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Cognitive and educational attainments at school age of children who failed to thrive in infancy: a population-based
R F Drewett1, S S Corbett, C M Wright
1Department of Psychology, University of Durham, UK. r.f.drewett@durham.ac.uk
Insights
Children with nonorganic failure to thrive in infancy show persistent stunting and reduced head circumference into school age. However, these growth deficits do not impact cognitive or educational outcomes.
Area of Science:
- Pediatrics
- Child Development
- Growth Monitoring
Background:
- Failure to thrive (FTT) in infancy is a concern for child development.
- Nonorganic FTT, without identifiable medical causes, requires careful definition and follow-up.
- Longitudinal growth standards are crucial for identifying and assessing FTT.
Purpose of the Study:
- To investigate the long-term physical and cognitive outcomes of infants diagnosed with nonorganic failure to thrive.
- To determine if early growth deficits persist into school age and affect developmental milestones.
Main Methods:
- A cohort of children identified with nonorganic FTT in infancy was compared to a control group.
- Children were assessed at 7-9 years of age for anthropometric measurements (height, weight, head circumference, BMI).
- Cognitive function, IQ, and educational achievements (reading, spelling) were evaluated.
Main Results:
- Children with a history of nonorganic FTT were significantly shorter, lighter, and had smaller head circumferences than controls at school age.
- Despite significant physical differences, no statistically significant differences were found in IQ scores between cases and controls.
- Educational assessments, including reading and spelling, also showed no significant disparities between the groups.
Conclusions:
- Nonorganic failure to thrive, defined by velocity-based criteria, leads to persistent stunting and reduced head circumference.
- These physical growth deficits in childhood do not appear to be associated with cognitive or educational disadvantages later in life.
Abstract:
A 1-year cohort of children born at term in Newcastle-upon-Tyne in 1987/8 was screened for failure to thrive in infancy using a conditional longitudinal standard which identified those whose weight gain was in the lowest 5%. A group of 136 cases and 136 controls (from the same GP practice and living in a neighbourhood with the same deprivation index) was followed up at 7-9 years of age, when 79% of cases and 87% of controls were successfully studied. Cases at 7-9 were significantly shorter (mean 126.0 cm, SD 5.6) than controls (mean 130.7 cm, SD 5.9); adjusted for parental heights a difference of 4.4 cm (95% CI 2.92 to 5.90 cm) remained. They had smaller head circumferences (mean 51.9 cm, SD 1.8) than controls (mean 52.8 cm, SD 1.7), were significantly lighter (medians 23.8 kg, IR 21.5 to 26.9 in cases, and 27.9 kg, IR 25.2 to 31.6 in controls) and had a lower body mass index (median 14.9, IR 14.1 to 16.0 in cases, and 16.3, IR 15.3 to 17.8 in controls). Despite these large growth differences, no statistically significant differences in cognitive outcomes were found. Mean IQ was 87.6 (SD 17.4) in cases and 90.6 (SD 17.1) in controls; after adjustment for organic cause and mother's IQ the mean difference was 1.7 IQ points (95% CI -5.2 to 1.9). There were no statistically significant differences in the reading, spelling, or reading comprehension scores; the mean standardised reading score was 93.5 (SD 16.2) for cases and 94.5 (SD 15.6) for controls. These results show that when carefully defined by velocity-based anthropometric criteria, nonorganic failure to thrive in infancy is followed by persisting stunting and wasting, and a reduced head circumference, but is not associated with cognitive or educational disadvantages at school age.