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.     

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.     

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)     

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.     

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.     

Web of deceit: A literature review of Munchausen syndrome by proxy

Munchausen syndrome by proxy (MSBP) is a form of child abuse wherein the mother falsifies illness in her child through simulation and/or production of illness, and presents the child for medical care, disclaiming knowledge as to etiology of the problem. From the literature, 117 cases of MSBP were reviewed. The most common presentations of MSBP were bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever, and rash. Short-term morbidity rate was 100%; long-term morbidity rate was 8%. Mortality rate was 9%. Failure to thrive was associated with MSBP in 14% of cases. All perpetrators of MSBP were the mothers. The origins of this type of aberrant maternal behavior remain abstruse, as do the long-term psychological effects on the child victims. Guidelines for medical, social service, and legal management are provided.     

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.     

Non-organic failure to thrive: Decision for and videotaped evaluations

Infants hospitalized for non-organic failure to thrive in the first six months of life are in a life-threatening situation and are already at risk for poor bonding with mother. In light of this, the meaning and use of foster care and how this separation affects the developing mother-child relationship are the issues addressed through examination of 16 cases in which 8 of the infants were placed in foster care and 8 discharged home after the failure to thrive hospitalization. This paper examines (1) maternal histories of pregnancy, labor and delivery and the neonatal status of placed and non-placed infants; (2) the developmental and weight status of placed children; (3) the nature of the decision criteria for after-hospital care; and (4) the mother-infant relationship at initial intake in terms of mother's report of events and observations of feeding and play interactions during a videotaped assessment process. The study found that the interactions between mother and infant in those situations which required foster care were clearly more dysfunctional when compared to those in which the baby was discharged home to mother. Babies in the two groups were comparable in weight status at the time of hospitalization although babies in foster placement had slightly lower scores on the Bayley Scales. Maternal histories of pregnancy, labor, and delivery were similar for the two groups as were the birth and neonatal histories of the infants.     

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.     

Book Review Section 4

Contemporary scholars argue that in recent decades American racism has changed its face, away from an outright racism that is no longer socially acceptable toward a more subtle form termed "aversive," "laissez-faire," or "colorblind" racism. This ideology embraces mounting American individualism, transferring group-based explanations of disparities between Blacks and Whites to individual-based rationales. Using this ideology, Whites can appear to embrace "equality for all" while maintaining a belief in the inferiority of Black individuals. This qualitative study examines the role of colorblind racism in the rural town of Andrews, which experienced rapid and significant growth in its Black community. The Andrews school district response to its newly diverse student population was characterized by difference blindness—an institution-wide refusal to acknowledge the Black students' particular backgrounds and needs. Black students' academic failure was attributed to their personal deficiencies, a response exemplified in the high school's Classy Living and Social Skills program. Ultimately, blindness to difference and lack of a collective response served to reinforce racism in this community. Andrews schools will need to acknowledge and address the needs of all their students to stimulate academic success and true equality.     

Coping and Psychological Distress in Mothers of Very Low Birth Weight Young Children

Objective. This study sought to increase understanding of relations among coping strategies, sociodemographic variables, and psychological distress in mothers of high-risk (HR) and low-risk (LR) very low birth weight (VLBW; < 1,500g) infants. Design. The sample (N = 199) consisted of 77 mothers of HR VLBW infants, 43 mothers of LR VLBW infants, and a control group of 79 mothers of healthy, term infants. Data were collected with self-report questionnaires at birth and at 24 months postpartum. Relations among infant medical risk, multiple birth, maternal race, social class, and maternal coping were investigated. Hierarchical regression analyses were used to identify predictors of maternal psychological distress and to determine whether coping differentially moderated maternal psychological distress across groups. Results. Infant medical risk, social support, and maternal coping independently predicted maternal psychological distress. Mothers of HR VLBW infants reported significantly greater psychological distress than mothers of LR VLBW or term infants. Greater use of avoidant and express emotions coping predicted higher psychological distress for all mothers. Greater use of humor coping had a buffering effect, reducing distress only for mothers of HR VLBW infants. Maternal coping scores were related to maternal race and social class, rather than to severity of infant medical risk. Conclusions. Sociocultural sources of resiliency, as well as biological risk factors, should be considered when developing strategies to enhance coping and parenting in HR populations.     

讨论式教学法在高职课堂中的运用与思考

在高职的课堂教学实践环节中,讨论式教学法和案例情景表演法结合应用具有一定的可能性和实效性,本文探讨了高职教师对实施讨论式教学法存有顾虑的原因,即沉默的压力带给高职教师的冲击,想像的失望带给高职教师心理的落差,分歧依然存在带给高职教师的尴尬。     

Effects of maternal absence due to employment on the quality of infant-mother attachment in a low-risk sample

Recent reports have suggested that day-care experience initiated prior to 12 months of age is associated with increased proportions of infants whose attachment to mother is classified as "insecure-avoidant." However, reviewers have questioned the generality of these findings, noting that samples in which associations between early day-care experience and avoidant attachment patterns have been reported come from high-risk populations, and/or that the infants' day-care settings may not have been of high quality. In the present study, effects of maternal absences on infant-mother attachment quality were assessed in a low-risk, middle-class sample (N = 110). In all instances, substitute care had been initiated at least 4 months prior to the infant's first birthday and was provided in the infant's home by a person unrelated to the baby. Infants were assessed using the Ainsworth Strange Situation when they were 12-13 months of age. Analyses indicated that a significantly greater proportion of infants whose mothers worked outside the home (N = 54) were assigned to the category "insecure-avoidant" as compared to infants whose mothers remained in the home (N = 56) throughout the first year of life. Analyses of demographic and psychological data available for the sample indicated that this relation is dependent upon maternal parity (primi- vs. multiparous mother). The association between attachment quality and work status was significant only for firstborn children of full-time working mothers. The results are interpreted as evidence that the repeated daily separations experienced by infants whose mothers are working full-time constitute a "risk" factor for the development of "insecure-avoidant" infant-mother attachments.     

“非直接利益冲突”警示下“三旧”改造政策价值导向优化

在“非直接利益冲突”高发之际,广东省却肩负“三旧”改造的关键任务。在追求效率中,“三旧”改造出现规划轻人本、土地私权受损、收益分配失衡、优惠政策倾斜等偏差,诱发了民众的社会挫败感、不信任感、不公平感、相对剥夺感等消极心理。坚持服务、公平、民主、诚信的政策价值导向优化则是化解消极心理,预防冲突冲突的理想路径。     

Similarities and differences between nonorganic failure to thrive and deprivation dwarfism

Although the terms, nonorganic failure to thrive and deprivation dwarfism, are sometimes used interchangeably, and while the family pathology is similar in both conditions, the clinical features differ. The majority of children with nonorganic failure to thrive are under 2 years and often 18 months of age. Weight loss is the most marked feature and they are often withdrawn and apathetic. In contrast, the documented ages of children with deprivation dwarfism range from 2 to 15 years although the history may reveal earlier feeding and behavior problems. Short stature is the most striking feature, their weight often being in proportion to their height. They may steal and hoard food and have bizarre eating habits. In some cases reversible hypopituitarism has been documented. It is suggested that deprivation dwarfism constitutes a subgroup within the nonorganic failure to thrive syndrome. Management in both conditions is similar. It should emphasize a practical, supportive approach and be on a long-term basis.     

The role of person familiarity in young infants' perception of emotional expressions

This research investigated the role of person familiarity in the ability of 3.5-month-old infants to recognize emotional expressions. Infants (N = 72) were presented simultaneously with two filmed facial expressions, happy and sad, accompanied by a single vocal expression that was concordant with one of the two facial expressions. Infants' looking preferences and facial expressions were coded. Results indicated that when the emotional expressions were portrayed by each infant's own mother, infants looked significantly longer toward the facial expressions that were accompanied by affectively matching vocal expressions. Infants who were presented with emotional expressions of an unfamiliar woman did not. Even when a brief delay was inserted between the presentation of facial and vocal expressions, infants who were presented with emotional expressions of their own mothers looked longer at the facial expression that was sound specified, indicating that some factor other than temporal synchrony guided their looking preferences. When infants viewed the films of their own mothers, they were more interactive and expressed more positive and less negative affect. Moreover, infants produced a greater number of full and bright smiles when the sound-specified emotion was "happy," and particularly when they viewed the happy expressions of their own mothers. The average duration of negative affect was significantly longer for infants who observed the unfamiliar woman than for those who observed their own mothers. These results show that when more contextual information-that is, person familiarity-was available, infants as young as 3.5 months of age recognized happy and sad expressions. These findings suggest that in the early stages of development, infants are sensitive to contextual information that potentially facilitates some of the meaning of others' emotional expressions.     

Smoking hygiene: an educational intervention to reduce respiratory symptoms in breastfeeding infants exposed to tobacco

The American Academy of Pediatrics recently removed nicotine from the category of drugs contraindicated during breastfeeding. Little evidence demonstrates that infants exposed to nicotine through breastfeeding experience increased health risks beyond the airborne risks associated with passive smoking. The purpose of this longitudinal, five-week, quasi-experimental pilot study was to determine whether "smoking hygiene," an educational intervention, reduces the frequency of respiratory symptoms experienced by infants whose mothers both smoke and breastfeed. Twenty-nine mother-infant pairs entered the study with 28% dropping out. Of the 21 mother-infant pairs who completed the study, 66% of the nine infants in the control group experienced respiratory illness, compared to 42% of the 12 infants in the intervention group (x2 = .814; p > .05). Thus, the difference was statistically nonsignificant in this small sample, but the trend worsened the anticipated direction. The study demonstrates some of the difficulties of intervening with this group of mothers.     

大学新生相对剥夺感对人际适应性的影响:核心自我评价和社交焦虑的链式中介效应

为考察大学新生相对剥夺感对人际适应性的影响,采用相对剥夺感量表、核心自我评价量表、社交焦虑量表和人际适应性量表对536名大学新生进行调查。结果发现:(1)大学新生相对剥夺感、核心自我评价、社交焦虑和人际适应性两两之间均显著相关;(2)核心自我评价和社交焦虑分别在大学新生相对剥夺感对人际适应性的影响中起部分中介效应;(3)核心自我评价和社交焦虑在大学新生相对剥夺感对人际适应性的影响中起链式中介效应。研究结果进一步揭示了大学新生的相对剥夺感对人际适应影响的内在机制。     

Infants of depressed mothers show "depressed" behavior even with nondepressed adults

To determine whether the "depressed" behavior (e.g., less positive affect and lower activity level) of infants noted during interactions with their "depressed" mothers generalizes to their interactions with nondepressed adults, 74 3-6-month-old infants of "depressed" and nondepressed mothers were videotaped in face-to-face interactions with their mothers and with nondepressed female strangers. "Depressed" mothers and their infants received lower ratings on all behaviors than nondepressed mothers and infants. Although the infants of "depressed" versus nondepressed mothers also received lower ratings with the stranger adult, very few differences were noted between those infants' ratings when interacting with their mother versus the stranger, suggesting that their "depressed" style of interacting is not specific to their interactions with depressed mothers but generalizes to their interactions with nondepressed adults as early as 3 months of age.     

Some factors affecting mother-child relationships following low birthweight delivery in a Nigerian sociocultural environment

Twenty mothers with low birthweight babies, cared for in a neonatal unit and kept in incubators (as index group) and 20 mothers with full-term babies (as control group) were studied to determine the extent of maternal separation and deprivation following delivery and the effects of these on mother-child relationships. The population was prospectively sampled and an interview method using a structured questionnaire, was adopted to obtain the information for the study. The result showed a delayed post-partum contact, negative reactions and some delays in maternal attachment in mothers of premature infants. Nevertheless, some degree of adjustment in the mother-child relationship, as shown by some positive perceptions of the infants, took place 6 months after leaving hospital. Other social and cultural factors that may contribute to the negative reactions of the mothers to premature delivery are highlighted.