Faltering Growth weight faltering, failure to thrive

1
Faltering Growth (weight faltering, failure to
thrive)

• Charlotte Wright
• University of Glasgow / RHSC Yorkhill

2
Non-organic Failure to Thrive

• Hospitalism Chapin 1915
• Maternal deprivation Bowlby 1973
• At risk register category in Scotland and in
  England till 1989

3
Diagnosing growth faltering and failure to thrive
Weight falling through centile spaces, low weight
for height or no catch-up from a low birth
weight Recommendations For Best Practice For
Weight And Growth Faltering In Young Children,
Childrens Society 2002
Primary Care 5 threshold Fall through 2 weight
centile spaces (1.3 SD) adjusted for initial
centile position
4
Usual perception of how do FTT, poverty and
neglect inter-relate
?
Deprivation
Neglect
FTT
5
Evidence from research on the role of deprivation
and neglect in weight faltering

• Slightly higher rates in most (and least deprived
  areas) but majority of cases arise in average
  areas
• No gradient with parental educational level
• Short term (or no) effect of maternal depression
  
• Most weight faltering children (95) have no
  evidence of abuse or neglect

6
Why does this differ from our clinical experience
?

• Referral bias Batchelor, Clinic notes study
• Constitutionally small vs FTT
• No difference in subsequent growth pattern
• Big difference in social class

7
Why is there no relationship in the UK between
weight faltering and deprivation?

• Welfare foods scheme
• Social security
• Reduced price of food
• Increased availability
• Small families

8
Evidence from research that weight faltering
reflects undernutrition

• Low dietary intake
• Low BMI
• Subsequent catch-up in weight and height
• Those treated heavier and taller

9
The Parkin Project Population based study of
screening and intervention in failure to thrive
10
Infants are highly vulnerable to malnutrition

• High energy requirements (3 x adult/kg)
• Rapid growth (2 x weight in 1st 4 months)
• Low density diet (milk)
• Higher morbidity
• Dependence on others for all food
• Preverbal

11
Why do babies fail to thrive in normal homes ?

• Child factors
• Low appetite drive
• Minor illnesses
• Subtle neurodevelopmental delay
• ?Undemanding
• Maternal factors
• Distracted / depressed
• Dietary mis-match
• Over-persuading

12
Weight faltering and deprivation

• Almost no association with deprivation, maternal
  mental health or neglect
• Need to offer services appropriate to actual
  problem under-eating
• Primary care HV led management works
• Needs to be de-stigmatised and re-thought