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

Although failure to thrive (FTT) is generally thought to be a nutritional p roblem, 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 po pulation screening found that only a minority of case children were associa ted with neglect, organic illness or deprivation, even though dietary infor mation suggested an underlying nutritional cause in the majority. Limited c ase-control data suggested significantly delayed weaning and less liking fo r food in general among the case children. The second study found diminishe d appetite, delayed progression onto solid foods and fewer foods eaten by f orty-four children referred with FTT compared with forty-five controls, but was unable to detect a significant difference in energy intake, even allow ing for varying body composition and other confounding variables. This stud y also revealed the bias introduced by recruiting case children by referral rather than screening, and that despite rigorous matching procedures the c ontrols were not representative of the general population. These studies su ggest a wide range of differences in eating behaviour and feeding patterns between children with FTT and controls, but suggest that measurements of nu trient totals may not be robust. Studies of FIT based on referred children can be misleading, as can comparison with controls, unless allowance can be made for important confounding social variables.