Primary Prevention of Failure to Thrive: Social Policy Implications

Although FTT occurs in children of all social classes, researchers have consistently noted that clinical populations of children with FTT are drawn disproportionately from low income families (Evans, Reinhart & Succop, 1972; Glaser, Heagarty, Bullard & Pivchik, 1968; Mitchell, Gorrell & Greenberg, 1980; Pollitt, 1975; Shaheen, Alexander, Truskowsky & Barbero, 1968). The mechanisms which link poverty to growth failure in childhood are varied and complex; biology, psychopathology, and prevailing socioeconomic conditions interact to produce FTT. The biologic sequelae of poverty begin prenatally. Low income mothers are at increased risk of bearing low birthweight infants (MacMahon, Kover & Feldman, 1972), infants who constitute 10–40% of reported clinical series of children later hospitalized with FTT (Mitchell et al. 1980; Shaheen et al. 1968; Oates & Yu, 1971), but only 7% of all newborns. Children reared in poverty bear an increased burden of post-natally acquired illnesses, any one of which may interfere with growth (Holmes, Hassanein, Miller, 1983). Finally, the Preschool Nutrition Survey (Owen et al., 1974), the Ten State Nutrition Survey (Garn & Clark, 1975), and the Health and Nutrition Examination Surveys (U.S. Department of Health Education and Welfare, 1975) all link poverty to the primary biologic risk for FTT - diets of inadequate quality and quantity (Goldbloom, 1982).