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EDITOR - We read with some interest Wright et al's (1) carefully
randomised controlled trial. We noted with some alarm a failure to comment
on the high mortality rate in the intervention group. At follow up beyond
3 years two children in the intervention group of 95 were dead but none of
the 92 control group.
The authors comment that a substantial number of children both in the
intervention and control groups were seen at hospital despite low levels
of organic disease. They state that only 5% of the cases identified had
major organic disease and that by involving health visitors fewer
referrals to hospital could lead to financial savings. 15 (13%) children
in the intervention group and 24 (22%) controls were seen at hospital
solely for investigation of their failure to thrive. No comment is made on
the possibility that the fatal outcomes may result from different
management in the intervention group. How can one conclude that health
visitors are effective in the management of failure to thrive and state
that the results are encouraging when two out of 95 children are dead?
Surely when there is a not insignificant risk of serious organic
disease and precious young lives are at stake the cost of swift hospital
referral to a paediatrician can be fully justified. The importance of
hospital based management should not be dismissed so lightly.
When our own son showed signs of failure to grow his health visitor
recommended vitamin supplements and a review in two months.
Prompt hospital referral may have led to a better outcome. There was
a delay in diagnosing hepatoblastoma and although he has survived, earlier
referral might have spared him the need for a liver transplant.
Judith Hanslip Senior Registrar in Psychiatry
Peter Hodgkinson Centre, Lincoln County Hospital, Greetwell Rd., Lincoln.
Mark Randall
Consultant in Child & Adolescent Psychiatry
Moore House
10-11 Lindum Terrace
Lincoln LN2 5RT
1. Wright C M, Callum J, Birks E, Jarvis S. Effect of community based
management in failure to thrive: randomised controlled trial. BMJ
1998;317:571-4 (29 August.)
Effect of community based management in failure to thrive
EDITOR - We read with some interest Wright et al's (1) carefully
randomised controlled trial. We noted with some alarm a failure to comment
on the high mortality rate in the intervention group. At follow up beyond
3 years two children in the intervention group of 95 were dead but none of
the 92 control group.
The authors comment that a substantial number of children both in the
intervention and control groups were seen at hospital despite low levels
of organic disease. They state that only 5% of the cases identified had
major organic disease and that by involving health visitors fewer
referrals to hospital could lead to financial savings. 15 (13%) children
in the intervention group and 24 (22%) controls were seen at hospital
solely for investigation of their failure to thrive. No comment is made on
the possibility that the fatal outcomes may result from different
management in the intervention group. How can one conclude that health
visitors are effective in the management of failure to thrive and state
that the results are encouraging when two out of 95 children are dead?
Surely when there is a not insignificant risk of serious organic
disease and precious young lives are at stake the cost of swift hospital
referral to a paediatrician can be fully justified. The importance of
hospital based management should not be dismissed so lightly.
When our own son showed signs of failure to grow his health visitor
recommended vitamin supplements and a review in two months.
Prompt hospital referral may have led to a better outcome. There was
a delay in diagnosing hepatoblastoma and although he has survived, earlier
referral might have spared him the need for a liver transplant.
Judith Hanslip Senior Registrar in Psychiatry
Peter Hodgkinson Centre, Lincoln County Hospital, Greetwell Rd., Lincoln.
Mark Randall
Consultant in Child & Adolescent Psychiatry
Moore House
10-11 Lindum Terrace
Lincoln LN2 5RT
1. Wright C M, Callum J, Birks E, Jarvis S. Effect of community based
management in failure to thrive: randomised controlled trial. BMJ
1998;317:571-4 (29 August.)
Competing interests: No competing interests