FOOD FOR THOUGHT: BIOPSYCHOSOCIAL FACTORS AND FEEDING BEHAVIOURS IN FAILURE TO THRIVE
Authors: Mazze Nina , Cory Emma , Gardner Julie , Alexanian-Farr Mara , Mutch Carly , Marcus Sherna , Johnstone Julie , van den Heuvel Meta 
Published: May 2018

Abstract

BACKGROUND
Failure to thrive (FTT) is prevalent in 5% of the paediatric population and results from the interactions between the child’s health, behaviour, development and social environment. A multi-disciplinary team approach to treat FTT is effective but resources are not always available.

OBJECTIVES
To characterize biopsychosocial factors and feeding behaviours in children presenting with failure to thrive in our clinic.

DESIGN/METHODS
A retrospective cross-sectional chart review of children referred to our academic growth and feeding clinic was performed. Children between the ages of 2 months and 5 years with a first clinic visit between 1st January 2015 and 31st of December 2016 were included. Data from the patient’s first visit was included in the study. In a REDCAP database, anthropometric measures according to WHO growth curves, medical history and concurrent developmental delays were recorded. Factors important to the child’s social environment (e.g. maternal mental health, financial problems) were identified. These factors were self-reported by parents to the clinic team or noted on the patient’s referral. Specific attention was paid to the identification of feeding behaviours of children (e.g. vomiting, gagging) and parents (e.g. force feeding, use of distractions). Descriptive statistics were used to analyze the data.

RESULTS
The study included n = 138 (53.6% male) children with a mean age of 16.9 (SD 10.8) months. The mean weight-for-age percentile was 16.0 (SD 24.3), mean height-for age percentile was 23.8 (SD 30.7), and mean weight-for-length percentile was 16.8 (SD 23.4). 88 (63.8%) children had both growth and feeding behaviour concerns. 26 (18.8%) children were born prematurely and 24 (17.4%) were small for gestational age. 57 (41.3%) children had a history of gastro-oesophageal reflux. In 10 (7.2 %) children, a genetic diagnosis was identified. Concurrent developmental delays were described in the gross motor (20.3%), fine motor (8.0%), speech and language (20.3%) and social domains (6.5%). Feeding developmental milestones that were delayed included not-self feeding (17.4%) and a diet inappropriate for age (20.3%). Important factors that were identified in the child’s social environment were: maternal depression (5.1%), CAS involvement (10.1%) and financial problems (7.2 %). Maternal anxiety was reported but difficult to define. In more than half (50.7%) of the children, feeding behaviours of vomiting, gagging and/or crying and arching were described. Parents used force feeding (14.5%) and distractions (47.1%), and reported mealtimes longer than 30 minutes (70.3%). Most commonly used distractions were television (25.4%) and mobile screens (14.5%).

CONCLUSION
In our academic population of children with FTT, there is a high incidence of concurrent developmental delays, delayed feeding milestones and feeding behaviour problems. Almost half of the parents used distractions and even more parents prolonged mealtimes to make their child eat. These results underscore the importance of a multi-disciplinary team approach to address feeding behaviours and child development in our population of children with FTT.