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Effect of community based management in failure to thrive: randomised controlled trial
C M Wright1, J Callum, E Birks
1Department of Child Health, Newcastle University, Donald Court House, Gateshead NE8 1EB. c.m.wright@ncl.ac.uk
Insights
Health visitor intervention significantly improves growth in children with failure to thrive. This approach, with specialist support, leads to better weight and height compared to standard care.
Area of Science:
- Pediatrics
- Public Health
- Child Development
Background:
- Failure to thrive (FTT) affects young children, impacting growth and development.
- Early identification and intervention are crucial for improving outcomes in FTT.
- Existing management strategies for FTT may have limitations in effectiveness.
Purpose of the Study:
- To assess the efficacy of a health visitor-led intervention for children under two years experiencing failure to thrive.
- To compare the growth outcomes of children receiving the intervention versus those receiving conventional management.
Main Methods:
- A controlled trial design, with primary care practices randomized.
- Intervention involved structured health visitor management, with access to dietetic, pediatric, and social work support.
- 229 children identified with FTT were followed up to age 3 years via home visits and record reviews.
Main Results:
- The health visitor intervention group showed significantly better weight and height compared to the control group.
- Recovery rates from failure to thrive were higher in the intervention group (76%) versus the control group (55%).
- Fewer children in the intervention group were lost to follow-up compared to the control group.
Conclusions:
- Health visitor intervention, even with limited specialist input, offers a significant improvement in growth for children with failure to thrive.
- This intervention model demonstrates effectiveness in enhancing child growth outcomes compared to conventional care approaches.
Objective:
To evaluate the effectiveness of a health visitor led intervention for failure to thrive in children under 2 years old.
Design:
Controlled trial, randomised by primary care practice.
Setting:
Newcastle upon Tyne health district.
Intervention:
Structured health visitor management, with dietetic, paediatric, and social work input as required.
Subjects:
229 children (120 in intervention practices and 109 in control practices) were identified as failing to thrive by population screening during the first 2 years of life. Follow up was by home visit of a research nurse and review of the childrens' records at age 3 years.
Main Outcome Measures:
Follow up weight and height and number of routinely collected weights.
Results:
95 of the 97 families offered intervention completed at least the initial assessment. At follow up, 187 (82%) records were reviewed, and these suggested that 15 (16%) controls were lost to follow up immediately after the screening weight was taken compared with only one child in the intervention group. In the 134 (58%) families who consented to home visits, children in the intervention group were significantly heavier and taller and were reported to have better appetites than childen in the control group, although both groups were equally satisfied by the services they had received. When the children were last weighed, 91 (76%) in the intervention group had recovered from their failure to thrive compared with 60 (55%) in the control group (P<0.001).
Conclusion:
In failure to thrive, health visitor intervention, with limited specialist support, can significantly improve growth compared with conventional management.