Search tips
Search criteria 


Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child. 2005 September; 90(9): 925–931.
Published online 2005 May 12. doi:  10.1136/adc.2004.050179
PMCID: PMC1720590

What is the long term outcome for children who fail to thrive? A systematic review


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.

Figure 1
 (A) Meta-analysis of weight SD scores in children who had experienced failure to thrive in infancy as compared with controls. (B) Meta-analysis of height SD scores in children who had experienced failure to thrive in infancy compared with controls. ...
Figure 2
 Meta-analysis of intellectual scores in children who had experienced failure to thrive in infancy compared with controls.

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group