Tuesday, July 03, 2007
Failure to thrive, a condition that affects about five out of every 100 infants and toddlers in the United States, can impact a child’s stature and school performance for up to eight years after the diagnosis. But new research from the University of Maryland School of Medicine has found that a home intervention program during the first year of life is successful at mitigating the effects of failure to thrive (FTT) as the child gets older. The study, published in the July 2007 edition of the journal Pediatrics, found that children with FTT who received home visits from intervention specialists performed better in school, were better behaved and weighed about five pounds more at age eight than children with FTT who didn’t receive home visits.
"Pediatricians and other physicians across the United States use standardized growth charts to track the growth and development of infants and toddlers," says Maureen Black, Ph.D., a professor of pediatrics at the University of Maryland School of Medicine and director of the Growth and Nutrition Clinic at the University of Maryland Hospital for Children. "Children with failure to thrive don’t keep pace in terms of height and weight and usually fall under the 5th percentile on this growth chart. This condition often begins during the second six months of life."
Numerous medical conditions can cause FTT, including prematurity, reflux, food allergies and metabolic disorders. But the majority of children seen in the Growth and Nutrition Clinic at the University of Maryland Hospital for Children who suffer from FTT don’t have an underlying medical condition. "Medical problems make up a small percentage of FTT cases," says Dr. Black. "Other causes include a lack of access to adequate food, irregular or inconsistent mealtime routines, competing activities that interfere with meals, children with low appetites, and children’s delayed development in transitioning to pureed and solid foods.
FTT occurs among children of all economic classes, but the prevalence is highest among children in low-income families. According to Dr. Black, many children with FTT experience growth and cognitive recovery by school age, but they continue to be at risk for poor growth, low academic achievement and poor academic work habits that are likely to undermine future performance in school.
In 1989, Dr. Black and colleagues recruited 249 children from pediatric primary care clinics that serve low-income areas of Baltimore to participate in the study. Approximately 130 of those children suffered from FTT not caused by a medical condition, and 119 served as a comparison group with average growth. Children with FTT were randomly assigned to one of two groups. Both groups received clinical intervention for FTT in the interdisciplinary Growth and Nutrition Clinic at the University of Maryland Hospital for Children. The home intervention group also received that service for one year. The control group did not receive home intervention.
The home intervention was delivered by three specialists employed by PACT, a community agency specializing in early intervention. One-hour visits were scheduled weekly for one year and focused on supporting the caregiver’s personal, family and environmental needs, modeling and promoting positive parent-infant interactions and problem-solving strategies regarding personal, parenting and children’s issues. The home visitors did not focus on nutrition or feeding behavior and did not weigh the children. Participants from the FTT groups and the comparison group returned to the Growth and Nutrition Clinic at four, six and eight years of age for evaluations.
"At the end of the first year, infants who received home visits had better development than those who had not, their caregivers were more nurturing, and their homes were more stimulating," says Dr. Black. "At that point, their growth was no different from those children with FTT who had not received home visits."
Dr. Black examined the study group again at age eight. She found that home intervention had benefits that lasted until at least age 8. Children with FTT who had not received the home intervention were shorter, thinner and had lower arithmetic scores than the comparison children. Thus, early home intervention protected the children with FTT from poor growth and school problems. In addition, children with FTT who received home visits were better behaved in school than those who with FTT who received no home interventions.
"It is likely that the stimulating caregiving environment resulting from early intervention was effective in helping children build strong work habits that enabled them to take advantage of academic opportunities," says Dr. Black. "Children who do well in school are better able to avoid roadblocks such as violence, drugs and teen pregnancy. Efforts to provide early intervention to vulnerable children and their families are good investments and should be continued, along with long-term follow-up evaluations to assess and ameliorate additional developmental risks."
This study was supported by the Maternal and Child Health Research Program at the U.S. Department of Health and Human Services.