Affiliation:
1. Divisions of Hospital Medicine and
2. Child Abuse and Neglect, Department of Pediatrics, Children’s Mercy Hospital, School of Medicine, University of Missouri–Kansas City, Kansas City, Missouri; and
3. Children’s Hospital Association, Lenexa, Kansas
Abstract
OBJECTIVES:
To investigate the association of in-hospital weight gain with failure to thrive (FTT) etiologies.
METHODS:
With this retrospective cross-sectional study, we included children <2 years of age hospitalized for FTT between 2009 and 2012 at a tertiary care children’s hospital. We excluded children with a gestational age <37 weeks, intrauterine growth restriction, acute illness, or preexisting complex chronic conditions. Average daily in-hospital weight gain was categorized as (1) below average or (2) average or greater for age. χ2, Fisher’s exact test, and 1-way analysis of variance tests were used to compare patient demographics, therapies, and FTT etiologies with categorical weight gain; multivariable logistic regression models tested for associations.
RESULTS:
There were 331 children included. The primary etiologies of FTT were neglect (30.5%), gastroesophageal reflux disease (GERD) (28.1%), child-centered feeding difficulties (22.4%), and organic pathology (19.0%). Average or greater weight gain for age had a specificity of 22.2% and positive predictive value of 33.9% for differentiating neglect from other FTT etiologies. However, sensitivity and negative predictive value were 91.1% and 85.0%, respectively. After adjusting for demographics and therapies received, neglect (P = .02) and child-centered feeding difficulties (P = .01) were more likely to have average or greater weight gain for age compared with organic pathology. Children with GERD gained similarly (P = .11) to children with organic pathology.
CONCLUSIONS:
In-hospital weight gain was nonspecific for differentiating neglect from other FTT etiologies. Clinicians should exercise caution when using weight gain alone to confirm neglect. Conversely, below average weight gain may be more useful in supporting GERD or organic pathologies but cannot fully rule out neglect.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health
Cited by
6 articles.
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