Failure to Thrive Ann Brandner, MSW, LISW Judy Wood, LSW Children's Hospital Medical Center Cincinnati, Ohio

Robert A Shapiro, MD, Patricia A. Myers, MSW 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

Robert A Shapiro, MD, Patricia A. Myers, MSW Neglect: Family Characteristics Mothers 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

Robert A Shapiro, MD, Patricia A. Myers, MSW Neglect: Family Characteristics Fathers Unavailable or unsupportive May be emotionally detached Controlling or abusive Poor parenting skills

Robert A Shapiro, MD, Patricia A. Myers, MSW Neglect: Family Characteristics Child 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

Robert A Shapiro, MD, Patricia A. Myers, MSW Neglect: Family Characteristics Family 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

Robert A Shapiro, MD, Patricia A. Myers, MSW Neglect: Family Characteristics Environment Poverty is the greatest risk factor Lack of resources –food –housing –health care

Robert A Shapiro, MD, Patricia A. Myers, MSW 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

Robert A Shapiro, MD, Patricia A. Myers, MSW 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)

Robert A Shapiro, MD, Patricia A. Myers, MSW Deliberate Starvation Usually an older child Confined to room Not fed May also be physically abused

Robert A Shapiro, MD, Patricia A. Myers, MSW Identification of FTT Diagnosis at well child visit or ED PHN high risk follow-up visits Abuse/neglect investigations

Robert A Shapiro, MD, Patricia A. Myers, MSW 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

Robert A Shapiro, MD, Patricia A. Myers, MSW Social Worker’s Role in Assessment Psychosocial 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 child’s development Assess physical environment Observe parent-child interaction Identify strengths Assess risk factors

Robert A Shapiro, MD, Patricia A. Myers, MSW Social Worker’s Role in Assessment Management 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

Robert A Shapiro, MD, Patricia A. Myers, MSW 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

Robert A Shapiro, MD, Patricia A. Myers, MSW 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

Robert A Shapiro, MD, Patricia A. Myers, MSW Barton Schmitt, M.D. 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 doesn’t visit or cannot learn

Robert A Shapiro, MD, Patricia A. Myers, MSW Treatment Parent can demonstrate care of child Economic resources Consistent medical follow up Support Parent education Therapy Developmental stimulation