Objectives: Failure to thrive (FTT) is a serious condition of childhood, with failure to grow as expected for age and gender. Numerous potential etiologies have been suggested, including occult obstructive sleep disturbance (OSD). We determined the prevalence of OSD in an FTT population, examined correlation to tonsil size, and assessed correlation with a parental questionnaire regarding symptoms.
Patients and methods: A cross-sectional prevalence study was conducted. Thirty-six FTT children in Boston Medical Center's FTT Clinic aged 12 to 60 months were evaluated by formal polysomnography, parental questionnaire, and physical examination. The prevalence and nature of sleep disorders in this population are compared with published age-appropriate norms.
Results: The prevalence of OSD in an FTT population in these 36 children is 5.5%. This is compared with the prevalence in the general pediatric population, which is between 0.7 and 4.3%.
Conclusions: The prevalence of OSD in FTT tends toward higher than published values for the general pediatric population but does not reach statistical significance. Tonsillectomy and adenoidectomy have been suggested in the literature to be of benefit to improve the growth of children with FTT. Sleep disturbance has been suggested as the underlying pathology. However, using current guidelines, we could not identify an increased prevalence of sleep disturbance in children with FTT. Nonetheless, a continued high level of clinical suspicion is necessary in appropriate diagnosis and treatment of OSD, found in some children with FTT. That growth in children with FTT often improves following management of sleep disturbance (eg, tonsillectomy) is not explained by a significantly higher incidence of OSD in this population.