A randomised controlled trial of specialist health visitor intervention for failure to thrive   Commentary

Abstract

Aims-To determine whether home intervention by a specialist health visitor aVects 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 diVerences 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. (Arch Dis Child 1999;80:500-506)

The Developmental Sequelae of Nonorganic Failure to Thrive

“…A significant proportion of children who fail to thrive show catch-up growth (e.g., Kristiansson & Fa$ lstro$ m, 1987), suggesting that the chronic problems experienced by Puckering and colleagues ' sample may have been particularly severe. Wright, Callum, Birks, and Jarvis (1998) found that health visitor intervention was related to better physical outcomes following failure to thrive, but there is little evidence that such intervention has a positive impact on cognitive outcomes following FTT (Raynor, Rudolph, Cooper, Marchant, & Cottrell, 1999). Moreover, the majority of infants who fail to thrive are not identified or referred (Batchelor & Kerslake, 1990 ;Skuse et al, 1992), and so would not experience any potential benefits from hospital-or community-based intervention.…”

Psychosocial and educational outcomes of weight faltering in infancy in ALSPAC

“…However, considering that randomised trials of interventions for FTT have failed to demonstrate convincing effects in these areas,34 35 it seems unlikely that clinical interventions have masked the impact on psychological development and educational attainment.…”

Anthropometric indices of failure to thrive

“…We received data on children enrolled in a randomised controlled trial of health visitor intervention in failure to thrive,3 calculating anthropometric indices for all children using five methods as shown in table 1. For calculation of the three first methods, median height and weight were taken as the 50th centile of the 1990 growth standards 4.…”