Failure to thrive and faltering growth: diagnostic approach — OSCE

Station brief (candidate)

• Interpret the growth trajectory in plain language.
• Explain that faltering growth is a pattern needing a cause, not a final label.
• Take a focused feeding and social history (role-player).
• Outline examination priorities and when tests are needed.
• Agree a nutrition support plan, review timing and safety-net.
• Avoid blame; use teach-back. [1] [2] [6]

Role-player notes

You are a worried parent. You mix formula “by eye,” offer juice between feeds, and feel blamed by a previous clinician. You become defensive if shamed, and cooperative if the doctor explains the chart kindly and offers practical help. [1] [6]

Expected candidate performance

1. Opening: “Your baby’s weight has been rising more slowly than before. That is called faltering growth. It is common and we look for fixable causes together.” [2]
2. Data: Confirm measurements; explain trend versus single point. [1]
3. History: Intake, mixing method, juice, vomiting/diarrhoea, illness, development, food money, mood/support. [1] [3]
4. Plan: Feed structure, correct formula mixing, dietetic support, possible feed observation, directed tests if indicated, review in a short interval. [1] [2]
5. Safety-net: Return if lethargy, fewer wet nappies, vomiting, breathing difficulty or ongoing weight loss. [5]
6. Communication: Shared plan, consent for any tests, trauma-informed tone; interpreter if language discordance. [4] [6] [7]

Marking domains

• Clinical reasoning (pattern vs point; mechanism buckets).
• Practical management without invented doses.
• Non-blaming communication and teach-back.
• Safety-net and follow-up specificity.
• Safeguarding awareness without premature accusation. [1] [2] [6]

Common fails

• “Your baby is failing because you are not trying.”
• Ordering every test before fixing obvious intake errors.
• No follow-up date.
• Ignoring social determinants. [1] [3]