for-age z-score below -2. This infant is not yet below that threshold, so the priority is not referral but rather a feeding assessment to identify and correct the problem before the z-score falls further.

The rationale for acting now rather than waiting is supported by the observation that once growth faltering is recognized, accumulated nutrient deficits can be difficult to recover . Early identification and prompt correction of feeding problems offer the best chance of restoring a normal growth trajectory. The nurse should assess the feeding pattern immediately, provide targeted counseling, and schedule close follow-up to monitor the response.References (research sources)

- [1]Etiologies of Poor Weight Gain and Ultimate Diagnosis in Children Admitted for Growth Faltering.Research articlePeterson Lu E, Bowen J, Foglia M, Ribar E, Mack M, Sondhi E (2023) · DOI: 10.1542/hpeds.2022-007038

- [2]Faltering growth.Research articleDean E (2017) · DOI: 10.7748/ncyp.29.5.11.s11

- [4]Beyond Picky Eating.Research articleLim TSH, Aw M, Slosky L, Nyp SS (2020) · DOI: 10.1097/DBP.0000000000000846

## 임상 시나리오

Interpreting Infant Growth TrendsTrend matters more than a single value
Evaluate the trajectory of the weight-for-age z-score. A drop from -0.1 to -1.0 between 4 and 6 months, with only 0.2 kg gained, indicates growth faltering even though the value remains above -2.

In an infant with no reported illness, the most common cause of a flattening weight curve is inadequate caloric intake. Assess for feeding problems such as early introduction of water, diluted formula, or foods replacing breast milk.

CautionDo not wait until the z-score falls below -2 to act. A downward shift of nearly one full standard deviation is a red flag that requires a feeding assessment now.

## 핵심 개념

- **Growth Faltering** — A slower than expected rate of weight gain for age and sex, identified by a downward trend in growth chart z-scores over time, even if the current value remains above the cutoff for underweight.
- **Weight-for-Age Z-score** — A statistical measure comparing an infant's weight to a reference population median; a drop of nearly one full standard deviation between visits signals a concerning deceleration in growth.
- **Underweight** — Defined as a weight-for-age z-score below -2; this infant at -1.0 is not yet underweight, but the trend toward that threshold requires intervention.

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