A treatment program for failure to thrive: A cost/effectiveness analysis

Failure to thrive (FTT) is a frequent cause for the admission of infants to the hospital. Such hospitalizations are often lengthy and expensive, and usually do not contribute to an understanding of the etiology of FTT. Generally, organic causes of FTT can be ruled out by a thorough history and physical examination. In this study two groups were examined: 17 infants who were admitted to foster medical placement homes (MPH), private homes with specially trained parents; and a comparison group of 18 infants who were treated in a more traditional way with diagnostic hospitalization. The groups were similar in all regards prior to admission. All infants were less than a year of age. Family disruption was a prominent feature in both groups, but socio-demographic analysis showed them to be similar in all areas studied. The comparison group gained an average of 276 grams in the hospital over 8.6 days. The MPH group gained 362 grams in the hospital over 8.7 days, with an additional 1270 grams in the medical placement home over 31.1 days. Five children were admitted to the medical placement home without hospitalization. After correcting for an expected weight gain of 15 grams per day (normal growth), the comparison group showed a catch-up growth of 16 gms/day, while the MPH group gained 29 gms/day in excess of expectation, almost twice the comparison group. A 100-gram weight gain cost +308 in the MPH program and +1,635 in the traditional approach. This five-fold difference was felt to be a significant deterrent to the continuing approach of admitting children to the hospital for for the workup of FTT.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

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.     

Similarities in siblings' experiences of neglectful parenting behaviors

OBJECTIVE: Researchers and policymakers typically assume that within families, individual children are at an equivalent risk of neglectful behaviors. There is evidence that siblings experience differential parental treatment, and some research suggests that parents may maltreat their children to differing degrees. However, because neglect is typically a family-level construct, there may be a high correlation between siblings for this type of parental behavior. Therefore, our objectives were to investigate the extent to which siblings reported similar parental neglectful behaviors, whether sibling correlations for family-level types of neglectful behaviors were greater than those for child-specific forms of neglectful behaviors, whether high-risk groups differed from lower-risk groups in similarity for sibling reports for neglectful behaviors, and factors predicting differences in sibling reports of parental neglectful behaviors. METHOD: We assessed parental neglectful behaviors using child reports for 59 sibling pairs, representing both clinical and community samples. All children completed the Multidimensional Neglectful Behaviors Scale, which measures both child-specific and family-level neglectful parenting behaviors. RESULTS: Sibling intraclass correlations for neglectful behaviors were high and significant, and there were no differences in sibling correlations between clinical and community samples. Furthermore, there were no differences in correlations for family-level and child-specific items. Opposite sex siblings reported greater differences in parental neglectful behaviors, with boys reporting more neglectful behaviors than girls. CONCLUSIONS: Siblings report similar neglectful parenting behaviors, regardless of whether the family is high-risk or not, and whether neglectful behaviors are measured as a family-level or child-specific phenomenon.     

Failure-to-thrive, maltreatment and the behavior and development of 6-year-old children from low-income, urban families: a cumulative risk model

OBJECTIVE: A cumulative risk model was used to examine the relationship among failure-to-thrive (FTT), maltreatment, and four aspects of children's development: cognitive performance (standardized testing), adaptive functioning at school, and classroom behavior (teacher report), and behavior at home (maternal report). METHOD: The sample included 193 6-year-old children and their families, recruited from pediatric clinics serving inner-city, low-income, primarily African-American families, who were part of a longitudinal investigation of child development and maltreatment. Four risk groups were formed based on their growth and maltreatment history: neither FTT nor Maltreatment, FTT Only, Maltreatment Only, and both FTT and Maltreatment. FTT was defined as a deceleration in weight gain (weight-for-age below the 5th percentile) prior to 25 months of age among children born at term with birth weight appropriate for gestational age. Maltreatment was defined as having at least one report to CPS for neglect, physical abuse and/or sexual abuse. RESULTS: Risk status was negatively associated with each of the four developmental outcomes. Children with a history of both FTT and maltreatment had more behavior problems and worse cognitive performance and school functioning than children with neither risk factor. Children with only one risk factor (either FTT or maltreatment) achieved intermediate scores. CONCLUSIONS: Findings support a cumulative risk model as being more detrimental to children's development than the presence of a single risk factor alone, consistent with theories linking the accumulation of environmental risks to negative consequences. These results underscore the importance of interventions to prevent both FTT and maltreatment during children's early years.     

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.     

Child abuse: Thoughts on doctors, nurses and prevention

It is obviously better if child abuse can be prevented in the first place. There are many problems in society which doctors and nurses and other health care professionals can hardly be expected to fix up, but there are many weaknesses in what we do which can and should be repaired. As a group we are weak in our appreciation of the demoralizing strain that an awkward or crying baby can bring upon a household, particularly that of the nuclear family. The media paint a mythical picture of parenthood, possibly unreal, and leading to the isolation of the mother who wants to complain that her child is very trying. As a group, doctors and nurses are more concerned about reassurances that a child is not seriously ill or else will outgrow his particular symptom and are not very good at bending their energies towards providing relief of the symptom. The sanity of many families has been preserved by the judicious use of safe analgesics and sedatives. Many people obtain these in spite of the physician and not through him.To turn to an even earlier phase of infancy, where hospital personnel are intensely involved and could well mend their ways often — in Western countries more and more babies are being born in hospital. Frequently, insufficient efforts are made to ensure that the labour and delivery are pleasant emotional experiences for the mother. In the name of safety, sterility and administrative needs, many of the emotional needs of the parents are unmet. It is now being shown that actual physical attachment between mother and baby in the time — hours and days — after the baby is born can be extremely important in developing the mother/child bond which is the child's greatest protection. In many countries including mine there have to be associations of mothers who want to breast feed their own children, and these mothers often find that their greatest difficulties are with hospital personnel.The very necessary scientific measures required to ensure the safety of low birth weight and premature infants can separate mother from baby even more and this is reflected in the well-known increase in later child abuse among babies who have spent their early weeks in intensive care units. If the hospital personnel really try, they can make the mother and father feel at home in these ultrascientific units. The staff must not merely permit but must actively invite the parents into the special nursery, explain the surroundings and equipment, show how to gown and hand wash, how to open the Humidicrib, touch the baby and take part in the nursing management from the earliest possible time — the second or first day. Explanations appropriate to the parental level of understanding must be given and repeated.Anything which will strengthen the bonds within the family must be welcomed as something that will prevent child abuse.     

The psychological ecology of the neglectful mother

Interviews were conducted with 152 neglectful mothers and with 154 non-neglectful, who were matched on race, economic status, urban/rural status and other life circumstances. The neglectful mothers reported less support available from informal networks; they also described their neighborhoods as less friendly and helpful than did the controls. However, the conclusion that neglect is related to living in settings that are socially impoverished was not supported by independent interviews with neighbors. Rather, it appeared that neglectful mothers are often isolated by those around them. Because they are seen as deviant and unlikely to reciprocate help, they do not have access to such support as there may be in their ecology. A new model is presented for preventive, community-based intervention, based on the findings of the research.     

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.     

Child health and maltreatment

Children who are abused have been said to have more illnesses than children who are not maltreated. The relationship between abuse and illness has been hypothesized to function in 2 ways: (1) that abuse precedes the illnesses and children from abusive homes become ill because of the damaging environment they endure, or, conversely, (2) that the illnesses precede the abuse, with the fussy behavior of ill children eliciting abuse. This study was intended to clarify the temporal relationship between illnesses and maltreatment. Health data were collected on a sample of 80 children: 11 from abusive families, 31 with nonorganic failure to thrive (NOFT), 14 from neglectful families, and 24 from control families. Hospital records (both inpatient and outpatient) for these children from the time of birth until they were 3 years old were searched by data collectors unaware of the child's classification. Children from abusive families or with NOFT appeared to be ill more often than control children, particularly during the first few months after birth, before abuse had been reported, but not necessarily before NOFT had been discovered. Health records of neglected children were not significantly different from those of controls. In addition to the abused. These 6 children also had more illnesses than control children, again particularly during the first few months after birth. Having ill children is described as a source of stress that may trigger abuse in an already stressed family.     

试论绑架罪的立法缺陷与完善

刑法第239条存在一定的立法缺陷：“绑架他人作为人质”的内容应该能涵盖“以勒索财物为目的绑架他人或者偷盗婴幼儿”的内容;为体现对婴幼儿的特别保护,“以婴幼儿为人质的”应作为绑架罪的一加重处罚情节：起刑点十年有期徒刑和绝对死刑的规定没有注意与其它法条之间的协调,也不符合罪责刑相一致原则,故对这一条款应予以修改和完善。     

Self-reported disciplinary practices among women in the child welfare system: association with domestic violence victimization

OBJECTIVE: To examine the association between physical domestic violence victimization (both recent and more than a year in past measured by self-report) and self-reported disciplinary practices among female parents/caregivers in a national sample of families referred to child welfare. METHODS: Cross-sectional survey of more than 3,000 female caregivers in the National Survey of Child and Adolescent Well-being (NSCAW) study, a nationally representative sample of children and their families referred to child welfare agencies for investigation of abuse and neglect. Women reported physical domestic violence victimization and their disciplinary practices for their child on different versions of the Conflict Tactics Scales. RESULTS: Four hundred and forty-three women reported prior year domestic violence, 1,161 reported domestic violence but not in the past 12 months, and 2,025 reported no domestic violence exposure. Any prior domestic violence exposure was associated with higher rates of self-reported psychological aggression, physical aggression and neglectful disciplinary behaviors as compared to those with no domestic violence victimization in bivariate comparisons. After controlling for child behavior, demographic factors, and maternal characteristics, those with remote and recent domestic violence victimization employed more self-reported psychological aggression, while only caregivers with recent DV reported more physical aggression or neglectful behaviors. CONCLUSIONS: In a national child welfare sample, self-reported aggressive and neglectful parenting behaviors were common. In this sample, domestic violence victimization is associated with more self-reported aggressive and neglectful disciplinary behaviors among female caregivers. The mechanism for these associations is not clear. PRACTICE IMPLICATIONS: Rates of aggressive and neglectful disciplinary practices are especially high among female parents/caregivers exposed to domestic violence. Child welfare agencies should plan routine and structured assessments for domestic violence among parents/caregivers and implement parenting interventions to reduce harmful disciplinary practices for those families identified.     

Emotional abuse and neglect (psychological maltreatment): a conceptual framework

OBJECTIVE: Emotional abuse and neglect is an under-recognized, but actually common, form of child abuse. Professionals in the field continue to find difficulty in recognizing and operationally defining it, and experience uncertainty about proving it legally. There are also questions about intervention and therapy to protect the child in the least detrimental manner. These difficulties have led to delays in recognition and protective intervention. Emotional abuse and neglect are defined as a carer-child relationship that is characterized by patterns of harmful interactions, requiring no physical contact with the child. Motivation to harm the child is not necessary for the definition. Unlike sexual abuse that is a secret activity, these forms of ill treatment are easily observable. The child's development is impaired in all domains of functioning but, not being specific to emotional abuse and neglect, cannot be regarded as diagnostic. METHOD: Research, clinical experience and theoretical considerations have led to a conceptual framework and operational definitions of five categories of harmful interactions between parent and child. This framework is contrasted with the APSAC categories. RESULTS: It is postulated that the different categories of ill treatment respectively require different therapeutic interventions. CONCLUSION: Concerns about the presence of emotional abuse need to trigger an assessment process that includes identifying the nature of the abusive or neglectful interactions and a time-limited trial of specific interventions. The family's response to this process and its outcome will determine the need for statutory involvement, as well as providing a basis for litigation if this is required.     

Increased reliability of an objective personality measure for children

The Missouri Children's Picture Series (MCPS) is explored as an assessment tool for boys in residential treatment. Extreme ease of administration is an attractive feature of the test. Boys in treatment usually have shown low test-retest reliability, in contrast to other populations. Higher, significant reliability was obtained in the present study by a split-deck procedure. It is suggested that the test is better administered to disturbed boys in two sittings, to offset their distractibility and short attention span. Under these conditions, the test can be applied to future work with this type of subject population.     

Extreme food behavior in abusive families

The availability of food can provide a positive tool in the treatment of abusive and neglectful families. This concept evolves from the belief that inadequate parents are most often people who have been deprived of an adequate “parenting” experience in their own lives. Deprivation creates a void of security which may result in many extremes of behavior. Many of these extremes, as they are related to food habits, have been defined here.Gorging is identified as the first extreme, and differentiation is made between the dynamics of the discriminate gorger who can be helped specifically and the indiscriminate gorger who needs infinite abundance to feel secure. Secondly, the physical and emotional insecurities which result in a need to hoard food are examined, and some insight is offered into understanding the obese patient and the steps necessary before anticipating any effective regulation of the obese person's eating habits. The last personal extreme discussed is despised-food intake which is an easily recognizable symptom of deprivation.The extremes of interaction between peers and spouses at group meals have been addressed, and it is noted that group meals which are traditionally instruments of socialization can be extremely stressful for groups of insecure members.Finally, the extremes of parent-child interaction are outlined, and it is shown how these extremes can reduce the family's mealtime to a devastating emotional battleground. The characteristics of overfeeding and withholding are defined, and it is shown how this chain of extremes results in a complete breakdown of the “parenting” process in which all members fail. Based on the clinical observations made at The National Center for the Pre- vention and Treatment of Child Abuse and Neglect in Denver, it is suggested that feeding can be used as a therapeutic tool not only to attract and hold patient attendance, but also to facilitate progress in therapy through the reduction of physical anxiety.     

Phonological and semantic factors in the object-naming errors of skilled and less-skilled readers

Children who read poorly have difficulty naming objects, and their errors usually bear a semantic or a phonetic resemblance to the correct words. Excessive semantic and phonetic naming errors could both be due to underlying phonological deficiencies in poor readers. When children cannot name an object because its name is not represented well in long-term memory or cannot be processed well, semantic information as well as partially available phonological information may be used in selecting an alternative response. This hypothesis was tested by looking for the joint influence of semantics and phonology in the naming errors of third-grade children. The same children were asked to name a set of pictured objects, repeat the object names after being spoken by the examiner, and recognize the objects from their spoken names. A separate group of children produced associative responses to the same pictures. First, it was found that, compared with skilled readers, less-skilled readers who named objects without any time pressure had a deficit that could not be attributed to repetition difficulty or limited vocabulary. Second, the naming errors showed a semantic relationship to the correct words that was as strong as that of the associative responses. Third, the naming errors also showed a phonetic relationship to the correct words, whereas the associative responses did not. Finding a joint semantic and phonetic effect in the naming errors of children suggests that the errors may be attributable to phonological deficiencies.     

Coping with Short-term Sustained Peak Demands ,several cost-effective strategies

For most open universities, in fact for most universities, there will arise occasions when some online activities will have to be completed by all students in a very short time interval. These occasions usually result in a great rush to get online as quickly as possible ; the rush is often made worst by the limited good choices on offer such that usually only the earliest can get the best. Choosing and confirming elective subjects, when only a limited number for each are offered, on a first-come-first-served basis is an example. At the Open University Malaysia the rush occurs when confirming offered subjects and choosing face-to-face meeting timetable. Most students rushed to be earliest to ensure choice slots in the timetable are obtained. Available I. T. resources such as Internet bandwidth and servers cannot cope with these short-term sustained peak demands. Unless these peak demands are met, however, online services will slow down drastically resulting in long queues of users waiting to be served. Providing excess capacity, if at all possible, to ensure these short duration peak demands can be met would not be cost-effective since most of the time these resources are not utilised. This paper will look at some cost-effective approaches to meeting these short-term peak demands.     

解决短期高峰需求的成本效益策略

For most open universities, in fact for most universities, there will arise occasions when some online activities will have to be completed by all students in a very short time interval. These occasions usually result in a great rush to get online as quickly as possible; the rush is often made worst by the limited good choices on offer such that usually only the earliest can get the best. Choosing and confirming elective subjects, when only a limited number for each are offered, on a first-come-first-served basis is an example.At the Open University Malaysia the rush occurs when confirming offered subjects and choosing face-to-face meeting timetable. Most students rushed to be earliest to ensure choice slots in the timetable are obtained.Available I. T. resources such as Internet bandwidth and servers cannot cope with these short-term sustained peak demands. Unless these peak demands are met, however, online services will slow down drastically resulting in long queues of users waiting to be served. Providing excess capacity, if at all possible, to ensure these short duration peak demands can be met would not be cost-effective since most of the time these resources are not utilised. This paper will look at some cost-effective approaches to meeting these short-term peak demands.     

如何应对网上短时学习需求高峰——学习成本节约策略研究

对多数开放大学来说,事实上,在许多大学中,总是会出现这样的情况,所有学生要在同一段时间内集中完成一些网上学习活动。这些活动通常造成学生在一定时间内蜂拥上网。由于学生较好的上网时间选择有限,网上学习拥挤高峰情况就会变得很糟。在通常情况下,只有那些最早上网的学生才能获得最佳在线学习机会。在马来西亚开放大学,当学生确认开设科目和占用网络槽口选择会面时间表的时候,往往就会出现网上使用高峰。大多数学生都会尽早赶去上网以确保能在时间安排表中获得网上会面的机会。那些可以利用的信息技术资源与功能,诸如互联网带宽和服务器等无法应付这些短时网络需求高峰。除非这些需求高峰得到满足,否则网络服务的速度将会迅速变慢,最终导致网络使用者排长队等候网络服务。假如可以提供超额的网络容量,要是可能的话,以确保这些短时需求高峰得到满足,那就不可能有成本效应。因为在大多数时间里,这些网络资源都没有得到充分利用。本论文着重探讨一些具有成本效应的方法以应对和满足短时网络高峰的需求。     

Coping with Short-term Sustained Peak Demands——several cost-effective strategies

For most open universities,in fact for most universities,there will arise occasions when some online activities will have to be completed by all students in a very short time interval.These occasions usually result in a great rush to get online as quickly as possible;the rush is often made worst by the limited good choices on offer such that usually only the earliest can get the best.Choosing and confirming elective subjects,when only a limited number for each are offered,on a first-come-first-served basis is an example. At the Open University Malaysia the rush occurs when confirming offered subjects and choosing face-to-face meeting timetable.Most students rushed to be earliest to ensure choice slots in the timetable are obtained. Available I.T.resources such as Internet bandwidth and servers cannot cope with these short-term sustained peak demands.Unless these peak demands are met,however,online services will slow down drastically resulting in long queues of users waiting to be served.Providing excess capacity,if at all possible,to ensure these short duration peak demands can be met would not be cost-effective since most of the time these resources are not utilised.This paper will look at some cost-effective approaches to meeting these short-term peak demands.