Nonorganic Failure To Thrive Infants Research Articles

Effects of oral zinc supplementation on zinc status and catch-up growth during the first 2 years of life in children with non-organic failure to thrive born preterm and at term

BackgroundWe aimed to analyze the effect of oral zinc supplementation on serum insulin-like growth factor-1 (IGF-1) levels and catch-up growth in infants with non-organic failure to thrive (NOFTT) who were born preterm as compared to those born at term. MethodsTotally, 105 NOFTT infants aged 2 years or less were enrolled and divided into two groups according to gestational age at birth. Oral zinc sulfate was administered for 6 months to 49/66 children born at term, and 21/39 children born preterm. Serum zinc, IGF-1, weight, and height were measured at baseline and at 6 months. ResultsThere were no differences in baseline serum zinc levels between the two groups. In preterm NOFTT infants, zinc supplementation significantly increased serum zinc levels compared to those in the non-supplementation group (Δ zinc 0–6 month 10.3 ± 26.4 μg/dL vs. −8.8 ± 23.7 μg/dL, p = 0.018), but it did not significantly change serum IGF-1 levels or weight- and height for age Z-scores. In NOFTT infants born at term who received zinc supplementation, serum zinc levels, IGF-1, weight for age Z-score, and height for age Z-score increased at 6 months (p = 0.001, p = 0.014, p = 0.049, and p = 0.029, respectively), but this increase was not significantly greater than in the non-supplementation group. Only the increase in serum zinc levels was significant after 6 months (Δ zinc 0–6 month 16.8 ± 32.0 μg/dL vs. −10.0 ± 22.6 μg/dL, p = 0.002). ConclusionZinc supplementation in NOFTT infants improves serum zinc status, regardless of gestational age at birth. Zinc supplementation in NOFTT infants born at term may improve serum IGF-1 levels and growth, but it does not in NOFTT infants born preterm. Overall nutritional support rather than supplementation of a single nutrient may be more effective for catch-up growth in NOFTT infants born preterm.

Non-Organic Failure to Thrive

Source: Ramsay M, Gisel EG, McCusker J, et al. Infant sucking ability, non-organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study. Dev Med Child Neurol. 2002;44:405–414.These investigators explored whether inefficient sucking, later feeding difficulties, and/or maternal depression contributed to non-organic failure to thrive (NFTT). Healthy term infants and their mothers were recruited from St. Mary’s Hospital in Montreal, Canada, within 24 hours of birth and were tested at 1 week of age to determine if inefficient sucking was associated with slow weight gain. Those with inefficient sucking comprised the index group (n=265), and an equal number of randomly selected infants with efficient sucking (sustained frequency, amplitude, and duration) comprised the matched control group (n=255). Both groups were retested in the home at 2, 6, 10, and 14 months of age with various combinations of the Edinburgh Postnatal Depression Scale completed by the mother, a feeding questionnaire administered by trained evaluators, an observation of infant feeding behavior, anthropometric measurements of the infant, and measurement of the infant’s suck. NFTT was defined as exhibiting 2 of the following: 1) weight loss across 2 major percentiles (n=32), 2) weight for length below 90th percentile of ideal weight (adjusted for parental height) (n=15), and 3) weight for age below 5th percentile (n=3), all in the absence of recognized organic disease. Eighteen infants were thus classified as NFTT. Inefficient sucking at 1 week did not predict later feeding difficulties, and postnatal growth was not influenced by early or concurrent maternal depression or maternal feeding practice.The data in this study did not allow an analysis of the possibility that these NFTT infants were simply adjusting their growth curve to a genetically preprogrammed lower one. The researchers were unable to demonstrate an association between early sucking efficiency and later feeding difficulties. This does not rule out a predominantly oral motor etiology for much of what is classed as NFTT; it simply demonstrates that a measure of sucking efficiency at 1 week is not sensitive to the later expression of feeding difficulties. Indeed, while 94% of infants with efficient sucking remained efficient at 2 months, only 50% of infants with inefficient sucking remained inefficient at 2 months. Perhaps this study’s failure to demonstrate any association between maternal depression and NFTT will help retire that tired presumption. The 2 etiologies for these growth patterns that would seem to be underestimated are: 1) subtle oral-motor difficulties1 and/or 2) the infants are simply following a familial growth curve. However the cookie crumbles, the infant’s failure to grow appropriately is often attributed to the mother. Perhaps this presumption should also be retired.

A Prospective Study of Family Environments of Children Hospitalized for Nonorganic Failure-to-Thrive

Family functioning of nonorganic failure-to-thrive (NOFT) infants was compared with that of physically healthy, normally growing infants of similar socioeconomic status shortly after the time of the diagnosis of this condition (average age of 5 months) and again at 4 years of age. Families of NOFT infants demonstrated less adaptive relationships than did comparison-group infants, as measured by the Family Relationships Inventory (FRI) at both time points, but a comparable number of changes in residence and constellation on follow-up. Contrary to prediction, the quality of family relationships at point of diagnosis did not predict subsequent family relationships, residence, or constellation changes in the NOFT sample. However, more adaptive family relationships in the comparison group at study entry predicted fewer residence and constellation changes and more cohesive relationships 3 years later. The impact of significant discontinuities in family functioning and status should be considered in research and in clinical interventions with NOFT children.

Behavioral Style in Failure-To-Thrive Infants: A Preliminary Communication

In a pilot inner-city survey, nine 1-year-old infants with nonorganic failure to thrive (NOFT) and pairwise matched controls from the same deprived inner-city area were studied at home. A multimethod approach to the study of infant behavioral style was adopted. A consistent pattern of NOFT infants' behaviors in mothers' descriptions, in observation of play behavior, and in interaction with the examiner during standard testing emerged. NOFT infants were found to be more fussy, demanding, and unsociable. They were also less task-oriented and persistent, and their mothers expressed more negative emotions during play interaction. Mental development was significantly delayed in NOFT infants. The findings emphasize the importance of behavioral contributions from both infant and mother to the relationship problems characteristic of NOFT.

Maternal interactional behavior with nonorganic failure-to-thrive infants: A case comparison study

Mothers of 47 6-month-old infants with early histories of nonorganic failure to thrive (NOFT) infants and a matched comparison group of physically healthy infants were observed in interactions with their infants in their homes one month following hospitalization. Mothers of NOFT infants were observed to have less adaptive social interactional behavior, less positive affective behavior, and demonstrated more arbitrary termination of feedings. No group differences were found in flexibility or sensitivity of maternal feeding, or in environmental circumstances such as number of persons present, noise level, or level of activity. These salient deficiencies in maternal interactional behavior may continue to disrupt the NOFT child's physical growth and psychological development following initial diagnosis and hospitalization. Additional studies are needed to identify patterns of maternal interactional behavior which influence psychological prognosis and to assess the responsiveness of maternal interactional behavior to intervention.

The family environment in nonorganic failure to thrive: a controlled study.

Compared 48 families of nonorganic failure to thrive (NOFT) infants with those of 52 physically healthy infants of similar demographic characteristics using the Family Environment Scale (FES). Families of NOFT infants had more problematic relationships as indicated by lower scores on the Family Relationships Inventory (FRI) components of the FES, including lower Cohesion and Expressiveness, than families of physically healthy infants. Contrary to predictions, families did not differ in level of Conflict or Organization. Families of NOFT infants had lower intellectual and Cultural Orientation. These findings suggest that problematic intrafamilial relationships are associated with NOFT and may influence the psychological outcomes of children with this condition. Studies are needed to document the effects of family functioning on the physical growth and psychosocial development of NOFT children.

Nonorganic failure to thrive in infancy: an update on nutrition, behavior, and growth.

Failure to thrive (FTT) has been defined in a number of ways, but most definitions include a weight less than the 5th percentile on the growth chart or a decreasing rate of weight gain. Nonorganic failure to thrive (NOFTT), i.e., FTT not due to organic disease, is the most common category of FTT in the United States and is associated with delayed growth and development and abnormal behaviors. Factors extrinsic to the infant are primarily responsible for NOFTT. That acute undernutrition may be a cause of the poor weight gain is suggested by anthropometric studies and by the observation that NOFTT infants often gain weight when food is supplied. Yet, decreased caloric intake has been documented in only a few infants, and not all infants immediately gain weight when given adequate calories. Current thinking attributes lack of weight gain in NOFTT to probably mixed interacting causes, including decreased nutrition, and abnormal hormonal mechanisms associated with abnormal behavior. That behavior and nutrition are related is recognized, but their interactions have not been adequately documented or explained. It is unknown whether behavior affects growth directly through nutrition or independently of nutrition. Until the cause or causes of poor growth and development in NOFTT are understood, permanently reversing the process will be difficult. This report reviews what is presently known about nutrition and growth in NOFTT.

Behavior as a Diagnostic Aid in Failure-to-Thrive

The presence of a defined set of behaviors was examined in 67 hospitalized infants, 3-24 months old; 17 with organic failure-to-thrive (OFTT), 17 with nonorganic failure-to-thrive (NOFTT), and 33 with no signs of failure-to-thrive. The usefulness of assessing these behaviors to distinguish nonorganic from organic failure-to-thrive infants was evaluated. The frequency of behaviors per infant as well as the intensity of behaviors was greater for NOFTT. The order of decreasing frequency of behaviors was similar in both OFTT and NOFTT infants. Four of the 7 most prevalent behaviors occurred significantly more frequently in NOFTT than OFTT infants. The presence of these behaviors does not rule in NOFTT or rule out OFTT. However, when a number of the behaviors are present, particularly if they occur in high intensity, and when no organic disease is found, a diagnosis of NOFTT is suggested. Response to appropriate treatment remains the most reliable confirmation of the diagnosis.

Long-Term Hospitalization of Nonorganic Failure-to-Thrive Infants

Hospitalization remains an available treatment option for nonorganic failure-to-thrive (NOFT) infants, even though it separates an infant from his/her caregiver and may further weaken an already impaired caregiver-infant attachment. Long-term hospitalization as an intervention for NOFT has been noted, but not documented, in previous reports in the literature. The present study describes patient characteristics, growth in hospital, and length of stay among a group of NOFT infants referred for and treated through long-term hospitalization. The study also investigated the effects of an additional family-oriented outpatient intervention program on hospital course and discharge planning for these infants. Results of the study found that NOFT infants referred for extended hospitalization were an impoverished group, with the majority showing below average development functioning. One-third presented with "interactional" failure-to-thrive, in which biological vulnerability coexisted with, but was not causative of, the infant's poor growth. Infants averaged 18 weeks in hospital, but lengths of stay differed, dependent on the presence of an outpatient treatment group and additional medical problems with both factors reliably associated with shorter lengths of stay. Infants in county welfare custody who did not receive additional outpatient intervention were also more likely to be placed outside the parental home at discharge.

Psychosocial assessment and care for infants hospitalized for non‐organic failure to thrive1

Abstract Patterns of psychosocial assessment and care of 30 infants hospitalized for non‐organic failure to thrive (NOFT) were studied by means of an indepth chart review. The following findings emerged: underutilization of psychosocial services, an emphasis on diagnostic assessment rather than treatment planning, and inconsistent charting of information concerning follow up and treatment following hospitalization. Findings suggest a need for a comprehensive intergration of psychosocial assessment with physical diagnosis in the hospital based care of NOFT infants. A high level of psychologist visibility and availability to the staff and active involvement with families is seen as a means of facilitating more effective assessment and treatment planning for these infants at risk. Greater attention to treatment planning and involvement of community resources for ongoing clinical intervention following the hospitalization is needed to lessen the long‐term developmental, emotional and family problems associate...