Failure to thrive (FTT) is a sign of inadequate nutrition for optimal growth and development. FTT has multiple definitions, which include the following: weight-forage below the third percentile; a rate of weight gain that is disproportionate to the rate of length gain; weight-for-length less than 10th percentile (in children <24 months); and a decrease in 2 or more major growth percentile curves. 1,2 FTT more commonly presents in children less than 18 months of age. 2 In the United States, children with FTT account for 5% to 10% of primary care pediatric patients and 3% to 5% of pediatric hospital admissions. 2 Previous studies have described patient characteristics of children with failure to thrive. 3-8 These studies often made a distinction between "organic" (with an underlying medical pathology) and "nonorganic" (underlying behavioral and psychological) causes. 4,8-10 However, some researchers have advocated to abandon the use of the dichotomous "organic" versus "nonorganic" description of FTT. 1,11,12 The dichotomous division is thought to be too simplistic for clinical and research purposes and does not capture the complexity of patients presetting with FTT. Several researchers make the case that FTT is explained by multiple biopsychosocial factors and arises from the interaction between these factors. 9,11 Feeding difficulties are common in children with FTT. 13 The term "feeding difficulties" is commonly used as an umbrella term that refers to a "feeding problem of some sort." 14(p345) These problems can include 858526G PHXXX10.

ObjectivesTo describe the acceptability, safety and effectiveness of neuromuscular electrical stimulation (NMES) in infants and young children with neurological impairment (NI) who have severe dysphagia.DesignA prospective pilot study using a before and after study design.SettingThe Hospital for Sick Children, Toronto, Canada.PatientsTen infants and young children (0–24 months) with NI and severe dysphagia on videofluoroscopic swallow study (VFSS) who were referred to an occupational therapist (OT). Those with neurodegenerative conditions were excluded.InterventionNMES treatments lasting 20–45 min twice weekly for the duration of 2–4 months. The NMES was administered during feeding therapy sessions by a trained OT.Main outcome measuresImprovement in swallowing function as measured by VFSS and the need for tube feeding, adverse events and parental acceptability.ResultsSeven of 10 enrolled subjects (median age, 8.9 months) completed biweekly NMES treatments (median number of treatments per subject, 18). All of the seven (100%) subjects who completed treatment showed an improvement in swallow function on VFSS. Of the five patients who were not safe to orally feed on any consistency of liquid or puree at baseline, three established full oral feeding and two established partial oral feeding. At baseline, 5/7 children were completely fed by tube versus 0/7 at the end of treatment. No adverse events occurred other than mild skin irritation at the site of electrode placement. Five of seven caregivers felt that feeding was improved and were satisfied with the intervention.ConclusionsOur prospective pilot study of NMES in seven neurologically impaired infants and young children with severe dysphagia suggests that NMES is safe, acceptable to parents and has potential efficacy. Trials are needed to determine if any treatment benefit exists.Trial registrationClinicalTrials.gov NCT01723358.

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ObjectivesDysphagia in childhood has important health impacts for the child and their family as well as the healthcare system. This systematic review aims to determine the effectiveness of neuromuscular electrical stimulation (NMES) for treatment of oropharyngeal dysphagia in children.MethodsA search was performed on November 2020 in MEDLINE (from 1946), EMBASE (from 1947), PsycINFO (from 1806), CINAHL (from 1937), CENTRAL (from 1996) and Scopus (from 1970) databases. Studies of children (≤18 years) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Cochrane Collaboration’s tool for randomised controlled trials (RCTs) and a modified Newcastle-Ottawa assessment for observational studies. A meta-analysis was not conducted due to clinical heterogeneity in studies.ResultsTen studies were included (5 RCTs, 4 case series, 1 cohort study; including 393 children, mean or median age below 7 years, including children with neurologic impairments). In all studies, swallowing function improved after NMES treatment. The standardised mean difference (SMD) for improvement of swallowing dysfunction in treatment compared with control groups in the RCTs ranged from 0.18 (95% CI −0.7 to 1.06) to 1.49 (95% CI 0.57 to 2.41). Eight of 10 studies reported on the child’s feeding ability, and, with one exception, there was improvement in feeding ability. Few studies reported on health status (N=2), impact on caregiver (N=1), adverse events and harms (N=2), and child’s quality of life (N=1). In most studies, outcome follow-up was less than 6 months. The studies demonstrated moderate to high risk of bias.ConclusionsNMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, uncertainty remains. Well-designed RCTs are needed to establish its effectiveness before its adoption in clinical practice.PROSPERO registration numberCRD42019147353.

BACKGROUND Failure to thrive (FTT) is prevalent in 5% of the paediatric population and results from the interactions between the child’s health, behaviour, development and social environment. A multi-disciplinary team approach to treat FTT is effective but resources are not always available. OBJECTIVES To characterize biopsychosocial factors and feeding behaviours in children presenting with failure to thrive in our clinic. DESIGN/METHODS A retrospective cross-sectional chart review of children referred to our academic growth and feeding clinic was performed. Children between the ages of 2 months and 5 years with a first clinic visit between 1st January 2015 and 31st of December 2016 were included. Data from the patient’s first visit was included in the study. In a REDCAP database, anthropometric measures according to WHO growth curves, medical history and concurrent developmental delays were recorded. Factors important to the child’s social environment (e.g. maternal mental health, financial problems) were identified. These factors were self-reported by parents to the clinic team or noted on the patient’s referral. Specific attention was paid to the identification of feeding behaviours of children (e.g. vomiting, gagging) and parents (e.g. force feeding, use of distractions). Descriptive statistics were used to analyze the data. RESULTS The study included n = 138 (53.6% male) children with a mean age of 16.9 (SD 10.8) months. The mean weight-for-age percentile was 16.0 (SD 24.3), mean height-for age percentile was 23.8 (SD 30.7), and mean weight-for-length percentile was 16.8 (SD 23.4). 88 (63.8%) children had both growth and feeding behaviour concerns. 26 (18.8%) children were born prematurely and 24 (17.4%) were small for gestational age. 57 (41.3%) children had a history of gastro-oesophageal reflux. In 10 (7.2 %) children, a genetic diagnosis was identified. Concurrent developmental delays were described in the gross motor (20.3%), fine motor (8.0%), speech and language (20.3%) and social domains (6.5%). Feeding developmental milestones that were delayed included not-self feeding (17.4%) and a diet inappropriate for age (20.3%). Important factors that were identified in the child’s social environment were: maternal depression (5.1%), CAS involvement (10.1%) and financial problems (7.2 %). Maternal anxiety was reported but difficult to define. In more than half (50.7%) of the children, feeding behaviours of vomiting, gagging and/or crying and arching were described. Parents used force feeding (14.5%) and distractions (47.1%), and reported mealtimes longer than 30 minutes (70.3%). Most commonly used distractions were television (25.4%) and mobile screens (14.5%). CONCLUSION In our academic population of children with FTT, there is a high incidence of concurrent developmental delays, delayed feeding milestones and feeding behaviour problems. Almost half of the parents used distractions and even more parents prolonged mealtimes to make their child eat. These results underscore the importance of a multi-disciplinary team approach to address feeding behaviours and child development in our population of children with FTT.