The development of an adherence measure for pediatric failure to thrive/faltering growth.

Abstract

Objective: Failure to thrive/faltering growth (FTT/FG) is often multiply determined and involves caregiver adherence to various recommendations to optimize child weight gain.The current study at an interdisciplinary FTT/FG clinic (a) documented the taxonomy of treatment recommendations made for children with FTT/FG (Study 1) and (b) developed an adherence measure, which was used by trained clinicians to examine the relationship between adherence and weight gain (Study 2). Methods: In Study 1, all treatment recommendations made to caregivers of 102 children with FTT/FG were recorded and categorized into domains. Based on domains identified in Study 1, a seven-domain adherence measure was developed. Using a new sample in Study 2 (n = 131, aged 1 to 10 years), clinicians assessed caregiver adherence to recommendations made at the prior clinic visit and examined the association between adherence and weight gain. Results: From Study 1, clinic recommendations fell within seven domains, including the following four that were expected to be associated with weight gain: liquids, food, behavior, and meal structure. Study 2 found that caregiver adherence, overall, was generally high (M = 3.0, SD = .80, rated on a 0 to 4 scale). Greater overall adherence was associated with greater weight gain (r = .253, p = .02). Examining specific recommendations, adherence to using high-calorie add-ons and limiting long mealtimes were associated with greater weight gain. Conclusions: The adherence measure developed in this study can be used to assist clinicians in the management of FTT/FG. Future research is needed to further identify specific treatment recommendations whose adherence is most closely associated with children's weight gain. Implications for Impact StatementFailure to thrive/faltering growth (FTT/FG), is complex as clinical presentations may vary depending on the child, with a universal goal of increasing weight and growth. Understanding the role of caregiver adherence to recommendations from interdisciplinary providers for FTT/FG has not been explored in the extant literature, and this study developed an adherence measure for this population in an interdisciplinary clinic setting. Overall adherence and adherence to several specific recommendations were significantly associated with greater weight gain, demonstrating a novel application of adherence assessment for children with FTT/FG.

Introduction to the special issue on pediatric adherence and self-management: Topical reviews and clinical applications of evidence-based assessment and intervention.

“…Addressing disparities in health outcomes and care is a priority in pediatric psychology (Valrie, Thurston, & Santos, 2020). Articles by David et al (2022), Cartwright et al, Levert et al (2022), and Sweenie et al (2022) focus on evidence-based assessment and practice in systemically excluded and marginalized populations. The articles (a) describe health care system, family, and individual-level factors that can influence adherence and self-management and (b) illustrate adaptations to evidence-based practice in order to meet the specific needs of groups in the context of structural inequities.…”