Primary Prevention of Failure to Thrive: Social Policy Implications

  • Deborah A. Frank
  • Deborah Allen
  • J. Larry Brown


Although FTT occurs in children of all social classes, researchers have consistently noted that clinical populations of children with FTT are drawn disproportionately from low income families (Evans, Reinhart & Succop, 1972; Glaser, Heagarty, Bullard & Pivchik, 1968; Mitchell, Gorrell & Greenberg, 1980; Pollitt, 1975; Shaheen, Alexander, Truskowsky & Barbero, 1968). The mechanisms which link poverty to growth failure in childhood are varied and complex; biology, psychopathology, and prevailing socioeconomic conditions interact to produce FTT. The biologic sequelae of poverty begin prenatally. Low income mothers are at increased risk of bearing low birthweight infants (MacMahon, Kover & Feldman, 1972), infants who constitute 10–40% of reported clinical series of children later hospitalized with FTT (Mitchell et al. 1980; Shaheen et al. 1968; Oates & Yu, 1971), but only 7% of all newborns. Children reared in poverty bear an increased burden of post-natally acquired illnesses, any one of which may interfere with growth (Holmes, Hassanein, Miller, 1983). Finally, the Preschool Nutrition Survey (Owen et al., 1974), the Ten State Nutrition Survey (Garn & Clark, 1975), and the Health and Nutrition Examination Surveys (U.S. Department of Health Education and Welfare, 1975) all link poverty to the primary biologic risk for FTT - diets of inadequate quality and quantity (Goldbloom, 1982).


Food Stamp Food Stamp Program Nutritional Deprivation General Account Office Emergency Food 
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  1. Amidei, N. Hunger in the Eighties: A Primer. Washington, D.C.:Food and Research Action Center, 1984.Google Scholar
  2. Ashem, B., Jones, M. Deleterious effects of chronic undernutrition on cognitive abilities. Journal of Child Psychology and Psychiatry, 1978, 19, 23–31.PubMedCrossRefGoogle Scholar
  3. Barrett, D., Radke-Yarrow, M., Klein, R.E. Chronic malnutrition and child behavior: Effects of early caloric supplementation on social and emotional functioning at school age. Developmental Psychology, 1982, 18, 541–556.Google Scholar
  4. Bowden, D.L., Palmer, J.L. Social policy: Challenging the welfare state. In The Reagan Record. Cambridge, MA: Ballinger, 1984.Google Scholar
  5. Brodkin, E.Z. The Error of Their Ways: Reforming Welfare Administration Through Quality Control (unpublished doctoral thesis). Massachusetts Institute of Technology, 1983.Google Scholar
  6. Casey, T. The In-human Resources Administration’s Churning Campaign. New York: Community Action Legal Services, 1983.Google Scholar
  7. Center on Budget and Policy Priorities. Falling Behind: A Report on How Blacks have Fared under the Reagan Policies. Washington, D.C., 1984.Google Scholar
  8. Children’s Defense Fund. American Children in Poverty. Washington, D.C., 1984Google Scholar
  9. Children’s Defense Fund. A Children’s Defense Budget: An Analysis of the President’s FY 85 Budget and Children. Washington, D.C., 1984.Google Scholar
  10. Citizens’ Commission on Hunger in New England. American Hunger Crisis: Poverty and Health in New England. Boston: Harvard University School of Public Health, 1984.Google Scholar
  11. Congressional Research Service. Background Material on Poverty. Washington, D.C.: United State House of Representatives Committee on Ways and Means: Subcommittee on Public Assistance and Unemployment Compensation, 1984.Google Scholar
  12. Council on Food and Nutrition. Malnutrition and hunger in the United States. Journal of the American Medical Association, 1970, 213, 272–275.Google Scholar
  13. Cravioto, J., Delicardie E. Nutrition, mental development, and learning. In F. Falkner & J Tanner (Eds.) Human Growth: Neurobiology and Nutrition. New York: Plenum Press, 1979.Google Scholar
  14. Edwards, L.N., Grossman, M. The relationship between children’s health and intellectual development. In Health: What is it worth? Measure of Health Benefits. Pergamon Policy Studies. New York: Pergamon Press, 1980.Google Scholar
  15. Evans, D., Hanson, J., Moodie, A., Van Der Spuy, H. Intellectual development and nutrition. Journal of Pediatrics, 1980, 97, 358–363.PubMedCrossRefGoogle Scholar
  16. Evans, S., Reinhart, J.B., Succop, R.A. Failure to thrive: A study of 45 children and their families. Journal of the American Academy of Child Psychiatry, 1972, 2, 440–459.CrossRefGoogle Scholar
  17. Federal Register. 4-19-84, 49, 77, 15590.Google Scholar
  18. Food Research and Action Center. Bitter Harvest: A Status Report on the Need for Emergency Food Assistance in America. Washington, D.C., 1984.Google Scholar
  19. Fraiberg, S. Clinical Studies in Infant Mental Health: The First Year of Life. New York: Basic Books, 1980.Google Scholar
  20. Freeman, H.E., Klein, R.E., Kagan, J., Yarbrough, C. Relations between nutrition and cognition in rural Guatemala. American Journal of Public Health, 1977, 67, 233–239.PubMedCrossRefGoogle Scholar
  21. Galler, J., Ramsey, F., Solimano, G., Lowell, W. The influence of early malnutrition on subsequent behavioral development. I. Degree of impairment in intellectual performance. Journal of the American Academy of Child Psychiatry, 1983, 22, 8–15.PubMedCrossRefGoogle Scholar
  22. Galler, J., Ramsey, F., Solimano, G., Lowell, W. The influence of early malnutrition on subsequent behavioral development. II. Classroom behavior. Journal of the American Academy of Child Psychiatry, 1983b, 22, 16–22.PubMedCrossRefGoogle Scholar
  23. Garn, S.M., Clark, D.C. Nutrition, growth, development, and maturation: Findings of the Ten State Nutrition Survey 1968-1970. Pediatrics, 1975, 56, 306–319.PubMedGoogle Scholar
  24. General Accounting Office. An Evaluation of the 1981 AFDC Changes: Initial Analyses. Washington, D.C., 1984.Google Scholar
  25. Glaser, H., Heagarty, M., Bullard, D., Pivchik, E. Physical and psychological development of children with early failure to thrive. Pediatrics, 1968, 73, 790–798.Google Scholar
  26. Goldbloom, R.B. Failure to thrive. Pediatric Clinics of North America, 1982, 29, 151–165.PubMedGoogle Scholar
  27. Graitcer, P.L., Gentry, E.M. Measuring children: One reference for all. The Lancet, 1981, 2, 297–299.CrossRefGoogle Scholar
  28. Grantham-McGregor, S., Schofield, W., Harris, L. Effect of psychosocial stimulation on mental development of severely malnourished children: An interim report. Pediatrics, 1983, 72, 239–243.PubMedGoogle Scholar
  29. Habicht, J.-P., Yarbrough, C., Martorell, R., Malina, R., Klein, R. Height and weight standards for preschool children: How relevant are ethnic differences to growth potential? The Lancet, 1974, 1, 611–614.Google Scholar
  30. Herrera, M., Mora, J., Christiansen, N., Ortiz, N., Clement, J., Vuori, L., Waber, D., De Paredes, B., Wagner, M. Effects of nutritional supplementation and early education: Physical and cognitive development. In R. Turner & F. Reese (Eds.), Life-Span Developmental Psychology. New York: Academic Press, 1980.Google Scholar
  31. Hicks, L.E., Langham, R.A., Takenaka, J. Cognitive and health measures following early nutritional supplementation: A sibling study. American Journal of Public Health, 1982, 72, 1110–1118.PubMedCrossRefGoogle Scholar
  32. Holmes, G.E., Hassanein, K.M., Miller, H.C. Factors associated with infections among breast-fed babies and babies fed proprietary milks. Pediatrics, 1983, 72, 300–306.PubMedGoogle Scholar
  33. Hoorweg, J., Stanfield, J. The effects of protein energy malnutrition in early childhood on intellectual and motor abilities in later childhood and adolescence. Developmental Medicine and Child Neurology, 1976, 18, 330–350.PubMedCrossRefGoogle Scholar
  34. Institute for Research on Poverty. Poverty in the United States: Where do we stand now? In Focus. Madison,WI: University of Wisconsin, 1984.Google Scholar
  35. Johnson, N. Testimony before Citizens’ Commission on Hunger in New England, October 31, 1983 by Director of Boston Food Bank, 1983.Google Scholar
  36. Lacey, K.A., Parkin, J.M. The normal short child: Community study of children in Newcastle-upon-Tyne. Archives of Diseases of Childhood, 1974, 49, 417–424.CrossRefGoogle Scholar
  37. Lasky, R.E., Klein, R.E., Yarbrough, C., Engle, P.L., Lechtig, A., Martorell, R., The relationship between physical growth and infant development in rural Guatemala. Child Development, 1981, 52, 219–226.PubMedCrossRefGoogle Scholar
  38. Lattimer, A. Testimony Before House Agricultural Committee, Subcommittee on Nutrition, October 20, 1983.Google Scholar
  39. Los Angeles Times. Gallup Poll: Poor Families. January, 1984.Google Scholar
  40. MacMahon, В., Kover, M.G., Feldman, J.J. Infant Mortality Rate: Socioeconomic Factors. U.S. Department of Health, Education and Welfare, Publication No. HSM 72-1045. Washington, D.C.: National Center for Health Statistics, March, 1972.Google Scholar
  41. Mahaffey, K.R., Annest, J.L., Roberts, J., Murphy, R.S. National estimates of blood lead levels: United States, 1976–1980 Associated with selected demographic and socioeconomic factors. New England Journal of Medicine, 1982, 307, 573–579.Google Scholar
  42. Maslow, A. Toward a Psychology of Being. Princeton, NJ: Van Nostrand, 1968.Google Scholar
  43. Massachusetts Department of Public Health. Preliminary Findings. Boston, MA: Boston Department of Health and Hospitals, 1984.Google Scholar
  44. Massachusetts Department of Publ ic Health, Division of Family Health Services. 1983 Massachusetts Nutrition Survey. Boston, MA, 1983.Google Scholar
  45. McKay, H., Sinisterra, L., McKay, L., Gomez, H., Lloreda, P. Improving cognitive ability in chronically deprived children. Science, 1978, 200, 270–277.PubMedCrossRefGoogle Scholar
  46. McLaren, D.S., Yatkin, U.S., Kanawati, A., Saggagh, S., Kadi, Z. The subsequent mental and physical development of rehabilitated marasmic infants. Journal of Mental Deficiency Research, 1973, 17, 273–281.PubMedGoogle Scholar
  47. Mitchell, W.G., Gorrell, R.W., Greenberg, R.A. Failure to thrive: A study in a primary care setting: Epidemiology and follow-up. Pediatrics, 1980, 65, 971–977.PubMedGoogle Scholar
  48. Moon, M., Sawhill, I.V. Family incomes: Gainers and losers. In The Reagan Record. Cambridge, MA: Ballinger, 1984.Google Scholar
  49. National Center for Health Statistics. Monthly Vital Statistics Report. October 5, 1983,31,13; September 21, 1984, 32, 13.Google Scholar
  50. Oates, R.K., Yu, J. Children with non-organic failure to thrive. A community problem. Medical Journal of Australia, 1971, 2, 194–203.Google Scholar
  51. Oatis, P., Bobo, R., Herman, D. Nutritional status of hospitalized children (Effect of socioeconomic status). Pediatric Research, 1982, 4, 583.Google Scholar
  52. Owen, G.M., Kram, K.M., Garry, P.F., Lowe, J.E., Lubin, A.H. A study of nutritional status of preschool children in the U.S. 1968–1970. Pediatrics, 1974, 53, 597–646.PubMedGoogle Scholar
  53. Peterkin, В., Kerr, R.L., Hama, M.Y. Nutritional adequacy of diets of low income households. Journal of Nutrition and Education, 1982, 14 (3), 102.Google Scholar
  54. Pollitt, E. Failure to thrive: Socioeconomic, dietary intake, and mother-child interaction data. Federation Proceedings, 1975 34, 1593–1597.PubMedGoogle Scholar
  55. Public Interest Health Consortiums for New York City. Prenatal health care in New York City. City Health Report, 1984, 1.Google Scholar
  56. Ramsey, J. Personal Communication, Director, Second Harvest National Food Bank Network, September 1984.Google Scholar
  57. Salvation Army, Regional Statisticians: Eastern, Central, Southern, Western Territories. Personal Communications, September 1984.Google Scholar
  58. Sameroff, A., Chandler, M.J. Reproductive risk and the continuum of caretaking casualty. In P.D. Horwitz (Ed.), Review of Child Development Research. Chicago, IL: University of Chicago Press, 1978.Google Scholar
  59. Shaheen, E., Alexander, E., Truskowsky, M., Barbero, G.J. Failure to thrive - A retrospective profile. Clinical Pediatrics, 1968, 7, 225–261.CrossRefGoogle Scholar
  60. Smeeding, T. Is the safety net still intact? In D.L. Bowden (Ed.), The Social Contract Revisited: Aims and Outcomes of President Reagan1s Social Welfare Policy. Washington, D.C.: The Urban Institute Press, 1984.Google Scholar
  61. Spivak, H. Unpublished Data, 1983.Google Scholar
  62. Suskind, R.M. Malnutrition and the immune response. In R.M. Suskind (Ed.), Textbook of Pediatric Nutrition. New York: Raven Press, 1981.Google Scholar
  63. Trowbridge, F.L. Prevalence of growth stunting and obesity: Pediatric nutrition surveillance system. Mortality and Morbidity Weekly Report, 1984, 32 (55), 23–26SS.Google Scholar
  64. U.S. Department of Agricultural Research Service, Consumer and Food Economics Research Division. Family Food Plans Revised, 1964. Washington, D.C., 1969.Google Scholar
  65. U.S. Department of Commerce, Bureau of the Census. Estimates of Poverty Including the Value of Noncash Benefits: 1979–1982. Washington, D.C., 1984.Google Scholar
  66. U.S. Department of Commerce, Bureau of the Census. Estimates of Poverty Including the value of Noncash Benefits: 1983. Washington, D.C., 1984.Google Scholar
  67. U.S. Department of Health, Education, and Welfare. Preliminary Findings of the First Health and Nutrition Examination Survey, United States, 1971–1972: Dietary and Biochemical Findings. HRA 74-1219-1, Washington, D.C., 1975.Google Scholar
  68. U.S. Department of Health and Human Services. Dietary Intake Source Data: United States (1976-1980). Vital Health Statistics. 2, 231, PHS 83-1681, Washington, D.C., 1983.Google Scholar
  69. U.S. Department of Health and Human Services. Hematological and Nutritional Biochemistry Reference Data for Persons 6 Months - 74 Years of Age: United States 1976–1980. 2, 32, PHS 83-1682, Washington, D.C., 1982.Google Scholar
  70. U.S. Department of Labor. The Employment Situation, July, 1984. Washington, D.C., 1984.Google Scholar
  71. Waterlow, J.C. Classification and definition of protein-calorie malnutrition. British Medical Journal, 1972, 3, 566–569.PubMedCrossRefGoogle Scholar
  72. Worthington-Roberts, В., Vermeersch, J., Williams, S.R. Nutrition in Pregnancy and Lactation. St. Louis, MO: C.V. Mosby, 1981.Google Scholar

Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • Deborah A. Frank
    • 1
    • 2
    • 3
  • Deborah Allen
    • 1
    • 2
    • 3
  • J. Larry Brown
    • 1
    • 2
    • 3
  1. 1.Grow Team, Boston City Hospital, Department of PediatricsBoston University School of MedicineUSA
  2. 2.Community Health Improvement ProgramHarvard University School of Public HealthUSA
  3. 3.Physician Task Force on Hunger in AmericaHarvard University School of Public HealthUSA

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