Failure to Thrive and the Risk of Child Abuse: A Prospective Population Survey

Abstract

Objective — To identify the relative importance of failure to thrive during infancy as a risk factor for later abuse or neglect. Design — Whole population birth cohort (1 January to 31 December 1986) studied prospectively over a four year period. Setting — An inner city health district in London, England. Subjects — 2609 births, of whom 47 were identified as having non-organic failure to thrive by first birthday. Main outcome measures — Registration on Child Protection Register, or subject to investigation of suspected abuse or neglect without registration. Results — 2·5% (64) of birth cohort had been placed on the Child Protection Register during the period 1986–1990, and a further 1·2% (32) had been a cause for concern. The relative risk attributable to nonorganic failure to thrive was 4·3 (95% CI 1·65 to 11·94) and exceeded other measured risk factors, including birth weight <2500g, 1·96 (95% CI 1·01 to 3·82); gestation <35 weeks, 3·26 (95% CI 1·32 to 3·75); ordinal position >4, 1·53 (95% CI 0·72 to 3·23). A multiple logistic regression confirmed the independent contribution of non-organic failure to thrive to subsequent poor parenting warranting professional intervention. Conclusions — Early postnatal non-organic failure to thrive is a risk factor for later serious parenting deficiencies, but previous research has overstated its importance. Within the community studied the nature of subsequent risk was (non-nutritional) neglect, rather than non-accidental injury. More than eight out of 10 cases do not give further cause for concern.