Psychiatric and social factors of failure to thrive
A physical cause for failure to thrive may be present in a family with psychiatric and social problems and therefore a physical cause must be excluded for all infants. The exclusion of a physical cause is often helpful in persuading the parents to accept that psychiatric or social factors are the main reason for the problem. Features in the history that may suggest this possibility include maternal depression, marital discord, or a disorganised household. Maternal food preferences may result in the exclusion of certain foods, such as cow’s milk, from the diet without reason and without adequate supervision, and may result in a deficient energy intake.
There are more subtle ways in which maternal emotional factors may affect the infant. The mother may be depressed and tense, and this anxiety is transmitted to the child, who does not feed. The mother then reacts by removing the food. In other families the child may be intrinsically less responsive than the average child to food and this may affect the mother’s response to the child at mealtimes. In both these examples the amount of food taken by the child falls to a plateau where the infant appears to be satisfied with the amount given. Another possibility is that the mother keeps to a diet herself as she perceives that she is overweight and also gives a diet to the infant in a similar way.
Some infants are deliberately underfed as part of child abuse. Normal weight gain occurs when fostering has been carried out.
Effective management of infants with this diagnosis requires a team approach involving a health visitor, the family doctor, a child psychiatrist, and paediatrician. Regular advice from a health visitor or dietitian often improves the rate of weight gain.
References:
Bernard Valman. 2002. ABC of the First Year. London: BMJ Books.
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