A pilot study to explore factors affecting faltering growth in children



Background:  Faltering growth (FG) is multifactorial in origin with evidence to suggest inadequate nutritional intake as a main underlying cause (Cooke, 2010). The effect of maternal and social factors on FG and nutritional intake are unclear from published research (Wright, 2000). This study aimed to compare the nutritional intake of children with and without FG and to determine the impact of maternal characteristics and infant feeding history.

Methods:  A control comparison study of 24 children (12 FG; 12 controls) recruited through clinics at AMNCH, Dublin was undertaken. Participants completed a questionnaire exploring social, demographic, parental and health history, and a 7-day food dairy was completed using household measures. Food diaries were analysed using NETWISP© (v3.0, Tinuviel Software, UK) for protein, total fat, saturated, monounsaturated and polyunsaturated fat, carbohydrate, sugars and starch. Also analysed were vitamins A, D, E, thiamin, riboflavin, B6, B12, folate, pantothenic acid, biotin, vitamin C and the minerals sodium, potassium, calcium, magnesium, phosphorous, iron, copper, zinc, chloride, manganese, selenium and iodine.

All data was entered into SPSS (v11.5, SPSS, Chicago, USA) for statistical analysis using independent t-tests and Chi-square tests to compare groups, explore relationships between factors. Ethical approval was granted by the Adelaide and Meath National Children's Hospital(AMNCH) Ethics Committee and the School of Biomedical Sciences Research Ethics Filter Committee.

Results:  There was no significant difference between the control and the FG group with the exception of birth weight (Table 1).

Table 1.   Characteristics of participants
 Control group (n = 12)FG group (n = 12)P-value*
  1. Values mean (standard deviation); *Data analysed using independent t-tests and Chi-square; significance at P < 0.05.

Age (months)14.2 (6.8)15.6 (8.1)NS
Birth weigh (Kg)3.54 (0.61)3.00 (0.55)0.044
Breast fed63NS
Age weaned (months)5.2 (1.64)5.9 (1.97)NS
Mean energy intake (kcal)1256.831170.25NS

No statistical differences between the control and FG groups were found in maternal or social factors. There was also no statistical difference in the feeding history of the two groups; however it was noted that more of the control group were breastfed. The mean intakes of all nutrients except protein, monounsaturated fat, starch, sodium, manganese, selenium and B12 were also higher in the control group.

Discussion:  This was a small study with results that were unsurprising in that no relationships were found between maternal and social factors and the presence of FG. Additionally the lower intakes, with the exception of the above nutrients, in the FG group do support the theory that poor nutritional intake is the main causative factor in FG (Wright, 2000). The trend towards lower rates of breast feeding in the FG group is a finding of interest and should be further investigated. Limitations included approximation of food weights which may have lead to errors in the mean daily values of the nutrients. Also age variation of participants made assessment of intakes more difficult as in early childhood recommended nutrient intakes vary greatly.

Conclusion:  Nutritional intakes of children with FG appear to be lower than those of their healthy counterparts and therefore a larger study, to clearly demonstrate the significance of this is warranted. The possible protective role of breast feeding should also be investigated further.

References:  Cooke, R.J. (2010) Catch-up growth: implications for the preterm and term infant. Eur. J. Clin. Nutr. 64, S8–S10.

Wright, C.M. (2000) Identification and management of failure to thrive: a community perspective. Arch. Dis. Child. 82, 5–9.