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.' NW
For more information
* When Feeding Fails is available for 5.95 plus p&p from the Children's Society Publishing Department, Edward Rudolf House, Margery Street, London WC1X 0JL (0207 841 4415). It also publishes My Child Still Won't Eat which gives advice to parents.
