A psychosocial conceptualization of nonorganic failure to thrive

The Importance of a Multifaceted Approach in the Assessment and Treatment of Childhood Feeding Disorders

The objective of this article is to describe the use of a multifaceted approach in the assessment and treatment of a child with a severe feeding disorder in an inpatient setting. Family and ward-staff interviews, video observations, and behavioral measures were used in the assessment and treatment of a 2-year-old girl admitted to a pediatric ward with failure to thrive and was being tube fed. Causal and maintaining factors were identified and the subsequent intervention (the feeding program) combined a behavioral treatment (learning principles applied at mealtimes) and family-centered work (systematic parent training procedures). By the time of the psychological intervention, the majority of developmentally and age-appropriate feeding behavior appeared to be absent and the child only fed through a naso-gastric tube. The number and variety of feeding behaviors and the amount and variety of foods taken increased during treatment. These behaviors were maintained during the follow-up and generalized into the home environment. There was also an observed increase in the child's capacity for emotional expression. Successful outcomes can be achieved with complex feeding problems by using a multifaceted approach that places emphasis on effective transdisciplinary collaboration and the inclusion of the family in all stages of the process.

Nonorganic failure to thrive: developmental outcomes and psychosocial assessment and intervention issues

Serious growth problems, such as Nonorganic Failure to Thrive (NFTT), place an infant/toddler at significant risk for poor developmental outcomes. Evidently, an NFTT child's malnutrition and subsequent poor growth and development are accentuated by a family context of impoverishment, dysfunctional relationships, inadequate education, and a dearth of developmentally enriching experiences. The purpose of this review is to describe NFTT, to present development outcomes, and to discuss psychosocial assessment and intervention issues relevant to this developmental disability of early childhood. An ideographic approach to case conceptualization, evaluation, and treatment is suggested to achieve successful developmental outcomes and to guide research endeavors.