Failure to Thrive

An initial assessment is important for planning treatment and is best accomplished by a multidisciplinary team that can continue to provide long-term follow-up care to the family (Frank and Drotar 1994). A detailed review of what the child eats and drinks provides basic information. Parent-child feeding interactions and the child's feeding behavior and oral-motor skills should be evaluated. Psychosocial evaluation should include information from all of the child's caretakers (e.g., child care staff, relatives), the family, and the child. Assessment of the family environment should include the caretakers' cultural beliefs, psychological functioning, family stressors, and social supports and community resources that can be used on the child's behalf.

Intervention should be guided by the family needs identified in the evaluation. Treatment is typically multifaceted and requires good interdisciplinary and interagency collaboration (Black 1995). Parents may obtain advice about increasing calories in the child's diet. They may be given iron or zinc supplements for their child if needed. Any medical or physical problems the child has are treated. Parents may get advice about managing children's behavior during mealtime; they can often benefit from coaching around viewing videotapes of feedings. Much of the treatment can be done in the home. Referral for early intervention services may aid the child's general development. Helping families access community-based resources from government programs should be a priority with low-income families. In the United States those include the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Food Stamp program (Baer 1999). In the event of severe malnutrition or failure of intensive outpatient intervention, pediatric hospitalization may be justified. Parental mental health and substance-abuse problems usually require individual attention. In the minority of cases that involve neglect or abuse, intervention by child protective services may be necessary to protect the child's physical and developmental well-being. With comprehensive evaluation and treatment, most undernourished children improve their nutritional status, growth, and development.