Child Abuse Review Vol. 9: 233–234 (2000)

Copyright �c 2000 John Wiley & Sons, Ltd.

Failure to Thrive: a Response to Sidebotham

Sidebotham raises some interesting points for debate, which wewelcome. We are pleased that the challenge was recognized regard-ing the unhelpfulness of the organic and non-organic divisions thathave been used in the past. It was used as a title because it is thephrase employed within child protection in Scotland and is thusone we felt practitioners would recognize as being of concern withinboth health and social care. Weight indices are a pertinent pointand Sidebotham is correct to challenge this. There is much con-temporary debate on this issue (Skuse, 1993; Wright et al., 1993,1998), but current research, if not practice, is by no means con-sistent in its approach. One of the authors (JT) is completing asystematic review of the links between parenting, social factors andfailure to thrive (FTT). Even allowing for international differences,of 52 studies relevant to the review criteria (the majority of whichhave a medical orientation), 11 different growth standards wereused. Even where researchers used the same growth standard, therewas huge variability in centiles employed. Further, to suggest thatcurrent sources all use shifts across centile lines as a basis for diag-nosis is idealistic, but misinformed. Only 35 of the 52 (67%) in factdid so.

Sidebotham’s central contention exemplifies the main argumentwe were making: ‘If FTT is both more common and less sinisterthan thought previously, the imperative to intervene is less’ (Wright,2000, p. 19). Nonetheless, Wright urges multidisciplinary inter-vention for all children with FTT. Child protection issues shouldnot be so narrowly defined as to include only harm to children thatrequires recording on the Child Protection Register (Departmentof Health, 2000). FTT is not child abuse or neglect within narrowdefinitions, but FTT children have been shown to be at a 4–5 timeshigher risk of subsequent maltreatment than normally growinginfants (Skuse et al., 1995). The fact that children are at risk ofany adverse outcomes whatsoever (physiological, psychosocial ordevelopmental) means to us that they are in need of the best pro-tection they can get. That requires a multiagency response.

Julie TaylorResearcher/Lecturer

School of Nursing and MidwiferyUniversity of Dundee

Brigid DanielLecturer

Department of Social WorkUniversity of Dundee

References

Department of Health. 2000. Framework for the Assessment ofChildren in Need and Their Families. The Stationery Office:London.

Skuse DH. 1993. Epidemiological and definitional issues in failure

Reply‘The challengeregarding theunhelpfulness ofthe organic andnon-organicdivisions used inthe past’

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Copyright �c 2000 John Wiley & Sons, Ltd. Child Abuse Review Vol. 9: 233–234 (2000)

to thrive. Child and Adolescent Psychiatric Clinics of NorthAmerica 2: 37–59.

Skuse D, Gill DG, Lynch M, Wolke D. 1995. Failure to thrive andthe risk of child abuse: a prospective population survey. Journalof Medical Screening 2: 145–150.

Wright CM. 2000. Identification and management of failure tothrive: a community perspective. Archives of Disease in Child-hood 82: 5–9.

Wright CM, Avery A, Epstein M, Birks E, Croft D. 1998. Anew chart to evaluate weight faltering. Archives of Disease inChildhood 78: 40–43.

Wright CM, Waterston A, Aynsley-Green A. 1993. Comparison ofthe use of Tanner and Whitehouse, NCHS, and Cambridgestandards in infancy. Archives of Disease in Childhood 69:420–422.