Skip to main content
Log in

Changes in psychopathology of parents of NOFT (non-organic failure to thrive) infants during treatment

  • Original Contributions
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

This clinical case-study of 50 infants suffering from NOFT (non-organic failure to thrive) and their parents supports the idea that the feeding problem is intimately related to parental disorders. We find a high rate (70%) of parental psychopathology (axis I diagnosis applying DSM-III-R) at the time of referral and a significant reduction (to 37%) during treatment of the infants and their parents. After a year only 12% of the parents were diagnosed with psychiatric disorders. In contrast personality disorders (axis II diagnosis applying DSM-III-R) show more stability and can be regarded as a trait variable, whereas the psychiatric disorders are of a more reactive nature. These conclusions may be influenced somewhat by the strictly hospital based design of our pilot study (infants and parents contacted only after clinical referral) and by inclusion only of firstborn infants. Nevertheless, they point to the psychopathology of parents as a main cause for non-organic failure to thrive. Psychopathological traits such as severe attachment behavior problems and primary bonding difficulties may have been latent and only became manifest due to the task of nurturing an infant for the first time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

FTT:

failure to thrive

NOFT:

non-organic failure to thrive

ZTT-DC:0-3:

ZERO TO THREE: Diagnostic Classification of the National Centers for Clinical Infant Programs

CI:

Cole's Index=body weight for length in % adjusted for age

References

  1. Altemeier WA, O'Connor SM, Sherrod KB, Vietze PM (1985) Prospective study for antecedents for nonorganic failure to thrive. Journal of Pediatrics 106:360–365

    Google Scholar 

  2. Bell LS, Woolston JL (1985) The relationship of weight gain and caloric intake in infants with organic and non-organic failure to thrive syndrome. Journal of the American Academy of Child Psychiatry 24:447–452

    Google Scholar 

  3. Belsky J, Vondra J (1989) Lessons from child abuse: the determinants of parenting. In: Cicchetti D, Carlson V (eds) Child Maltreatment. Theory and research on the causes and consequences of child abuse and neglect. Cambridge University Press, Cambridge

    Google Scholar 

  4. Benoit D, Zeanah C, Barton ML (1989) Maternal attachment disturbances in failure to thrive. Infant Mental Health Journal 10:185–193

    Google Scholar 

  5. Brewin CR, Andrews B, Gotlib IH (1993) Psychopathology and early experience: A reappraisal of retrospective reports. Psychological Bulletin, 113:82–98

    Google Scholar 

  6. Brinich EB, Drotar DD, Brinich PM (1989) Significance of bond security of the child to the mother for the psychological and physical development of failure to thrive children. Praxis in Kinderpsychologie und Kinderpsychiatrie, 38:70–77

    Google Scholar 

  7. Bushnell IWR, Sai F, Mullin JT (1989) Neonatal recognition of the mother's face. British Journal of Developmental Psychology 29:267–279

    Google Scholar 

  8. Chatoor I (1986) Mother-Infant/Toddler Feeding Scale. Copyright with the Children's Hospital National Medical Center, Washington, DC

    Google Scholar 

  9. Chatoor I, Dickson L, Schaeffer S, Egan J (1985) A developmental classification of feeding disorders associated with failure to thrive: Diagnosis and treatment. In: Drotar D (ed) New Directions in Failure to Thrive: Implications for Research and Practice. Plenum Press, New York

    Google Scholar 

  10. Chatoor I, Egan J, Getson P (1987) Mother-infant interactions in infantile anorexia nervosa. Journal of the American Academy of Child Adolescent Psychiatry 27:535–540

    Google Scholar 

  11. Chatoor I, Schaeffer S, Dickson L, Egan J (1984) Non-organic failure to thrive: A developmental perspective. Paediatric Annals 13:829–842

    Google Scholar 

  12. Crittenden PM (1990) Internal representational models of attachment relationships. Infant Mental Health Journal 11:259–277

    Google Scholar 

  13. Drotar D (1989) Behavioral diagnosis in nonorganic failure-to-thrive: a critique and suggested approach to psychological assessment. Journal of Developmental and Behavioral Pediatrics 10:1, 48–55

    Google Scholar 

  14. Drotar D (1991) The family context of nonorganic failure to thrive. American Journal of Orthopsychiatry 61:23–34

    Google Scholar 

  15. Drotar D, Eckerle D, Satola J, Pallotta J, Wyatt B (1990) Maternal Interactional behaviour with nonorganic failure-to-thrive infants: A case comparison study. Child Abuse and Neglect 14:41–51

    Google Scholar 

  16. Dubowitz H, Zuckerman DM, Bithoney WG, Newberger EH (1989) Child abuse and failure to thrive: Individual, familial, and environmental characteristics. Violence and Victims 4:191–201

    Google Scholar 

  17. Dunitz M, Scheer PJZ (1991) The inter-action model and relationship disturbances in early infancy. Workshop presented at the 38. Annual Meeting of the AACAP, San Francisco

  18. Dunitz M, Scheer PJZ, Kaschnitz W (1991) Interactional disturbances. Workshop at the meeting of the European Society for Child and Adolescent Psychiatry, London

  19. Emde RN (1991) The wonder of our complex enterprise-steps enabled by attachment and the effects of relationship on relationship. Journal of Infant Mental Health 12:163–172

    Google Scholar 

  20. Fischoff J, Whitten CF, Pettit MG (1971) A psychiatric study of mothers of infants with growth failure, secondary to maternal deprivation. Journal of Pediatrics 79:209–215

    Google Scholar 

  21. Freund A (1946) A psychoanalytic study of infantile feeding disturbances. Psychoanalytic Study of the Child 2:119–132

    Google Scholar 

  22. Greenspan SI, Lieberman AF (1980) Infants, mothers, and their interactions: A quantitative clinical approach to developmental assessment. In: Greenspan SJ, Pollock GH (eds) The Course of Life, Volume I: Infancy and Early Childhood (pp. 271–312). Bethesda, MD: National Institute for Mental Health

    Google Scholar 

  23. Grossmann K, Fremmer-Bonbik E, Rudolph I, Grossmann KE (1988) Maternal attachment representations as related to child-mother attachment patterns and maternal sensitivity and acceptance of her infant. In: Hinde RA (ed) Relations within families (pp. 241–260). Oxford Press, Oxford

    Google Scholar 

  24. Hanks HGI, Hobbs CJ, Seymour D, Stratton P (1988) Infants who fail to thrive: An intervention for poor feeding practices. Journal of Reproductive and Infant Psychology 6:101–111

    Google Scholar 

  25. Lachenmeyer JR, Davidovicz H (1987) Failure to thrive: A critical review. In Lahey B, Kazdin L (eds) Advances in Clinical Child Psychology. Plenum Press, New York

    Google Scholar 

  26. Lebovici S (1983) La mere, le nourisson, et le psychoanalyste: Les interactions Precoces. Le Centurion. Paidos, Paris

    Google Scholar 

  27. Lieberman AF, Birch M (1985) The etiology of failure to thrive: an interactional developmental approach. In: Drotar D (ed) New Directions in Failure to Thrive: Implications for Research and Practice. Plenum Press, New York

    Google Scholar 

  28. Lindberg R (1991) Early feeding problems in a normal population. International Journal of Eating Disorders 10:395–405

    Google Scholar 

  29. Main M, Goldwyn R (1984) Predicting rejection of her infant from the mother's representation of her own experience: Implications for the abused-abusing intergenerational cycle. Child Abuse and Neglect 8:203–217

    Google Scholar 

  30. National Center for Clinical Infant Programs (1994) ZTT-DC: ZERO TO THREE — Diagnostic Classification Manual - Washington DC: Author

    Google Scholar 

  31. Patton RG, Gardner LI (1962) Influences of family environment on growth: the syndrome of maternal deprivation. Pediatrics 30:957–962

    Google Scholar 

  32. Polan JH, Kaplan MD, Kessler DB, Shindledecker R, Newmark M, Stern DN, Ward MJ (1991) Psychopathology in mothers of children with failure to thrive. Journal of Infant Mental Health 12:55–64

    Google Scholar 

  33. Polan JH, Ward M (1994) Role of the mothers touch in failure to thrive. Journal of the American Academy of Child and Adolescent Psychiatry 33:1098–1105

    Google Scholar 

  34. Ramsay M, Gisel EG, Bounty M (1993) Non organic failure to thrive: Growth failure secondary to feeding-skills disorder. Development Medicine and Child Neurology 35:285–297

    Google Scholar 

  35. Russell A, Russell G (1989) Warmth in mother-child and father-child relationships in middle childhood. British Journal of Developmental Psychology 7:219–235

    Google Scholar 

  36. Sameroff AJ, Emde RN (1989) Relationship disturbances in early childhood. Basic Books, New York

    Google Scholar 

  37. Scheer P, Dunitz M, Kaschnitz W, Stix P (1993) Beziehungsstörungen zwischen Säuglingen und ihren nahen Bezugspersonen am Beispiel der E-Trink- und Nicht-organischen Gedeihstürung. In: Poustka F, Lehmkuhl U (eds) Psychotherapeutische und psychosomatische Grundlagen der Kinder- und Jugendpsychiatrie. (pp 213–225). Quintessenz Verlag, Frankfurt

    Google Scholar 

  38. Shapiro V, Fraiberg S, Adelson E (1976) Infant-parent psychotherapy on behalf of a child in a critical nutritional state. The Psychoanalytic Study of the Child 31:461–491

    Google Scholar 

  39. Singer LT, Song L, Hill BP, Jaffe AC (1990) Stress and depression in mothers of failure-to-thrive children. Journal of Paediatric Psychology 15:711–720

    Google Scholar 

  40. Skuse DH (1985) Nonorganic failure to thrive: a reappraisal. Archives of Diseases in Childhood 60:173–178

    Google Scholar 

  41. Skuse D, Pickles A, Wolke D, Reilly S (1994a) Postnatal growth and mental development: Evidence for a sensitive period. Journal of Child Psychology and Psychiatry 35:521–546

    Google Scholar 

  42. Skuse D, Reilly S, Wolke D (1994b) Psychosocial adversity and growth during infancy. European Journal of Clinical Nutrition 48:113–130

    Google Scholar 

  43. Skuse D, Wolke D, Reilly S (1992) Failure to thrive: Clinical and developmental aspects. In: Remschmidt H, Schmidt MH (eds) Developmental Psychopathology. Lewiston, NY: Hogrefe & Huber

    Google Scholar 

  44. Stern D (1977) The First Relationship: Infant and Mother. Fontana/Open-Books, London

    Google Scholar 

  45. Wolke D (1994) Sleeping and feeding across the lifespan. In Rutter M, Hay R (eds) Development across the lifespan. Blackwell Scientific Publications, London

    Google Scholar 

  46. Wolke D, Skuse D (1987) Home-observations of non-organic failure-to-thrive infants. Bulletin of the British Psychological Society 40:61

    Google Scholar 

  47. Woolston JL (1983) Eating disorders in infancy and early childhood. Journal of the American Academy of Child Psychiatry 22:114–121

    Google Scholar 

  48. Woolston JL (1985) Diagnostic classification: The current challenge in failure to thrive. In: Drotar D (ed) New directions in failure to thrive — Implications for research and practice (pp 225–233). Plenum Press, New York

    Google Scholar 

  49. Zeanah C, Barton ML (1988) Internal representations and parent-infant relationships. Journal of Infant Mental Health 10:135–140

    Google Scholar 

  50. Zeanah C, Benoit D, Barton M (1989) Working model of the Child Interview and manual. Providence, Rhode Island: Copyright with: Women's and Infant's Hospital

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Duniz, M., Scheer, P.J., Trojovsky, A. et al. Changes in psychopathology of parents of NOFT (non-organic failure to thrive) infants during treatment. European Child & Adolescent Psychiatry 5, 93–100 (1996). https://doi.org/10.1007/BF01989501

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01989501

Key words

Navigation