Article Text

Download PDFPDF
What is the long term outcome for children who fail to thrive? A systematic review
  1. M C J Rudolf1,
  2. S Logan2
  1. 1Community Paediatrics, East Leeds Primary Care Trust and University of Leeds, Leeds, UK
  2. 2Peninsula Medical School, Exeter, UK
  1. Correspondence to:
    Prof. M C J Rudolf
    Leeds University and East Leeds Primary Care Trust, Belmont House, 3–5 Belmont Grove, Leeds LS2 9DE, UK;


Aims: To ascertain the long term outcomes in children diagnosed as having failure to thrive (FTT).

Methods: Systematic review of cohort studies. Medline, Psychinfo, Embase, Cinahl, Web of Science, Cochrane, and DARE databases were searched for potentially relevant studies. Inclusion criteria: cohort studies or randomised controlled trials in children <2 years old with failure to thrive defined as weight <10th centile or lower centile and/or weight velocity <10th centile, with growth, development, or behaviour measured at 3 years of age or older.

Results: Thirteen studies met the inclusion criteria; eight included a comparison group, of which five included children identified in community settings. Two were randomised controlled trials. Attrition rates were 10–30%. Data from population based studies with comparison groups and which reported comparable outcomes in an appropriate form were pooled in a random effects meta-analysis. Four studies report IQ scores at follow up and the pooled standardised mean difference was −0.22 (95% CI −0.41 to −0.03). Two studies reported growth data as standard deviation scores. Their pooled weighted mean difference for weight was −1.24 SDS (95% CI −2.00 to −0.48), and for height −0.87 SDS (95% CI −1.47 to −0.28). No studies corrected for parental height, but two reported that parents of index children were shorter.

Conclusions: The IQ difference (equivalent to ∼3 IQ points) is of questionable clinical significance. The height and weight differences are larger, but few children were below the 3rd centile at follow up. It is unclear to what extent observed differences reflect causal relations or confounding due to other variables. In the light of these results the aggressive approach to identification and management of failure to thrive needs reassessing.

  • systematic review
  • failure to thrive
  • weight faltering
  • prognosis
  • outcome

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Atoms
    Howard Bauchner