Failure to thrive in a population context: two contrasting studies of feeding and nutritional status

Abstract

Although failure to thrive (FTT) is generally thought to be a nutritional problem, dietary intake in children with FTT has been little researched. We describe two community-based studies of dietary intake and eating behaviour in FTT. The first study of ninety-seven children with FTT identified by population screening found that only a minority of case children were associated with neglect, organic illness or deprivation, even though dietary information suggested an underlying nutritional cause in the majority. Limited case-control data suggested significantly delayed weaning and less liking for food in general among the case children. The second study found diminished appetite, delayed progression onto solid foods and fewer foods eaten by forty-four children referred with FTT compared with forty-five controls, but was unable to detect a significant difference in energy intake, even allowing for varying body composition and other confounding variables. This study also revealed the bias introduced by recruiting case children by referral rather than screening, and that despite rigorous matching procedures the controls were not representative of the general population. These studies suggest a wide range of differences in eating behaviour and feeding patterns between children with FTT and controls, but suggest that measurements of nutrient totals may not be robust. Studies of FTT based on referred children can be misleading, as can comparison with controls, unless allowance can be made for important confounding social variables.

Why are babies weaned early? Data from a prospective population based cohort study

“…The Dundee cohort study 22 found no increase in gastrointestinal infections in those weaned before 12 weeks. In the two Honduras trials of age at weaning, one found slightly increased risks of diarrhoea in those weaned later, 20 though the numbers were small and the prevalence of diarrhoea low.…”

Failure to think about failure to thrive

“…Research on the significance of FTT has been marred by two major methodological problems-problems of definition, as described above, and problems of referral or selection bias. 18 Many of the studies informing both clinical and preventive practice have been carried out on hospital populations that do not reflect the general child population. 19 20 Both these methodological problems tend to lead to overestimation of the clinical significance of FTT and its value as a predictor of future problems.…”

Coexistence of social inequalities in undernutrition and obesity in preschool children: population based cross sectional study

“…Most infants and young children with failure to thrive have a low BMI which is nutritional in origin. 30 Obesity was defined as BMI >95th centile, and severe obesity >98th centile (Clinical BMI charts, Harlow Printing/Child Growth Foundation). These definitions have high specificity and moderately high sensitivity 31 in identifying the fattest children within the population, and so are informative for individual children as well as populations.…”