Faltering growth is a condition that can affect children in any family. Maggie Jones looks at ways to deal with this frustrating problem
Rather than a sinister condition confined to the poorest or most negligent families, 'faltering growth' - formerly known as 'failure to thrive' - is in fact a common condition of childhood that could occur in any home.
One in 20 children aged under five develop distressing feeding problems and do not grow at the expected rate, and evidence now suggests that faltering growth occurs in all socio-economic groups. In only a tiny per- centage of cases is there emotional or physical abuse or neglect, and in only 5 per cent of cases is there an organic cause.
New research by the Children's Society shows that many children with faltering growth undergo medical tests, which are usually inconclusive. The babies or children are also frequently admitted to hospital, which causes more stress and worry for child and parents alike without resolving the problem. Often parents lose confidence in themselves and suffer feelings of guilt and failure, and the feeding problems get worse.
The Children's Society report, When Feeding Fails, looks at the experiences of 30 parents caring for a child with faltering growth. It also includes findings from a survey of 500 health visitors. The report shows that:
- 64 per cent of health visitors have infants with faltering growth on their casebooks.
- All parents reported feelings of total frustration.
- Several parents resorted to force-feeding their babies.
- Many parents wished health professionals could have spent more time with them.
- 18 of the 30 children had medical tests to identify reasons for their faltering growth, without result.
- Ten children were admitted to hospital because of concerns about their weight loss.
- 21 of the 30 families said they were unhappy about the services provided and the lack of support from health professionals.
So what is going on when a child experiences faltering growth? How can families be helped? Almost invariably, feeding problems took the parents in When Feeding Fails by surprise. In over a third of the cases, it was a second child who had problems and the parents reported that they had not experienced any problems with their first child. Some babies were difficult to feed from the beginning, refusing breast or bottle, or taking hours over feeds. For others, problems occurred at weaning, with the child showing a dislike of solids, or a dislike of lumpy foods. When the child's weight gain faltered, and health professionals advised the parents to give their children more calories, the parents often panicked, going to greater and greater lengths to make their child eat. This often created more feeding problems.
The Children's Society research put in place a package of enhanced home visits to talk to the families and help them develop new strategies for feeding their children.
Case studies from the report show how problems are tackled (see below).
No single cause
Angela Underdown, the author of the Children's Society report, says that it is important not to look for one single cause of faltering growth. 'Parents usually rack their brains for a reason for their child's feeding difficulties.
In some cases the baby may develop feeding problems after being born prematurely or having been fed through a naso-gastric tube. Sometimes the baby may have been ill at the time of weaning.
'More often, however, what happens is that the child doesn't take to food readily, the parents become anxious, and a vicious circle is set up in which the parents are constantly trying to feed the child and the child resists more strongly. It is by breaking into this cycle and offering new strategies that health professionals can best help.'
Angela Underdown is adamant that there should still be medical investigations to eliminate the possibility that there is an organic cause preventing the child's feeding.
'However, if we started to help the parents with different strategies for feeding their child, many of these feeding problems would have resolved themselves during the time it takes for a child to be referred for the medical tests.'
Case studies: Charlotte and Alex
Charlotte
Charlotte was six months old when she began to show an obvious dislike of food.
She would move her head from side to side, turning away from the food.
Mealtimes were stressful and upsetting for Charlotte and her parents, Sue and Mike. She would only breast-feed, and always rejected solid foods and other fluids. Charlotte stopped gaining weight and dipped below the expected weight curve.
By this time, Sue and Mike were exhausted and extremely concerned. They contacted numerous health professionals to find out why their daughter wasn't eating, but didn't feel that anyone understood the problem. 'They just said that Charlotte wouldn't starve herself to death. It was like coming up against a brick wall,' says Sue.
At 16 months, Charlotte was referred to the Children's Society's Feeding Matters Project. A practitioner visited the family's home and, following a period of listening, observation and assessment, a programme of health and support for the family was agreed.
The first step was to increase the calorie content of food and drink offered to Charlotte without at first increasing the quantity. Her parents were encouraged to establish a meal and snack routine for Charlotte to help her distinguish between mealtimes and playtimes and to send out clear messages to her about eating - for example, not to give her lots of attention for refusing to eat, but to praise her when she did take food.
This programme worked. 'We enjoy mealtimes now, and our lives have changed dramatically. We no longer worry about Charlotte's eating - mealtimes aren't a battle anymore,' says Sue.
Alex
Alex's feeding problem was even more stressful. At 11 months, he was so underweight that it was affecting his development, and he could only just sit up. Sometimes Alex coughed while being fed, and after the meal he would vomit.
His father no longer fed him because he would get very upset. Mealtimes were lasting up to an hour and a quarter. Alex's parents, Jim and Samantha, were very stressed and feared that he would be 'taken away'.
Alex's parents were encouraged to keep a diary of what he ate and mealtimes were videoed so that they could see what was happening. The Feeding Matters worker showed Jim and Samantha ways to encourage Alex to eat and drink, such as not leaving food and drink around while he was playing. Alex got used to a mealtime routine of three main meals a day with a morning and afternoon snack at regular intervals. After six weeks, Alex had begun to feed himself and his development was beginning to catch up.
Strategies to encourage eating
- Avoid distractions that prevent the child from concentrating on their food - for example, turn the TV off, don't try to play with the child at mealtimes, and don't leave food around while the child is playing.
- Don't give the child attention for not eating.
- Praise the child when they do eat.
- Eat at the same time as the child - it helps if the family sit down and eat together.
- Keep mealtimes regular, and cut down on snacks between meals.
- Give high calorie foods if the child eats small quantities.
- Give small portions and then offer more, rather than alarming the child with a huge plateful of food.
