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.     

Enhancing Maternal Interactive Behavior and Child Social Competence in Low Birth Weight, Premature Infants

Effects of a comprehensive early intervention program for low birth weight, premature infants—the Infant Health and Development Program—on mother-child interaction were examined at 30 months ( N = 683). Small significant positive effects were found: Intervention mothers had higher ratings on quality of assistance; intervention children had higher ratings on persistence and enthusiasm and on an overall child rating of competence and involvement and lower ratings on percentage of time off-task; intervention dyads were rated as more synchronous. Of a set of initial status variables indexing biological and environmental risk, only 2 treatment interactions were found. Intervention group black children had higher ratings on enthusiasm and lower percentage of time off-task. Independent of treatment, maternal ethnicity and education were significant predictors of maternal and dyadic ratings, while ethnicity and birth weight predicted child ratings. Implications for early intervention and center-based care are discussed.     

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.     

Maternal Regulation of Children''s Problem-solving Behavior and Its Impact on Children''s Performance

This study focused on a social interaction theory of the development of cognitive self-regulation. Specifically, the effect of mother-child interaction on the child's ability to problem solve was investigated. The general predictions were (1) children who interacted with their mothers throughout a problem-solving task would subsequently exhibit improved independent performance over practice-control children, who received corrective feedback from a female experimenter at the end of the task; (2) mothers would be more responsible for task activities, would more often regulate their child's task behaviors, and offer more specific verbal content when task demands on child competence increased than when they decreased. 60 3- and 5-year-olds either worked with their mothers or practiced alone and were given corrective feedback on a sorting task in which miniature pieces of furniture were placed in a doll house. As predicted, children who interacted with their mothers subsequently created more correct, adult-like groupings independently than children who received corrective feedback. Mothers displayed more task responsibility and regulation with younger children and when task demands on children of both age groups increased. Maternal verbal content became less specific when task demands decreased. Child performance was related to (1) variation in maternal regulation of the child; and (2) degree of specificity of maternal verbal content.     

Adolescent Mothers and Their Children's Early School Performance

This study examined differences in child-mother interaction, classroom adjustment during kindergarten, and retention in kindergarten between 41 first-born children of adolescent mothers (18 years old or younger at the time of the child's birth) and 88 first-born children of adult mothers (20 to 24 years old at the time of the child's birth). Maternal education was included as a covariate in comparisons. The children of adolescent and adult mothers were generally indistinguishable in areas of classroom adjustment, retention in kindergarten, and child-mother interaction when mothers' education was considered. Results are discussed in terms of implications for research and policy.     

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.     

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.     

Language problems in children with learning disabilities: do they interfere with maternal communication?

In this study, parent-child interaction in two carefully matched subgroups-school-age boys with learning disabilities (LD) who showed a discrepancy between their verbal IQ and performance IQ and had more extensive difficulties in higher-level language abilities (VIQ < PIQ, n = 8) and boys with LD who did not manifest a discrepancy between verbal IQ and performance IQ (VIQ = PIQ, n = 8), were investigated. The effects of the child's language problems on child task performance and on the quality of maternal communication were analyzed in a mother-child problem solving task. Children in the VIQ < PIQ group were found to be less successful on the task than children in the VIQ = PIQ group, and their mothers exhibited lower communication clarity in their instructions than the mothers of the children in the VIQ = PIQ group. An interesting interaction effect was found for communication deviances. For mothers in the VIQ < PIQ group the extent of deficient communication increased from the monologue to the dialogue situation, whereas communication deviances decreased for mothers in the VIQ = PIQ group. Three possible models are discussed in light of the differences between the subgroups.     

Family dynamics and child outcomes in early intervention: the role of developmental theory in the specification of effects

Evaluations of early intervention for children facing biological and/or socioeconomic risk have tended to focus most directly on change in the child, treating family variables primarily as mediators of change. In contrast, the current study used developmental theory to articulate hypotheses that address one way in which a focus on the relationship between mother and child may be related to intervention efficacy. This study examined maternal control strategy and child compliance as a function of early intervention beginning at birth for low birth weight, preterm infants and their families and related these aspects of mother–child interaction to behavioral outcomes at age 3 (n=645). Overall, mothers receiving early intervention were no more likely to use a preferred control strategy, guidance orientation, in a structured compliance task than were mothers participating in a follow-up only condition. However, an association between early intervention and maternal guidance was observed among mothers of children who were consistently noncompliant during the task. As a result, maternal guidance as observed in the compliance interaction was associated with reduced externalizing and internalizing behavior at program end for children participating in the intervention but not the follow-up only condition. Findings highlight the value of focusing on the mother–child dyad and illustrate one way in which developmental theory can assist in the specification of treatment effects.     

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)     

Children and mothers in war: an outcome study of a psychosocial intervention program

The present study was designed to evaluate the effects on children (age: M = 5.5 years) in war-torn Bosnia and Herzegovina of a psychosocial intervention program consisting of weekly group meetings for mothers for 5 months. An additional aim was to investigate the children's psychosocial functioning and the mental health of their mothers. Internally displaced mother-child dyads were randomly assigned to an intervention group receiving psychosocial support and basic medical care (n = 42) or to a control group receiving medical care only (n = 45). Participants took part in interviews and tests to provide information about war exposure, mental health, psychosocial functioning, intellectual abilities, and physical health. Results showed that although all participants were exposed to severe trauma, their manifestations of distress varied considerably. The intervention program had a positive effect on mothers' mental health, children's weight gain, and several measures of children's psychosocial functioning and mental health, whereas there was no difference between the two groups on other measures. The findings have implications for policy.     

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.     

Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect

OBJECTIVES: To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. METHODS: This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based agencies. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Child abuse and neglect were measured by observed and self-reported parenting behaviors, all hospitalizations for trauma and for conditions where hospitalization might have been avoided with adequate preventive care, maternal relinquishment of her role as primary caregiver, and substantiated CPS reports. Data were collected through annual maternal interviews (88% follow-up each year of all families with baseline interviews); observation of the home environment; and review of CPS, HSP, and pediatric medical records. RESULTS: HSP records rarely noted home visitor concern about possible abuse. The HSP and control groups were similar on most measures of maltreatment. HSP group mothers were less likely to use common corporal/verbal punishment (AOR=.59, p=.01) but this was attributable to one agency's reduction in threatening to spank the child. HSP group mothers reported less neglectful behavior (AOR=.72, .02), related to a trend toward decreased maternal preoccupation with problems and to improved access to medical care for intervention families at one agency. CONCLUSIONS: The program did not prevent child abuse or promote use of nonviolent discipline; it had a modest impact in preventing neglect. Possible targets for improved effectiveness include the program's implementation system and model.     

Predicting IQ from mother-infant interactions.

Longitudinal observations of maternal and infant characteristics were used to investigate the consequences of early day-care intervention for infants at high risk for intellectual retardation due to sociocultural factors. High-risk infants and their mothers were compared on social and intellectual characteristics with a control group not enrolled in an intervention program and with a random sample of mother-child dyads from the general population. Results from group comparisons indicated that mothers of high-risk infants in a day-care intervention group interacted with their infants in ways quite similar to mother of high-risk infants who were not enrolled in the intervention program. Both high-risk groups differed from the general population of mothers on interaction and attitudinal measures. Changes across time on the measures taken were roughly parallel from all three groups. Multiple regression analyses using maternal variables and mother-infant interactional variables to predict 36-month Stanford-Binet scores for the high-risk samples indicated that children's intelligence was predictable from previous maternal behaviors and attitudes, particularly for the control group, and that early day-care intervention apparently had altered the predictiveness of some maternal factors.     

不同教育背景母亲在亲子会话中词汇运用的差异比较

为探讨不同教育背景的母亲在母子会话中词汇运用水平的差异,本研究对40对母子在自发会话时母亲的词汇运用水平进行了研究,其中40位母亲具有不同的教育背景,其子女年龄分别在18个月、24个月、30个月、36个月四个年龄段。结果表明:在词汇的整体运用水平上,高教育背景母亲的词汇运用水平高于低教育背景母亲,且在基本词汇频次和丰富性等方面呈显著差异;在影响关系上,高教育背景母亲的母子双方词汇运用水平相关程度较高,二者多数为显著或极其显著,而低教育背景母子双方词汇运用水平相关程度低,甚至出现负相关,显示高教育背景母亲对儿童指向言语更为敏感。但研究结果同时显示:两类母亲在运用词汇时均对儿童词汇的年龄发展规律不敏感,因此两类母亲对儿童指向言语的年龄变化的敏感度都不高。     

Development of infants with disabilities and their families: implications for theory and service delivery.

This Monograph presents the results of a nonexperimental, longitudinal investigation of developmental change in 190 infants and their families after 1 year of early intervention services. The Early Intervention Collaborative Study (EICS), conducted in association with 29 community-based programs in Massachusetts and New Hampshire, was designed to assess correlates of adaptation in young children with disabilities and their families over time, to inform social policy by analyzing the influences of family ecology and formal services on child and family outcomes, and to generate conceptual models to guide further investigation. The study sample (mean age at entry = 10.6 months) includes 54 children with Down syndrome, 77 with motor impairment, and 59 with developmental delays of uncertain etiology. Data were collected during two home visits (within 6 weeks of program entry and 12 months later) and included formal child assessments, observations of mother-child interaction, maternal interviews, and questionnaires completed independently by both parents as well as monthly service data collected from service providers. Child and family functioning varied considerably. Developmental change in the children (psychomotor abilities, adaptive behavior, spontaneous play, and child-mother interaction skills) was influenced to some extent by gestational age and health characteristics, but the strongest predictor of change was the relative severity of the child's psychomotor impairment at study entry. Families demonstrated generally positive and stable adaptation (in terms of the effect of rearing a child with disabilities on the family, parenting stress, and social support), despite persistent challenges with respect to mother-child interaction and differences in reported stress between mothers and fathers. Documentation of services revealed that early intervention is a complex and multidimensional experience that spans multiple public and private systems. Vulnerable and resilient subgroups within the sample were identified, and different correlates of adaptive change were demonstrated. Results of data analyses suggest new perspectives on the study of early childhood disability. The implications of the findings for developmental theory and social policy are discussed.     

Stability in Mother-Child Interactions from Infancy through Adolescence

OBJECTIVE: The current study examines homotypic stability in mother-child interactions, applying similar rating scales of mother-child interactions at 1 and 4.5 years, and heterotypic stability from 1 to 13 years and 4.5 to 13 years, using conceptually similar but not identical rating scales at age 13. DESIGN: We coded videotaped mother-child interactions in 202 families when children were 1, 4.5, and 13 years of age during age-appropriate and developmentally salient structured tasks for relationship quality. RESULTS: Multiple regression analyses controlled for the effects of child birth order and gender as well as maternal age and education. Maternal and dyadic, but not child, mother-child interaction qualities at 1 year significantly predicted similar or equivalent constructs at 4.5 and 13 years. Heterotypic stability from 1 to 13 years was partially or fully mediated by the same constructs at 4.5 years. CONCLUSIONS: Maternal behaviors showed a pattern of homotypic and heterotypic stability, whereas dyadic behaviors were somewhat less stable. Child behaviors showed evidence of both homotypic and heterotypic instability.     

Prevention of child abuse and neglect through early diagnosis of serious disturbances in the mother-child relationship in Italy

At the obstetrical clinic of Modena University and a family center of the same municipality during the first six months of 1980 a questionnaire based on "Risks of Child Abuse" by Kempe, Gray and others was administered to 33 expectant mothers during the third trimester of pregnancy, a few days after delivery, and a month and one-half after childbirth, for the purpose of examining the mother-child relationship. Two principal groups of "risk factors" which may lead to child abuse and neglect appeared: mothers with preceding personal and social experiences, and cases of medical intervention (e.g., prematurity, caesarean). Use of a questionnaire that permitted early diagnosis made possible help in establishing a good mother-child relationship in the first months of life. Such help can be given by the hospital and public centers both before and after birth.     

Maternal Negativity and Children's Externalizing Behavior

Maternal negativity in parent-child interactions related to both the presence and persistence of child externalizing behavior problems. We examined how behavior of 120 mothers and their children in an interaction task at preschool related to assessments of child behavior problems at preschool, first grade, and third grade. At preschool and first-grade, children were assigned to three groups: comparison, moderate externalizing, and pervasive externalizing; at both timepoints the pervasive externalizing group had greater maternal negativity assessed at preschool. Maternal negativity was predicted, beyond the child's disruptive behavior in the task, by two variables: mother's perception of low spousal agreement and support related to child problems and depression. At third grade, child symptoms and diagnoses of ADHD and ODD were predicted by mothers' commands and repeat commands, though not negativity, in the preschool interaction task. Implications of these findings for early family intervention are discussed.