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Failure to thrive in infancy was associated with later stunting and wasting but not cognitive or educational disadvantages
  1. Charles Zeanah, Jr, MD1
  1. Tulane University School of Medicine New Orleans, Louisiana, USA

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 QUESTION: Are there long term effects of failure to thrive in infancy?

    Design

    Inception cohort followed up at 7–9 years of age.

    Setting

    Population based study in Newcastle upon Tyne, UK.

    Patients

    A 1 year birth cohort of children in 1987–8 was screened for failure to thrive in infancy using a conditional longitudinal standard that identified those whose weight gain was in the lowest 5%. 136 children (62% girls) had thrive index values below the 5th centile in ≥2 age bands. 136 children who had no thrive index below the 10th centile were also followed up (non-failure to thrive group). 83% were followed up at 7–9 years of age.

    Assessment of prognostic factors

    Failure to thrive defined as a thrive index below the 5th centile on ≥2 occasions between 3 and 18 months.

    Main outcome measures

    Height, head circumference, weight, body mass index, intelligence quotient (IQ), reading, reading comprehension, and spelling assessed at 7–9 years of age.

    Main results

    At 7–9 years of age, children in the failure to thrive group compared with those in the non-failure to thrive group were shorter (126.0 cm v 130.7 cm, p<0.01), had smaller head circumferences (51.9 cm v 52.8 cm, p<0.01), were lighter (23.8 kg v 27.9 kg, p<0.001), and had a lower body mass index (14.9 v 16.3, p<0.001). No differences existed between the groups for IQ (mean difference after adjustment for organic cause and mother's IQ 1.7, 95% CI –5.2 to 1.9); or reading, spelling, or reading comprehension (mean standardised reading score 93.5 v 94.5 {absolute difference 1.0, CI –3.2 to 5.2}*).

    Conclusion

    Non-organic failure to thrive in infancy was followed by stunting and wasting and a reduced head circumference but was not associated with cognitive or educational disadvantages at 7–9 years of age.

    Commentary

    The strengths of this study by Drewett et al are notable. It is population based, longitudinal, and carefully controlled. The number of studies of failure to thrive with these characteristics is limited, and the results deserve special notice. In this study, failure to thrive is also more carefully and thoughtfully defined than in many previous studies. The negative findings reported here agree with recent research suggesting that many of the previously documented problematic correlates and sequela of failure to thrive in infancy do not hold up when studies are population based.1, 2 Obviously, these types of studies (population based studies) avoid the possibility that factors related to referral bias might confound the outcomes being assessed.

    On the other hand, small and non-significant differences in IQ and reading scores in index and control cases are not necessarily unimportant. Although a practitioner treating a particular child may feel reassured by these findings, in fact, in terms of societal costs, small differences may be quite meaningful. For example, a recent meta-analysis of studies of outcomes of infants exposed prenatally to cocaine found a difference in IQ scores of 3.3 points between exposed and non-exposed children.3 This translated into an estimated US$10–80m in additional costs for services. Modest expressive and receptive language differences between exposed and non-exposed children translated into even higher costs.

    Practitioners should remember also that reassuring results in population based studies do not negate the findings from studies of referred infants. Rather, they point out the problems of extrapolating from non-representative (eg, referred) samples. Children referred for failure to thrive remain a high risk group, even if their problematic outcomes do not derive directly from growth failure.

    References

    View Abstract

    Footnotes

    • Source of funding: Wellcome Trust.

    • For correspondence: Dr R F Drewett, Department of Psychology, University of Durham, South Road, Durham DH1 3LE, UK. Fax +44 (0)191 374 7474.

    • * Numbers calculated from data in article.

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