Disparities in Pediatric Admissions for Growth Faltering

The objective of this study was to describe potential differences caused by race, ethnicity, and socioeconomic status in admission criteria and inpatient treatment of children with a diagnosis of growth faltering (GF).

A retrospective medical record review was conducted of children aged 1 to 24 months admitted to a tertiary children's hospital with a diagnosis of GF from January 2012 to January 2022. Demographic data, growth parameters, and inpatient treatment (ie, laboratory tests, consultations, interventions) were extracted from the electronic medical record. Data were analyzed via generalized estimating equations using logit link.

The study population (n = 982 encounters, n = 890 unique patients) was predominantly white (69%) and Medicaid recipients (60%). Black patients had the highest area deprivation index (ADI) score (7.0; P < .001). Black patients had lower admission (-3.1) and discharge (-2.7) weight-for-age z scores (WFAZ) compared with white patients (-2.5 and -2.0, respectively; P < .001) with no difference in median weight change or length of stay. Difference in admission WFAZ was associated with increased rates of social work consultations (odds ratio [OR] 1.76; P = .001) and Child Protective Services (CPS) referrals (OR 1.89; P = .008) for Black patients compared with white patients. White patients had higher lactation consultation rates (25%) compared with Black patients (13%; P = .002), attributed to higher breastfeeding rates in white patients.

This study identified differences in consultations based on race and socioeconomic status for children admitted with GF, related to Black patients admitted at lower WFAZ and thereby with more severe GF. Further study is needed to understand and address factors contributing to this difference to better elucidate disparities in care.