Authors' objectives:

This report provides a systematic review of the scientific evidence to answer the question of whether children, defined by investigators as failing to thrive o grow adequately, have a concurrent 'disability', or will have one within 6 months. The population of interest includes children age 18 years or younger, both male and female, of all racial, ethnic and socioeconomic groupings.

Authors' results and conclusions: Persistent disorders of growth: Overall these studies comparing children who were thriving with those who were undernourished in both developed and developing countries show that children with failure to thrive (FTT) have poorer growth in weight, height, and head growth, and that this poorer growth is often long-standing despite appropriate interventions. Earlier intervention leads to potentially better long-term outcome. Associations of FTT with immunologic/infectious outcomes: The evidence that children with FTT have significantly greater susceptibility to infection is strong, with significant immunologic dysfunction and clinical infectious complications seen consistently across a variety of conditions. The laboratory markers of immunologic dysfunction were apparent in children with moderate severity. Only one study demonstrated improvement following immunologic intervention. Severe complications were most prevalent among the most severely malnourished children. Disabilities related to child behavior associated with failure to thrive: The evidence identified by the search showed that children with failure to thrive concurrently exhibited a variety of behavioral disorders as well as at follow-up. The behavioral problems ranged from eating disorders, increased negative and decreased positive affective expression, to lower scores in communication and mood. Developmental disorders associated with failure to thrive: FTT is associated consistently with depressed developmental test scores. In both clinical and epidemiological samples, FTT is associated on average with roughly 2/3 of a standard deviation decrease in developmental test scores. As a result, a greater proportion of children who are failing to thrive than children in a reference population will score in the supplemental security income (SSI) qualifying range for developmental delay. Evidence that failure to thrive is associated with other psychosocial and family factors: Compared to well-nourished peers, children with FTT were more likely to have had neonatal problems (jaundice, possible sepsis, and poor feeding, and family problems). There were no differences however in the incidence of prematurity, LBW, or maternal pregnancy complications.

Authors' recommendations: The findings emphasize the importance of early and intensive intervention for children with poor growth velocity so as to prevent permanent growth retardation. The evidence also supports the value of identification of children with growth failure as a marker for chronic and multiple acute infections. Children with a history of FTT were found to have clinically and statistically significant behavioral deficits and consistently depressed scores in cognitive, neurological, and psychomotor development. The increased risks for secondary disability generally persist in spite of intervention. In summary, there is persuasive evidence that failure to thrive is associated with a range of organic and psychosocial difficulties and significant disability. Primary categories of associations include the child's age, socioeconomic factors (lower income, lower maternal education, less enriched family environment/interactions); neonatal morbidity; acute illnesses and hospitalizations; and neurological/anatomical abnormalities.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/downloads/pub/evidence/pdf/failthrive/failthrive.pdf

Year Published: 2003

URL for published report: http://www.ahrq.gov/clinic/epcsums/fthrivesum.htm

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)