Recovery in Young Children with Weight Faltering: Child and Household Risk Factors

Abstract

Objective: To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors.

Study design: Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6-36 months with weight/age <fifth percentile or crossing of 2 major percentiles. Children were categorized as <24 months vs ≥ 24 months. Child and household risk factors were summed into risk indices (top quartile = elevated risks, vs reference). Outcome was weight/age z-score change over 6 months. Analyses were conducted with longitudinal linear mixed-effects models, including age by risk index interaction terms.

Results: Enrolled 286 children (mean age 18.8 months, SD 6.8). Significant weight/age recovery occurred regardless of risk index or age. Mean weight/age z-score change was significantly greater among younger compared with older age (0.29 vs 0.17, P = .03); top household risk quartile compared with reference (0.34 vs 0.22, P = .046); and marginally greater among top child risk quartile compared with reference (0.37 vs 0.25, P = .058). Mean weight/age z-score change was not associated with single risk factors or interactions; greatest weight gain occurred in most underweight children.

Conclusions: Weight recovery over 6 months was statistically significant, although modest, and greater among younger children and among children with multiple child and household risk factors. Findings support differential susceptibility theory, whereby some children with multiple risk factors are differentially responsive to intervention. Future investigations should evaluate components of the mealtime behavior intervention.