Non-organic failure to thrive: Implications of placement through analysis of videotaped interactions

This paper presents 6-month follow-up on a group of 16 infants hospitalized during the first months of life for non-organic failure to thrive (N-O FTT) and their mothers. Eight of these infants were placed in foster care and eight were returned home with their parents following hospitalization. The effects of placement on infant outcomes were examined through comparison of developmental scores and weight percentile changes, and the implications of foster care placements for mother-infant interactions were examined through analysis of patterns of interaction in videotaped sessions of feeding and play six months after hospital discharge. This analysis snowed that (1) mothers in both groups failed to make significant progress in resolving their own emotional or psychological conficts through treatment available; (2) weight and developmental status of the infants did not improve as expected in either group, and finally that (3) the patterns of interaction between mother and infant showed little change over time, and, regardless of placement at home or in foster care, remained concerning.     

Long-term hospitalization of failure-to-thrive infants: Developmental outcome at three years

The present study documented later developmental outcome in a group of 29 failure-to-thrive (FTT) infants who received extended hospitalization in infancy as an intervention for their growth failure. All infants were seen at approximately 3 years of age and were given standardized assessments of intellectual and physical development. A standard interview documented demographic variables, health problems, placements subsequent to hospitalization and additional psychological and medical treatment. Infants were divided into three groups dependent on medical and treatment factors. Means and percentages of occurrence of outcome variables were compared through either one-way ANOVAS or single sample chi-square tests with post hoc analyses. Correlational analyses were used to understand the relationships between outcome and relevant demographic, medical, and treatment variables. In general, the infants manifest persistent intellectual delays at follow-up despite maintenance of weight gains achieved during early hospitalization. More than half the group suffered from chronic health problems. A large percentage of infants had been removed from parental custody at the time of follow-up. Several demographic, medical, and treatment factors bore moderate relationships to developmental outcome. Infants who achieved more optimal growth tended to be full-term at birth, later born and without a question of physical abuse in their social histories. Intellectual functioning was related only to parental and caretaker socioeconomic status. Infants placed in foster care were unlikely to return to their families of origin. The findings suggest the need for further investigation into the determinants and outcome of extended hospitalization as a treatment for FTT.     

Nonorganic failure to thrive: an outpatient approach

This article reviews our experience, as well as the medical literature, regarding the treatment of failure to thrive (FTT) on an outpatient basis. Nonorganic FTT can be accidental, neglectful, or deliberate. Accidental FTT occurs with errors in formula preparation, diet selection, or feeding technique. These errors can usually be corrected by education and demonstration. Deliberate underfeeding is rare, and these children usually require placement in foster care. Neglectful FTT usually occurs because the mother is overwhelmed or psychologically disturbed. Children with neglectful FTT do not automatically require hospitalization. If the degree of FTT is mild to moderate, the mother-child interaction is positive, the mother is not severely disturbed, and the baby has no inflicted injuries or deprivational behavior, the baby can be safely and more economically managed as an outpatient. Management includes new feeding instructions, a stimulation program, social work intervention, home visits by a public health nurse, and weekly weight checks. Most infants respond to this one-month therapeutic trial with an appropriate weight gain. Even after normal weight is attained, many of these families require long-term follow-up to help them deal with multiple psychosocial issues.     

Maternal interactional behavior with nonorganic failure-to-thrive infants: a case comparison study

Mothers of 47 6-month-old infants with early histories of nonorganic failure to thrive (NOFT) infants and a matched comparison group of physically healthy infants were observed in interactions with their infants in their homes one month following hospitalization. Mothers of NOFT infants were observed to have less adaptive social interactional behavior, less positive affective behavior, and demonstrated more arbitrary termination of feedings. No group differences were found in flexibility or sensitivity of maternal feeding, or in environmental circumstances such as number of persons present, noise level, or level of activity. These salient deficiencies in maternal interactional behavior may continue to disrupt the NOFT child's physical growth and psychological development following initial diagnosis and hospitalization. Additional studies are needed to identify patterns of maternal interactional behavior which influence psychological prognosis and to assess the responsiveness of maternal interactional behavior to intervention.     

Hospitalized cases of nonorganic failure to thrive: the scope of the problem and short-term lay health visitor intervention

This paper describes the characteristics of thriving and failure to thrive (FTT) children and their mothers and examines the effect of short-term lay health visitor intervention in cases of nonorganic failure to thrive (NO FTT). Twenty-five FTT children and mothers received lay health visitor (LHV) intervention in addition to other community and medical treatment; 25 other FTT children and mothers did not receive the LHV intervention but did receive all other medical and community treatment. Twenty-five thriving children and mothers were matched with the FTT children and mothers in the LHV group on the child's age at intake, sex, birth weight, and the mother's age, ethnicity, and number of living children. At initial assessment, the FTT and thriving groups were found to be comparable on demographic factors, infant birth weight percentiles, apgar scores, complications of pregnancy or delivery, and separations in the newborn period. There were more premature births in the LHV group although the proportion of premature births for the FTT and thriving groups overall were similar. A majority of mothers in the FTT groups had negative memories of childhood in contrast to more positive memories in the thriving group. At initial assessment, the majority of thriving children were developmentally normal and had increased from their birth weight percentiles whereas all of the FTT children had decreased from their birthweight percentiles and over half were developmentally delayed. There were clear differences in mother-child interaction patterns in the thriving and FTT groups. Three patterns of interaction were identified in the FTT group: benign neglect, incoordination, and overt hostility. Intervention had no measurable effect on the child's weight, development, or interaction patterns. Only 8 of 37 FTT children reevaluated 6 months later showed "catch up" growth and only 7 had improved in developmental score category. Patterns of interaction were found to persist over the 6 months in all cases. One to three year follow-up of 44 families emphasized the severity of the condition and the need for differentiation of the severity of the disturbance in the mother-child relationship and for more intensive intervention than was available in this study. Of these 44 cases, 2 children had died, 5 had been physically abused or further neglected, and 10 were in alternative care arrangements.     

The families of children who fail to thrive: preliminary investigations of parental deprivation among organic and non-organic cases

A majority of cases of failure to thrive (FTT) do not have a known organic etiology. Social and psychological determinants are sought for these "non-organic failure to thrive" (N-O FTT) cases. Social and psychological differences between non-organic and organic cases are also explored here. With the introduction of the term, "maternal deprivation," medical practitioners have implicated mothers' deficiencies as instrumental in the etiology of N-O FTT. However, these mothers are themselves usually deprived. Lack of cooperation in childcare by both parents is noted when classic clinical cases are reviewed. We suggest that the concept, "parental deprivation," provides a more accurate model. Preliminary research findings support our hypothesis that mothers of FTT infants do not have good social support networks. Teen motherhood and socioeconomic status also appear to be important, but not necessary as determinants. An unexpected finding is that there are few differences in the social deficiencies of families of N-O FTT infants as compared to those failing for organic reasons. Two unanticipated findings appear noteworthy. First, infants failing for organic reasons are significantly smaller and thinner at birth, independent of pregnancy complications or prematurity. Second, infants failing for non-organic reasons are more likely to present during the period of infant-caretaker role development and less likely in the later toddler stage. Additional research into the feasibility of strengthening family supports as a basis of intervention is recommended.     

The development of abused and high-risk infants in different treatment modalities: residential versus in-home care

This paper outlines the Parental Stress Center (PSC) residential treatment program and its evaluation study, specifically focusing on the developmental status of infants in treatment. The Bayley scores for mental/motor development are given for a subgroup of 20 deprived infants admitted to the residential center and for two matched groups. One comparison group consisted of similarly deprived infants, the other of normal infants. The groups, tested three times, showed few differences either among the three groups at each time period or within each group over the three time periods. The most significant between-group difference was in motor scores at time 2, with both PSC infants and problem comparison infants scoring significantly below the normal comparison infants. The decline of motor scores of the PSC infants was probably attributable to the physical restrictions of the nursery. By the final testing at age 1, these scores had improved, and again there were no group differences. The results indicate that despite the use of multiple caregivers, the deprived infants admitted to residential care kept pace with similar babies in other treatment modalities. The overall high scores when compared to other research data indicate the decided worth of early intervention.     

Prognosis of children admitted to institutional care during infancy

The present study has investigated the prognosis of infants admitted to institutional care. The follow-up was made after five and ten years. Three groups of children were studied: those who were in adoptive homes, foster homes and biological homes, respectively, at the time of the investigation. Approximately 50% of the total population was treated in hospital after the neonatal period. More children in foster and biological homes were hospitalized because of trauma. At 4 years of age the psychomotor development was considered normal in 77% of the adopted children compared to approximately 55% in the other two groups. Furthermore, the children in foster and biological homes demonstrated a higher rate of psychological or behavioral disturbances. The children who were in foster homes had experienced more separations and 39% of them had been subjected to 6 or more placements. The experiences of institutional care per se in infancy do not predispose the child to health and behavioral problems. The determining factor for optimal development seems to be permanency of care and parenting capability.     

Failure to thrive: Parental indicators, types, and outcomes

The present study clinically evaluated and followed 42 parents and their infants with environmental failure to thrive (FTT) to determine if the type of FTT is related to assessments of parental awareness/cooperation, subsequent FTT outcome, and later neglect. The relationships between the parent's Child Abuse Potential (CAP) Inventory scores and the clinical measures were determined. As expected, the type of FTT was related to the degree of parental awareness/cooperation and to FTT outcome. The degree of parental awareness/cooperation was predictive of FTT outcome. However, no relationships were found between FTT type, parental awareness/cooperation, FTT outcome and later neglect. In contrast, while the CAP scores were not related to FTT type, parental awareness/cooperation, and FTT outcome, they were predictive of later neglect.     

Outcome of residential treatment for abused and high-risk infants

This paper reports the results of residential treatment plus short-term follow-up of 31 deprived infants. Also discussed are the effects of abuse and socioeconomic status (SES) on the outcome measures. Two matched comparison groups were utilized: infants with similar problems, not admitted to the Center; and infants with no history of maltreatment. All had anthropometric measures, tests on the Bayley scales, and measures of mother-baby interaction three times during the first year of life. The Time Two results were considered the best indicator of the value of treatment because Time Two marked the end of Center residence. At Time Two the experimental children had gained more in height for age. They had lost some ground on the psychomotor scale but stayed relatively equal with the others on the mental scale. On the interaction scales they clearly surpassed the comparison groups. By Time Three the living arrangements had worsened for a number of the experimental babies. Physical measurements were similar among the groups. The experimental group maintained its standing on the Bayley scales, had lost ground on the interaction scales, but still surpassed the problem comparison group. The Time Three results are discussed with respect to the gravity of infant abuse. Effects of SES were more apparent throughout than the effects of abuse.     

Minimizing adverse effects of low birthweight: four-year results of an early intervention program

The outcome of an early intervention program for low-birthweight (LBW) infants was examined in this study. The intervention consisted of 11 sessions, beginning during the final week of hospitalization and extending into the home over a 3-month period. The program aimed to facilitate maternal adjustment to the care of a LBW infant, and, indirectly, to enhance the child's development. Neonates weighing less than 2,200 grams and under 37 weeks gestational age were randomly assigned to experimental or control conditions. A full-term, normal birthweight (NBW) group served as a second control. 6-month analyses of dyads who completed all assessments over a 4-year period (N's = 25 LBW experimental, 29 LBW control, and 28 NBW infant-mother dyads) showed that the experimental group mothers reported significantly greater self-confidence and satisfaction with mothering, as well as more favorable perception of infant temperament than LBW control group mothers. A progressive divergence between the LBW experimental and LBW control children on cognitive scores culminated in significant group differences on the McCarthy GCI at ages 36 and 48 months, when the LBW experimental group caught up to the NBW group. Possible explanations for the observed delay in the emergence of intervention effects on cognitive development and the mediating role of favorable mother-infant transactional patterns are discussed in light of recent evidence from the literature.     

Hospitalized youth and child abuse: A systematic examination of psychiatric morbidity and clinical severity

Many children and adolescents who require psychiatric hospitalization have been physically or sexually abused, yet the association between reported histories of abuse and the complexity and severity of mental illness among psychiatrically hospitalized youth is poorly described with regard to current inpatient psychiatric practice. We sought to determine the association between histories of abuse and psychiatric complexity and severity in psychiatrically hospitalized youth including comorbidity patterns, psychotropic medication use, reason for admission and length of hospitalization. A systematic chart review was performed on 1433 consecutive psychiatric hospitalizations of children and adolescents that occurred over a 10-month period. Children with a history of abuse were more likely to be diagnosed with multiple DSM-IV-TR disorders than non-traumatized children. A history of sexual abuse was associated with more medication use than in their non-traumatized peers and a higher likelihood of treatment with antipsychotic medications, both at admission and discharge. Physical and sexual abuse were independently associated with increased length of stays, with exposure to both physical and sexual abuse associated with a 2-day increase in duration of hospitalization compared to non-traumatized patients. The findings from this study draw attention to the adverse impact of abuse on psychiatric morbidity and complexity and suggest the need for trauma-informed treatment in psychiatric hospital settings.     

The Impact of Taiwan's University Multiple-Channel Entrance Policy on Student Learning Outcomes

This research explores the impact of Taiwan's university multiple-channel entrance policy on student learning outcomes, using quantitative research to look for differences in the learning experiences of third-year students who were admitted via different methods (examination and placement, application for admission, recommendation and selection, and gifted aptitude selection) and who were at different types of institutions (public universities, public vocational/technical schools, private universities, and private vocational/technical schools). The source data for this research was a 2005 national survey of third-year university students by the National Taiwan Normal University Center for Educational Research and Evaluation. The data were analyzed using two-way analysis of variance (ANOVA) and found that among students at public universities and vocational/technical schools, those who applied for admission had a better learning experience, while those selected for gifted aptitude had a poorer learning experience. Among students at private schools, those admitted through examination and placement or application for admission had a significantly better learning experience than students admitted through selection. Overall, the learning experience of screened students was generally poor, so it is worth considering a review of this admission method.     

Institutional care of infants in Sweden: criteria for admission in 1970, 1975 and 1980

The purpose of the present study was to analyze the criteria used for admission of infants to institutional care in the metropolitan area of Stockholm in 1970, 1975 and 1980. The study included 337 infants. Their records from the institutional care have been studied. A significant decrease was observed from 1970 to 1980 on the following grounds for admission: teen-age mother, adoption, unsatisfactory housing situation, hospitalization of the mother. The following criteria for admission showed a significant increase: maternal alcohol and/or drug abuse as well as psychiatric disorders. It is concluded that there has been a dramatic change in the criteria used for admission of infants to institutional care from 1970 to 1980. Voluntary admissions of infants for maternal health reasons or social problems of a temporary nature have apparently been supplanted by non-voluntary admissions owing to maternal addiction and psychiatric insufficiency.     

A comparison of blood pressure in term, low birth-weight infants of smoking and nonsmoking mothers

Infants exposed to the components of cigarette smoke in utero are at an increased risk for perinatal death, low birth weight, sudden infant death syndrome, and premature delivery. The purpose of this pilot study was to compare blood pressure values in term low-birth weight infants (相似文献   

周期性随访对原发性高血压患者的影响

目的探讨社区规范化管理条件下,周期性随访对纠正患者不良生活行为方式、改善负性情绪、控制血压水平、加强遵医行为、降低与高血压相关的再住院率的影响。方法选择社区内原发性高血压患者60例,随机分为研究组与对照组,并对研究组成员进行多种形式的周期性随访。结果研究组随访前后不良生活行为方式的改进、负性情感的纠正、血压水平的控制、再住院率比较,差异有显著性意义。结论周期性随访对改变患者不良生活行为方式、改善负性情绪、控制血压水平、加强遵医行为、降低再住院率有良好的促进作用。     

Social class, birth order, and newborn experience

Early home experiences of a group of 32 2-week old infants, equally divided according to social class, birth order, and sex, were studied. Naturalistic observations were taken on 2 consecutive days for a total of 6 hours. Compared with later-borns, firstborns received significantly more caretaker interaction on all variables studied. Compared with lower-SES infants, those from higher-SES homes received significantly more direct verbal interaction although the 2 groups did not differ on total periods of other types of caretaking interaction. The findings are consistent with birth order and social class differences reported in home environments of older infants and children.     

Disposition and health outcomes among infants born to mothers with no prenatal care

ObjectiveThis study assessed infant disposition and health outcomes among offspring born to mothers without prenatal care, based on maternal characteristics and the reason for lack of prenatal care (i.e., denial of pregnancy, concealment of pregnancy, primary substance use, financial barriers and multiparity).MethodsA retrospective record review was completed at an urban academic medical center. Subjects were women who presented at delivery or immediately postpartum with no history of prenatal care (N = 211), and their infants.ResultsInfants of mothers with substance use problems had the highest rates of referral to child protective services and out-of-home placement at discharge, though mothers with other reasons for no prenatal care also experienced both referral and placement. Infants born to mothers using substances experienced the highest rates of neonatal intensive care unit admission, and the lowest mean birth weight.ConclusionsThough those without prenatal care experienced a variety of adverse outcomes, substance use problems were most frequently correlated with adverse infant outcomes. Mothers who either had lost custody of other children or with substance use problems were at highest risk of losing custody of their infants. Those who denied or concealed their pregnancy still frequently retained custody.Practice implicationsAmong mothers without prenatal care, those with substance use problems were least likely to retain custody of their infant at hospital discharge. Custody status of the mother's other children was also independently associated with infant custody. Mothers who denied or concealed their pregnancy still often retained custody. Referrals of mothers with no prenatal care for psychiatric evaluation were rare, though referrals to social work were frequent. Child protective services occasionally did not investigate referrals in the denial and concealment groups. Healthcare providers should be aware of the medical and psychological needs of this vulnerable population of infants and mothers.