Early intervention and recovery among children with failure to thrive: follow-up at age 8.
OBJECTIVE
We sought to examine the impact of a randomized, controlled trial of home visiting among infants with failure to thrive on growth, academic/cognitive performance, and home/classroom behavior at age 8.


METHODS
Infants with failure to thrive (N = 130) or adequate growth (N = 119) were recruited from pediatric primary care clinics serving low-income, urban communities. Eligibility criteria included age <25 months, gestational age >36 weeks, birth weight >2500 g, and no significant medical conditions. Evaluation included anthropometries, Bayley scales, maternal anthropometries, demographics, negative affect, IQ, and the Home Observation for Measurement of the Environment scale. Infants with failure to thrive were treated in an interdisciplinary growth and nutrition clinic and randomized into clinical-intervention-plus-home-intervention or clinical-care-only groups. The home-visiting curriculum promoted maternal sensitivity, parent-infant relationships, and child development. Follow-up visits were conducted by evaluators who were unaware of the children's growth or intervention history. At age 8, the evaluation included anthropometries, the Wechsler Intelligence Scale for Children III, and the Wide Range Achievement Test, Revised. Mothers completed the Child Behavior Checklist and teachers completed the Teacher Report Form.


METHODS
Multivariate analyses of variance were used to examine differences in growth, cognitive/academic performance, and home/school behavior, adjusted by maternal education, public assistance, and, when appropriate, infant Bayley score, maternal BMI, height, negative affect, IQ, and Home Observation for Measurement of the Environment scores.


RESULTS
Retention was 74% to 78%. Children in the adequate-growth group were significantly taller, heavier, and had better arithmetic scores than the clinical-intervention-only group, with the clinical-intervention-plus-home-intervention group intermediate. There were no group differences in IQ, reading, or mother-reported behavior problems. Children in the clinical-intervention-plus-home-intervention group had fewer teacher-reported internalizing problems and better work habits than the clinical-intervention-only group.


CONCLUSIONS
Early failure to thrive increased children's vulnerability to short stature, poor arithmetic performance, and poor work habits. Home visiting attenuated some of the negative effects of early failure to thrive, possibly by promoting maternal sensitivity and helping children build strong work habits that enabled them to benefit from school. Findings provide evidence for early intervention programs for vulnerable infants.
Black
Maureen M
MM
Department of Pediatrics, University of Maryland School of Medicine, 737 W Lombard St, Room 161, Baltimore, MD 21201, USA. mblack@peds.umaryland.edu
Dubowitz
Howard
H
Krishnakumar
Ambika
A
Starr
Raymond H
RH
D002648:Child; D002652:Child Behavior; D002657:Child Development; D003071:Cognition; D018479:Early Intervention, Educational; D004522:Educational Status; D005183:Failure to Thrive / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006128:Growth; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007360:Intelligence; D008297:Male; D009034:Mother-Child Relations; D011203:Poverty; D011632:Public Assistance; D012959:Socioeconomic Factors