The Impact of Socioeconomic Status and Different Treatment Modalities on Children With Faltering Weight: Technical...

Low socioeconomic status (SES) has been theorized to be a risk factor for faltering weight (previously "failure to thrive") in infants and children, but evidence is needed to understand the certainty of the association. Many treatment options exist with the aim of weight gain in infants and young children; however, the comparative effectiveness is not well understood.

This technical report assessed SES as a risk factor for faltering weight in children younger than 5 years who live in high-income countries and determined the comparative efficacy of available treatment options for children with faltering weight (eg, increased calories, supplementation, feeding/speech therapies). Feeding and speech therapies were almost always combined in the literature and were combined in this review.

The systematic review updates a previous review, from January 1, 2017 through June 27, 2022, for studies reporting on the relationship between SES and faltering growth on prevalence of faltering weight or thrive index (TI). To identify studies reporting on treatment options for faltering weight, reviewers searched PubMed, Embase, and Cochrane Library for comparative, English-language studies published from the database's inception through August 19, 2022. Eligible studies were conducted in high-income countries with at least 80% of the sample population younger than 5 years with suspected or diagnosed faltering weight. Data were extracted from studies and narratively summarized. Risk of bias was assessed by 2 researchers using the Prediction model of Risk of Bias Assessment Tool (PROBAST) tool, the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I), and version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB 2). Certainty of evidence was assessed using the Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach.

Of 9111 records, the search identified 2 new cohort studies to update the body of evidence from the previous SES review. Of the 5 studies reporting on prevalence of faltering weight, 2 showed a U-shaped association between SES and prevalence of faltering weight, 1 study showed an inverse relationship, and the other 2 studies showed no association. The 2 studies that reported on mean TI also showed U-shaped association between TI and SES. Certainty of evidence was very low for all studies. Of 8959 records, 1 study investigated increasing calorie intake; 3 studies investigated supplementation; and 3 studies investigated feeding and speech therapies for the treatment of children with faltering weight. None of the interventions studied were associated with a meaningful increase in weight gain compared with usual care. There is very low certainty that increased caloric intake and supplementation led to more growth than usual care and low certainty that feeding and speech therapy supplementation led to more growth than usual care.

The results suggest that SES is not a reliable predictor of failure to thrive in children younger than 5 years who live in high-income countries. Studies that investigated the impact of different treatment modalities for faltering weight have inconsistent findings.