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Failure to thrive diagnosis concern

By Aruna Prabhala

Diagnosis of failure to thrive is mired in confusion with different methods varying dramatically in the number of cases they identify, researchers warn.

Some diagnostic criteria miss most infants with the condition while others identify 'far too many', concludes their study, published online by the Archives of Disease in Childhood.

The research further complicates the task GPs face in managing the condition, with the researchers urging them to monitor infants over a period of time rather than relying on a single assessment.

The percentage of infants identified with failure to thrive who were suffering from significant under-nutrition varied from 58 to just 1 per cent with different criteria, the study found. Of 6,090 infants aged two to 11 months who were evaluated, 3 per cent had significant undernutrition.

But deceleration of weight gain identified as many as 18 per cent of infants as having failure to thrive, while the Waterlow method ­ assessing median weight for length ­ identified the condition in less than 1 per cent of infants.

Dr Charlotte Wright, a researcher on the study and consultant in community child health at the University of Glasgow, said no single method was good enough.

'It's remarkable the poor concurrence between the methods,' she told Pulse.

Professor Stuart Logan, director of the Institute of Health and Social Care Research at the University of Exeter, said: 'Part of the problem is that it is

not a simple disease to diagnose like diabetes. We may be using this label, implying something pathological when it is not there. The point is a lot of these kids are really just normal.'

Maryanne Lockin, director of nursing at Aurora University in the US and a researcher on failure to thrive, said a misdiagnosis could be 'devastating' for mothers.

She advised: 'The simplest way to assess it is to look at a child's growth chart over time. But it's a very complex process and every family needs to be looked at individually.'

GPs said correctly identifying failure to thrive was important as diagnosis could damage the doctor-patient relationship.

Dr Alastair Sutcliffe, a GP in Whitby, North Yorkshire, said: 'Parents can get a bit defensive as if you are attacking them or their child.'

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