Assessing the Socio-Ecological Factors That Influence Failure to Thrive in Children within the First 1000 Days of Life: Implications for Racial, Economic Equality & Child Well-Being

Background and Purpose: A child’s nutrition in the first 2 years of life (1000 days) is crucial in its neurodevelopment and lifelong mental health. In fact, child and adult health risks, including obesity, hypertension, and diabetes, are generally influenced by nutritional experiences during this period of life. Guided by the socio-ecological model, this study examines individual and familial level along with contextual level factors that may be associated with Failure to Thrive (FTT) within the first 1000 days of a child’s life (N=967 (Weighted N=428,433). Results of this study have potential to inform development of intervention with greater potential to promote optimal health outcomes in infants/children during this crucial developmental stage.

Methods: The study uses data from the Fragile Families & Child Well Being Study. Consistent with the construct of the theoretical framework, we used socio-ecological variables including: individual variables (child’s race & age) and familial level variables (household income, parental drug & alcohol use; father’s level of education and employment status) and a contextual variable (neighborhood safety). Failure to Thrive is operationally defined by three categories: underweight (n=920), stunting (n=998), and wasting (n=975) when the focal child was 3 years old. Logistic regression with a weight variable was performed to examine the relationship between the socio-ecological variables and FTT.

Results: Preliminary findings showed that race and ethnicity, marital status, parental drug and alcohol use were not significantly associated with FTT. We also observed that the contextual level variable was not related to FTT. However, father’s education (higher levels) negatively predicted FTT. Further, household economic stability positively predicted FTT.

Conclusions and Implications: Results of this study point to the critical role that familial level socio-ecological factors (particularly economic stability and father’s education) may play in influencing the well-being of children. This observation underscores the importance of considering familial level factors including fathers in interventions to promote the wellbeing of children during the first 1000 days of life - a critical period in a child’s development. Our study also points to the need to further examine the role of family level variables such as parental substance use and mental health problems in influencing the health outcomes of children in fragile households.