Modeling the Recurrent Failure to Thrive in Less than Two-year Children: Recurrent Events Survival Analysis

Amal Saki Malehi, Ebrahim Hajizadeh, Kambiz Ahmadi, Nahid Kholdi


Background: This study aimes to evaluate the failure to thrive (FTT) recurrent event over time.

Methods: This longitudinal study was conducted during February 2007 to July 2009. The primary outcome was growth failure. The analysis was done using 1283 children who had experienced FTT several times, based on recurrent events analysis.

Results: Fifty-nine percent of the children had experienced the FTT at least one time and 5.3% of them had experienced it up to four times. The Prentice–Williams–Peterson (PWP) model revealed significant relationship between diarrhea (HR=1.26), respiratory infections (HR=1.25), urinary tract infections (HR=1.51), discontinuation of breast-feeding (HR=1.96), teething (HR=1.18), initiation age of  complementary feeding (HR=1.11) and hazard rate of the first FTT event.

Conclusions: Recurrence nature of the FTT is a main problem, which taking it into account increases the accuracy in analysis of FTT event process and can lead to identify different risk factors for each FTT recurrences.


Failure to thrive; Recurrent event; Prentice–Williams–Peterson model; Children

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