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A randomised controlled trial of specialist health visitor intervention for failure to thrive
P Raynor1, M C Rudolf, K Cooper
1Community Paediatrics, Leeds Community and Mental Health Trust, Belmont House, 3-5 Belmont Grove, Leeds LS2 9NP, UK.
Insights
Specialist health visitor home intervention for failure to thrive did not improve child outcomes. However, it led to better health service coordination and reduced healthcare utilization for these children.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Failure to thrive (FTT) is a common pediatric concern requiring effective interventions.
- Specialist health visitor home interventions aim to improve outcomes for children with FTT.
Purpose of the Study:
- To evaluate the impact of specialist health visitor home intervention on children with failure to thrive.
- To assess effects on growth, diet, healthcare resource use, and developmental outcomes.
Main Methods:
- Randomized controlled trial comparing specialist home visiting with conventional care for 12 months.
- Outcomes included growth parameters, dietary intake, healthcare utilization, and standardized developmental and psychological scales.
Main Results:
- Both groups showed significant weight gain and improved developmental scores.
- The intervention group, particularly infants under 12 months, demonstrated a trend towards greater weight gain.
- Controls experienced more dietary referrals, social service involvement, and hospital admissions.
Conclusions:
- Specialist health visitor intervention did not yield statistically significant additional benefits for primary child outcome measures.
- The intervention facilitated a more coordinated healthcare approach and reduced health service use.
- Challenges in health service research for such interventions are noted.
Aims:
To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive.
Methods:
Children referred for failure to thrive were randomised to receive conventional care, or conventional care and additional specialist home visiting for 12 months. Outcomes measured were growth, diet, use of health care resources, and Bayley, HAD (hospital anxiety and depression), and behavioural scales.
Results:
Eighty three children, aged 4-30 months, were enrolled, 42 received specialist health visitor intervention. Children in both groups showed good weight gain (mean (SD) increase in weight SD score for the specialist health visitor intervention group 0.59 (0.63) v 0.42 (0.62) for the control group). Children < 12 months in the intervention group showed a higher mean (SD) increase in weight SD score than the control group (0.82 (0.86) v 0.42 (0.79)). Both groups improved in developmental score and energy intake. No significant differences were found for the primary outcome measures, but controls had significantly more dietary referrals, social service involvement, and hospital admissions, and were less compliant with appointments.
Conclusions:
The study failed to show that specialist health visitor intervention conferred additional benefits for the child. However, the specialist health visitor did provide a more coordinated approach, with significant savings in terms of health service use. Problems inherent to health service research are discussed.