Nonorganic failure to thrive

Alternative names
Maternal deprivation syndrome

Definition
Maternal deprivation syndrome is a failure to thrive caused by neglect (intentional or unintentional).

Causes, incidence, and risk factors

The majority of cases of failure to thrive (FTT) in infants and young children (under 2 years old) are not caused by disease.

Approximately two-thirds of all cases are caused by dysfunctional caregiver interaction, poverty, child abuse, and parental ignorance about appropriate child care.

Failure to thrive in children less than 2 years old is defined as failure to gain adequate weight, failure of linear growth, and failure to achieve some or all developmental milestones.

The health care provider may see poor hygiene, inappropriate clothing, and general lack of care. A parent may feed the child an unusual or overly restricted diet. Although the mother or other primary caregiver may appear concerned, the interplay and physical contact normally seen between mother and infant may be absent or distorted.

Factors that may contribute to nonorganic failure to thrive include:

     
  • Young age of parent (teenage parents)  
  • Unplanned or unwanted pregnancy  
  • Lower levels of education (especially failure to complete high school)  
  • Lower socioeconomic status  
  • Absence of the father  
  • Absence of a support network (family, close friends, or other support)  
  • Mental illness, including severe post-partum depression

Symptoms

     
  • Weight less than the 5th percentile, or an inadequate rate of weight gain  
  • Decreased or absent linear growth (“falling off” the growth chart)  
  • Lack of appropriate hygiene  
  • Subtle-to-blatant abnormalities in the interaction between mother and child

Signs and tests

Diagnosis of FTT begins with a thorough history and physical along with meticulous examination of the patient’s growth chart.

When the diagnosis is suspected, important information may often be obtained by admitting the infant to the hospital where, with adequate feeding and care, weight gain and resumed growth may be demonstrated in a matter of days. Often as little as 3 or 4 days of hospitalization may demonstrate renewed weight gain.

Other laboratory and imaging studies may be indicated based on the history and physical examination.

Treatment

Treatment of failure to thrive is a major undertaking which requires the input of a multidisciplinary team including physicians, nutritionists, social workers, behavioral specialists, and visiting nurses.

Many programs are available for young parents, single parents, and parents having other problems. Referrals should be made as early as possible to appropriate programs.

Helping extended family members recognize that a problem exists and recruiting their help will provide increased support for the mother and infant.

Expectations (prognosis)
With adequate attention and care, full recovery is expected. However, neglect severe enough to cause failure to thrive can kill if it continues.

Complications

     
  • Abandonment  
  • Developmental delay  
  • Abuse

Calling your health care provider

Call for an appointment with your health care provider if your child does not seem to be growing or developing normally. Also, ask for the provider’s advice if you think you don’t know how to properly care for your child, or if you are overwhelmed by feelings of sadness or other problems, and fear you may harm your baby.

Post-partum depression and other mental illnesses may make caregivers feel hopeless and unable to properly care for their children, but there are resources and help available - there is no shame in asking for help.

Prevention

The problems leading to FTT are complex. Once a teenager or young adult becomes pregnant, education is an important part of prenatal care. Parenting classes and support groups are often available and should be strongly encouraged.

Early intervention programs are specifically designed to bring together the necessary resources to assist children with failure to thrive. The earlier high-risk parents become involved with such programs, the better the probable outcome for the child.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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