What is the role of family interventions in the treatment of pediatric growth failure (failure to thrive)?

Updated: Nov 05, 2018
  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD  more...
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Answer

Provide support for the caregiver and offer suggestions for improving the feeding environment, such as the following:

  • Avoid blaming the caregiver.

  • Provide respite for the caregiver.

  • Avoid distractions, such as television, at meal time.

  • Offer a role model for the caregivers.

Psychosocial evaluation must be detailed and must provide an in-depth look at the functioning of the family and the child in the context of the family. Many impoverished and/or uneducated parents have children with growth failure; however, many have children with normal growth. The background of the parents and their attitudes and beliefs about child rearing may affect how their children are fed and how they grow. An appropriate beginning for this inquiry is to ask family members about their perception of the child's growth failure and medical condition. Inquire about the caregivers' level of concern and note whether it is discordant with the clinician's level of concern. Often, a disturbance in bonding may be obvious, but signs of problems with attachment can also be subtle. Note whether caregivers are changed or substituted frequently at feeding times. Current and past social history of the family, at a minimum, should address the following:

  • Finances and resources, living and childcare arrangements

  • Abuse and neglect risk factors, including any physical or sexual abuse

  • Domestic or interpersonal violence

  • Substance abuse or addiction

  • Mental health disorder, particularly depression and postpartum depression

  • Eating disorder


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