Child Development

Treatment

Inpatient investigation and initial treatment is
warranted for infants under a year in the following
cases: when the infant is suffering from more severe
growth failure; when there are signs of emotional de-
privation; when the parents have not sought medical
intervention; when the infant shows signs of physical
abuse; when the infant’s hygiene has been seriously
neglected; when the mother appears severely dis-
turbed or is abusing drugs or alcohol or is living a cha-
otic lifestyle overwhelmed with stresses; or when the
mother-infant interaction appears uncaring and in-
cludes feelings of anger.

During hospitalization, a primary-care nurse is
assigned to establish a warm and nurturing relation-
ship with the baby. The baby typically begins to blos-
som in its social interactions and rapidly gains weight.
As the baby begins to improve both in terms of weight
gain and psychosocially, hospital personnel can help
the mother engage with her baby, teaching her to re-
ceive and express the mutual signals of mother-infant
bonding. Understanding and addressing the moth-
er’s needs for emotional support and encouragement
is essential to rehabilitating the mother-infant rela-
tionship. The degree to which parents are aware of
the cause of the problem and actively cooperate in
their baby’s reattachment has been found to be pre-
dictive of the long-term outcome. Appropriate refer-
rals to child protective services agencies must be
made both to ensure the child’s continued safety and
to monitor the efforts to help the parents learn need-
ed skills.

Long-Term Prognosis for Recovery

Severe nonorganic failure to thrive is a potential-
ly fatal illness. Nutritional deprivation can lead to
death from starvation or overwhelming infection due
to a weakened immune system. With detection and in-
tervention, infants can in some cases recover from the
effects of their condition. Brain size as measured by
head circumference may be permanently reduced, es-
pecially if the failure to thrive occurred in the first six
months of life. During this time of its most rapid
growth, the brain is very susceptible to permanent
damage from the effects of poor nutrition.

Later emotional and learning problems are com-
mon in these children. A 1988 Case Western Reserve
University study found that the mean IQ score for
three-year-old children with a prior history of failure
to thrive was 85. A follow-up study of children from
this group showed that even those who subsequently
participated in early intervention programs had
problems of personality development, deficient prob-
lem-solving skills, and more behavioral problems in

general as compared to the controls. These problems

included impulse control, gratification delay, and the

ability to adapt behaviorally to new situations. An Is-

raeli study found that at age five, about 11.5 percent

of children with a history of failure to thrive had some

manifestations of developmental delay, compared

with no delays in the control children. They likewise

found an 18 percent incidence of poor school perfor-

mance compared with a 3.3 percent rate in the con-

trol group. Another follow-up study of children

diagnosed with nonorganic failure to thrive found

that at age six, half of the children in the study sample

of twenty-one had abnormal personalities and two-

thirds learned to read at a later-than-normal age.

Two of the twenty-one had died under suspicious cir-

cumstances, pointing up the vulnerability of children

with psychosocial failure to thrive. Another study de-

termined that out of fifteen children initially diag-

nosed with growth failure caused by emotional

deprivation, only two were functioning well three to

eleven years after diagnosis. Infants hospitalized with

failure to thrive prior to six months of age exhibited

decreased cognitive development, despite long-term

outreach intervention programs. Earlier age of onset

of growth failure, lower maternal education level, and

lower family income all predicted lower cognitive

level.

Summary

Failure to thrive in young children represents sig-

nificantly suboptimal growth due to intrinsic medical

(organic) or environmental (nonorganic) factors.

Nonorganic failure to thrive in particular represents

a recognizable syndrome of poor growth in infants

and young children with specific diagnostic features.

Nonorganic failure to thrive in early infancy poses a

significant risk of adverse long-term developmental

effects.

See also: MILESTONES OF DEVELOPMENT;

RESILIENCY

Bibliography

Berwick, D. ‘‘Nonorganic Failure to Thrive.’’ Pediatrics in Review 1

(1980):265–270.

Berwick, D., J. C. Levy, and R. Kleinerman. ‘‘Failure to Thrive: Di-

agnostic Yield of Hospitalization.’’ Archives of Disease in Child-

hood 57 (1982):347–351.

Bithoney, William, Howard Dubowitz, and H. Egan. ‘‘Failure to

Thrive/Growth Deficiency.’’ Pediatrics in Review 13

(1992):453–459.

Casey, P. ‘‘Failure to Thrive.’’ In M. Levine, W. Carey, and A.

Crocker eds., Developmental-Behavioral Pediatrics. Philadel-

phia: Saunders, 1992.

Drotar, D., and L. Sturm. ‘‘Prediction of Intellectual Development

in Young Children with Early Histories of Nonorganic Failure

to Thrive.’’ Journal of Pediatric Psychiatry 13 (1988):281–296.

FAILURE TO THRIVE 147