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Iron Deficiency in Children with Failure to Thrive

Children's Miracle Network
Administered in: College of Medicine


The goal of this research is to improve the quality of life for children who gain inadequate weight in early childhood, a condition referred to as failure to thrive (FTT). Children with FTT have small but repeatedly identified long-term deficits in neurodevelopmental outcomes compared to children who grow well early in life. In many children, a specific cause of FTT is not identified, and there is little evidence to guide clinicians' efforts to help children with FTT grow. Treatment often includes drinking high-energy oral supplements or receiving supplemental nutrition through a tube inserted through the nose into the stomach; these treatments can be uncomfortable for children and stressful for families. Iron deficiency may contribute to poor weight gain in some children. Clinicians have recognized poor appetite in children with iron deficiency, and children with iron deficiency have been found to have lower levels of certain hormones related to appetite and growth. Iron deficiency has also been shown to cause changes in brain structure and function in animal models, and is associated with behavior changes in affected children and mothers that may affect feeding interactions. In developing countries, iron supplementation has been shown to improve growth in malnourished children. Iron deficiency is common, occurring in 7 to 9 percent of young children in the U.S, and may be even more common in children with poor weight gain. Iron deficiency is also associated with neurodevelopmental deficits; therefore, children with both FTT and iron deficiency may have even worse long-term outcomes than children with either condition alone. In the proposed research, investigators will determine how common iron deficiency is among children with FTT in the U.S. using two methods: 1) analyzing pre-existing data from a national survey of children and 2) prospectively measuring iron status in approximately 90 children with FTT who are seen in the Penn State Health (PSH) system. The pre-existing dataset is from the National Health and Nutrition Examination Survey (NHANES), which measures growth, diet, and certain laboratory tests in a nationally representative sample of children and adults from across the U.S. Use of the NHANES data will allow determination of the frequency of iron deficiency in a national sample of children with FTT, and will also allow comparison of iron status in children with and without poor growth. Prospective evaluation of children with FTT seen at PSH will allow more detailed assessment of iron status in children with FTT as well as assessment of characteristics not available in NHANES data, including appetite, development, temperament, and parental stress. Multiple definitions of iron deficiency exist, and analyses of both NHANES and PSH data will help to identify which definition of iron deficiency is most useful for children with FTT. The results of the proposed research will provide information necessary to plan a larger study of iron status in children with FTT from across the country and, ultimately, to plan trials to evaluate the benefits of iron supplementation for children with FTT.

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