CHILDREN WHO FAIL TO THRIVE - PART 1 docx

50 5 Feeding/Eating Behaviour of Children who Fail to Thrive, and Parental Feeding Styles.. 87 7 Child–Parent Attachment Behaviour of Children who Fail to Thrive and Parental Responsiven

CHILDREN WHO FAIL

CHILDREN WHO FAIL TO THRIVE

CHILDREN WHO FAIL

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Library of Congress Cataloging-in-Publication Data

Iwaniec, Dorota.

Children who fail to thrive : a practice guide / Dorota Iwaniec.

p cm.

Includes bibliographical references.

ISBN 0-471-49720-7 (Paper : alk paper)

1 Failure to thrive syndrome 2 Parent and child I Title.

RJ135.I95 2004

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0-470-87077-X (hbk)

ISBN 0-471-49720-7 (pbk)

Typeset in 10/12pt Palatino by TechBooks, New Delhi, India

Printed and bound in Great Britain by Biddles Ltd, King’s Lynn

This book is printed on acid-free paper responsibly manufactured from sustainable forestry

in which at least two trees are planted for each one used for paper production.

For my grandchildren

Ben and Elena

List of Illustrations . ix

About the Author . xi

List of Epigraphs . xiii

Acknowledgements . xv

SECTION I: THE PROBLEM 1 Introduction . 3

2 Historical Perspective of Failure to Thrive . 13

3 Failure to Thrive: Definition, Prevalence, Manifestation, and Effect 28 4 Psychosocial Short Stature: Emotional Stunting of Growth . 50

5 Feeding/Eating Behaviour of Children who Fail to Thrive, and Parental Feeding Styles . 71

6 Parent–Child Interaction in Failure-to-Thrive Cases . 87

7 Child–Parent Attachment Behaviour of Children who Fail to Thrive and Parental Responsiveness . 102

8 Fabricated or Induced Illnesses and Failure to Thrive . 121

SECTION II: THE FRAMEWORK OF ASSESSMENT 9 A Framework of Assessment of Failure-to-Thrive Cases: Ecological Approach . 141

viii CONTENTS

SECTION III: INTERVENTION AND TREATMENT OF

FAILURE-TO-THRIVE CHILDREN AND THEIR FAMILIES

10 Levels of Intervention . 187

11 Some Theoretical Approaches to Failure-to-Thrive Intervention . 199

12 Multidimensional/Integrated Model of Intervention in Failure-to-Thrive Cases . 215

13 Approaches to Failure-to-Thrive Intervention Programmes . 239

14 Considerations Arising from Failure-to-Thrive Intervention Research . 255

Epilogue . 273

References . 275

Index . 289

LIST OF ILLUSTRATIONS

FIGURES

4.1 Psychosocial short stature: emotional stunting of growth 537.1 Numbers of individuals in the sample who were classified as

either secure, anxious/ambivalent or avoidant as children and

9.3 Percentile chart showing fall-down across percentiles: 0–1 year 146

12.6 Description and rules of symbolic, social and tangible rewards

TABLES

5.1 Interactional styles and characteristic behaviours of carers and

7.1 Numbers of individuals in the sample whose attachment

changed or stayed the same between childhood and

9.1 Types of attachments, parental behaviour and child’s

12.1 Integrated model of intervention in failure-to-thrive cases 218

ABOUT THE AUTHOR

Dorota IwaniecMA, DipEd, DipSW, CQSW, PhD, AcSS

Institute of Child Care Research, Queen’s University of Belfast,

5a Lennoxvale, Belfast BT9 5BY, Northern Ireland

Dorota Iwaniecis a Professor of Social Work and Director of the Institute ofChild Care Research at Queen’s University of Belfast She has extensive clini-cal and research experience of working with children and their families and,

in particular, in failure to thrive, neglect, emotional abuse, and behaviouraland emotional problems of children and adolescents She has been research-ing failure-to-thrive children for the last 25 years and has recently completed

a 20-year follow-up study Prior to coming to Queen’s University she worked

as a social worker, researcher, and trainer in Leicester for nearly 30 years, both

at the Social Services Department and at the Department of Child Health atLeicester Royal Infirmary

LIST OF EPIGRAPHS

Chapter 1 Apocrypha, II Esdras Ch 2, v 25

Chapter 2 Lucius Annæus Seneca (c.4 BC–AD 65): De Beneficiis, vii,

Sec 1

Chapter 3 Sir John Harington (1561–1612) The Englishman’s Doctor.

Or, The Schools of Salerne London: John Helme & John

Busby, Jun., 1607

Chapter 4 The Holy Bible: Proverbs, xv, 17

Chapter 5 Samuel Johnson (1709–84), quoted in James Boswell

(1740–95) The Life of Samuel Johnson LL.D (1791), dated

14 July 1763

Chapter 6 Francis Bacon, 1st Baron Verulam and Viscount

St Albans (1561–1626) Essays (1625), ‘Of Parents and

Children’

Chapter 7 Oscar Wilde (1854–19) A Woman of No Importance (1893),

Act I

Chapter 8 William Mason (1724–97) Ode, No vii, st 2 (1756)

Chapter 9 John Ruskin (1819–19) Time and Tide (1867)

Chapter 10 The Holy Bible, Isaiah, xliv, 15

Chapter 11 William Penn (1644–1718) Some Fruits of Solitude (1693),

Pt 1, No 52

Chapter 12 Ben Jonson (c.1573–1637) The Devil is an Ass (1616),

Act 1, Scene 2

Chapter 13 Carl Gustav Jung (1875–1961) ‘Vom Werden der

Pers ¨onlichkeit’ (1932), Gesammelte Werke (Olten:

Walter-Verlag, 1972), 17

Chapter 14 Coventry Kersey Dighton Patmore (1823–96) Tired

Memory

I acknowledge, most warmly and with gratitude, the unfailing support given

by my husband, Professor James Stevens Curl, during the writing of thisbook Without his help, this book would never have been completed I amalso very grateful and indebted to Mrs Maura Dunn for the production ofthe text and illustrations and her continuous loyal assistance during the ‘longjourney’ involved in writing and rewriting the text A big ‘thank you’ goes

to Dr Helga Sneddon, who, as my research assistant, helped with the dataanalysis of the 20-year follow-up study and literature review on the subject.She has worked closely with me for a considerable time Dr Emma Larkin hascontributed to the literature review on intervention, and Dr Sarah Allen hasalso helped: they have my thanks I am also grateful to my colleagues atQueen’s University of Belfast for their encouragement and interest in myresearch and writing Last, but not least, I am greatly indebted to formerfailure-to-thrive clients and their families for generously making the 20-yearfollow-up study possible

The publisher would like to thank the Child Growth Foundation for sion to reproduce some of their growth reference charts The Foundation isnot the source of the growth curves superimposed The charts in the book arenot intended for practice use If required, you may obtain the latest release ofthe charts from Harlow Printing (Maxwell Street, South Shields, NE33 49U,

permis-UK, Tel: 0191 427 4379, Contact: Ms Diane Hall)

Dorota Iwaniec

Holywood, Co Down

2002–3

Section I

THE PROBLEM

as shedding light on parental perceptions and management of difficultiesassociated with failure to thrive.

Many years of direct contact with these children and their families vided invaluable experience and the accumulation of knowledge about char-acteristics of children and parents, family dynamics, and problems associ-ated with growth and development Most importantly, it became clear thatthere were many aspects of failure to thrive, ranging from mild problems ofweight-faltering (due to some feeding problems, parental anxiety, and lack

pro-of experience in rearing children) to far more persistent and difficult failure

to thrive (associated with inadequate parenting, distorted perceptions andrelationships, and neglect and abuse)

Since the mid-1970s, when the present writer began to study children whofail to thrive, knowledge has expanded enormously, and many well-designedstudies have been carried out, examining different facets of the subject, in sev-eral parts of the world We now know far more about the prevalence of failure

to thrive (FTT), as a result of community-based studies, than we knew yearsago when most samples were drawn from hospitalised children with severefailure to thrive We have also learned that children identified during the earlyonset of weight-faltering can be helped relatively quickly without any long-term negative effects But, equally, we have established that some childrenwith more severe FTT may have had the condition induced because of poor

4 CHILDREN WHO FAIL TO THRIVE

or inadequate parenting, and may require more extensive intervention: suchchildren tend to show a very poor prognosis for improvement or recovery.Longitudinal studies have confirmed these findings

For these reasons, all those who have responsibilities for overseeing dren’s growth and development should take the first signs of growth-falteringvery seriously indeed ‘Prevention is better than cure’ may be a clich´e, but thesooner the problem is recognised, the better it is for both baby and care-giver.Some children may grow out of early difficulties, but some do not; for them,their problems grow as they do

chil-During the author’s involvement in this field, it became apparent that thefailure-to-thrive syndrome can have many shades, and is not a simple matter

of faltering growth during the first few months of a child’s life If that were thecase, most problems would be resolved by recourse to services and resourcesavailable to everybody However, despite the fact that mandatory help isgiven by health visitors, many children fail to thrive, so there must be otherpsychosocial factors at work which create the problems and prove resistant tonutritional treatment alone Such factors are many and varied, and so no twocases will be exactly the same, although there may be similarities betweenthem All children displaying symptoms of FTT are undernourished, and allfail to grow according to expected norms, but that is where the similaritiesend

There are substantial variations in reasons why certain children fail tothrive, not least those connected with poor nutrition Some children may havesucking/eating problems, or mild oral-motor dysfunction, while others maynot be acquiring sufficient nutrition because of parental lack of understand-ing of what and how to feed, or because of neglect In addition, some parentsmay react to presenting problems and to caring tasks in many different ways.Some worry and become anxious about their children’s poor intake of foodand poor growth; others become angry and frustrated; some may perceivetheir children’s refusal of food as personal affronts, involving rejection by thechildren themselves; others may assume that their children are simply nothungry

Parental attitudes to food will play roles as well How food is presented tochildren, and what is fed to them will often establish that fears concerningpotential obesity of children will be important factors in those parental atti-tudes Some will deliberately withhold food, and some will fabricate illnesses:

in both instances the children will fail to thrive

On the other hand, children will also react to parental behaviour: some will

be anxious, apprehensive, and fearful; while others will withdraw, becominglethargic and detached Thus, the behaviours of parents and of children mayinfluence each other and create tension, a sense of lack of achievement (andtherefore of disappointment), and trigger feelings of depression Such prob-lems are not conducive to healthy growth, and vicious circles may be createdwhich produce major difficulties requiring complex remedies

INTRODUCTION 5

To illustrate different routes to under-nutrition resulting in FTT, a few amples are given below:

ex-Examples

rPrevin, who was referred when he was 3 months old, was not given a sufficient

amount of food and the right formula as his mother did not like fat babies or fatpeople in general;

rIndira was referred when she was 2 years and 3 months old She had presented

with feeding difficulties from birth Her mother would spend hours trying tofeed her Indira would spit out food, heave, store food in her mouth, and refuse

to chew and swallow;

rAt the age of 1 year 11 months, Kevin looked extremely thin, and sick, and

developmentally was delayed His mother abandoned him after birth, but wasforced to take him back by her parents He was an unwanted child;

rPenny’s birth-weight was 4.1 kg (9 lb 1 oz.) At 21/2months her weight dropped

to 3.75 kg (8 lb 3 oz.) Her mother was informed two days after Penny was bornthat her 32-year-old sister had died of cancer;

rRose was 13 months old, the third child in the family She looked thin, small,

lethargic, and withdrawn Rose’s weight dropped to under the 2nd percentilefrom the 25th percentile, and at 6 weeks she still was under the 2nd percentile.Her mother suffered from post-natal depression;

rRebecca’s birth-weight was on the 25th percentile She stopped gaining weight

at 5 months, and fell below the 2nd percentile at 7 months Parental worriesthat there might be an organic reason for poor intake of food and poor growthwere dismissed At 16 months it was discovered that she suffered from severeneuromuscular incoordination of the oesophagus;

rNancy, aged 6 months, gained only just under 1 kg (2 lb 2 oz.) following her

birth Her mother was 16 years old and had spent all her life in care She was animmature person and there was nobody to help her

All these children failed to thrive, and they had one thing in common: theydid not get a sufficient amount of nutrition into their systems and all of themwere undernourished The reasons why they were underfed, however, differfrom case to case

Previn was underfed because of maternal and paternal attitudes towardsfood and preoccupation with weight Penny did not gain weight in spite ofunsuccessful attempts by her mother to feed her: this was associated withher mother’s depression connected with sudden bereavement and trauma.Rebecca did not thrive because of physical illness which was not detectedand dealt with early on Kevin’s physical and psychosocial growth was poorbecause of severe neglect and rejection Indira was extremely difficult to feedfrom birth and demonstrated oral-motor dysfunction Nancy was starvedunintentionally, as her mother proved unable to read her signals of hungerand did not know much about the nutritional needs of children and generallyabout parenting