Failure to Thrive

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Failure to Thrive

• Ann Brandner, MSW, LISW
• Judy Wood, LSW
• Children's Hospital Medical Center
• Cincinnati, Ohio
• 513-636-4711

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Introduction

• Identification is crucial
• Multidisciplinary intervention is needed
• Social work skills utilized
• interviewing to identify problems/strengths
• insure basic needs are met
• establish warm nurturing relationship
• case management

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Neglect Family CharacteristicsMothers

• Depressive symptoms
• Substance abuse
• Frequently intergenerational abuse
• Preoccupied with own needs
• Fewer verbal/physical contacts with infant
• Spends less time feeding baby
• Terminates feeding prematurely

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Neglect Family CharacteristicsFathers

• Unavailable or unsupportive
• May be emotionally detached
• Controlling or abusive
• Poor parenting skills

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Neglect Family CharacteristicsChild

• Usually presents by the age of 6 months
• Increased risk if difficult, premature, low birth
  weight
• Sick babies may be deficient in signaling needs
• Less socially responsive
• Poor eye contact
• Decreased activity level
• Older child may rock, head bang, gorge

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Neglect Family CharacteristicsFamily System

• Isolated
• Interactional style of disengagement (Alderette)
• unresponsiveness
• early push toward separation
• No association with... (Drotar)
• noise level in the home
• number of persons in the home
• distractions in the home

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Neglect Family CharacteristicsEnvironment

• Poverty is the greatest risk factor
• Lack of resources
• food
• housing
• health care

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Poverty Related FTT

• Major cause of FTT Worldwide
• Less frequent in the US
• WIC
• food banks
• food stamps
• Poverty increases risk for FTT
• poor nutrition
• limited assess to medical care
• low birth weight infant

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Accidental Related FTT

• Errors in formula preparation
• powder vs. concentrate vs. ready to feed
• Inappropriate food
• age appropriate diet
• Stretching formula with extra water
• Breast feeding problems
• Many caretakers (confusion)

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Deliberate Starvation

• Usually an older child
• Confined to room
• Not fed
• May also be physically abused

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Identification of FTT

• Diagnosis at well child visit or ED
• PHN high risk follow-up visits
• Abuse/neglect investigations

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Physical Signs of FTT

• General appearance
• dull vacant stare
• poor hygiene
• passive or irritable infant
• Undress the baby
• protruding abdomen
• wasted buttocks
• thin limbs
• pale

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Social Workers Role in AssessmentPsychosocial
Evaluation

• Parents perception of problem
• Early bonding
• Feeding history
• Who is in the household
• Violence, substance abuse
• Resources
• Support system
• Recent changes

• Compliance with health care
• Assess childs development
• Assess physical environment
• Observe parent-child interaction
• Identify strengths
• Assess risk factors

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Social Workers Role in AssessmentManagement of
the Hospitalized Child

• Monitor weights daily
• Involve family in care - encourage visitation,
  rooming in
• Reinforce positive behavior, teaching
• Assess parent involvement
• Developmental evaluation and stimulation
• Safe discharge plan

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Mandated Neglect Reporting

• Report neglectful FTT
• if child losing weight
• no improvement with medical / social intervention
• organic causes have been ruled out
• Report to police in severe FTT

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Consequences of Non-Organic FTT

• Acute
• Slowed growth
• Increased vulnerability to infections
• Risk for developmental delays

• Chronic
• Growth disturbance
• Insecure attachments
• Impaired cognitive abilities
• Behavior problems
• Death

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Guidelines for Placement

• F.T.T. associated with non-accidental injury
• Severe emaciation without seeking health care
• Severely disturbed infant
• Hostile, mother-child interaction
• Addicted severely disturbed or retarded parent
• Family poorly motivated or refuses intervention
• Hospital observation that mother doesnt visit or
  cannot learn

Barton Schmitt, M.D.
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Treatment

• Parent can demonstrate care of child
• Economic resources
• Consistent medical follow up
• Support
• Parent education
• Therapy
• Developmental stimulation