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Editor,—On reading Charlotte Wright's excellent review of failure to thrive,1 I was challenged to consider my own impressions of the long term outlook. In preparing a lecture on the subject recently, I undertook a (non-systematic) review of the literature and concluded that the prospects for growth were generally good, with recent studies suggesting that over 75% and 90% of children respectively achieve weights and heights over the 3rd centile. In contrast the outlook for development and behaviour appeared less good: intellectual problems were reported in 15–67% and behavioural problems in 28–48% of children in the studies I reviewed, with evidence from many studies that these difficulties persisted into school age.
My conclusions were therefore directly opposite those of Wright: “Although the growth consequences of FTT seem to be enduring there is now more reassuring evidence about its impact on cognition”. From the references quoted by Wright, we seem to be drawing on a similar body of literature, but have come to very different conclusions. I wonder how much this is down to a difference of perspective and hence interpretation? I do not consider a height differential of three quarters of a centile space (5 cm) particularly worrying, but perhaps I am influenced by being 187 cm tall. In contrast, I do consider a cognitive deficit of 1–1.5 standard deviations below population or control group means to be of far greater concern.2
Wright's final conclusion that “slow weight gain does have long term consequences” surely must apply both to growth and to developmental and behavioural outcomes. If the long term consequences only related to growth, there would be less need to intervene. If wider effects are accepted, we should continue to strive to identify growth faltering early and to identify effective interventions for this needy group of children.