Failure to thrive and anorexia nervosa

Eating disorders and childbearing: concealment and consequences

The reported incidence of eating disorders has increased markedly during the past 30 years. Numerous studies have linked a spectrum of eating disorders to serious medical complications resulting in hospitalization and death. The prevalence of such disorders occurs primarily in women of adolescent and childbearing age. This article reviews the published literature alerting the practitioner to the indicators of a condition that is seldom disclosed bythe client or detected by the caregiver. Predisposing factors, behavioral theories, and reproductive outcomes are discussed to provide clear evidence of the link between eating disorders and poor pregnancy outcome. Recommendations are offered for early recognition ofa repeatedly concealed disease and for management of eating disorders during the childbearing cycle.

Offspring of women with eating disorders

OBJECTIVE

We evaluated health and development, temperament, body satisfaction, nutritional status, and mealtime interaction patterns in offspring (ages 1-4) of women with current or past anorexia and/or bulimia nervosa in comparison to control children.

METHOD

Information was gathered via maternal report and interview, health and development records, a 3 day food diary, and a videotaped lunchtime interaction.

RESULTS

Children of women with eating disorders had significantly lower birth weights and lengths than control children. There were no differences observed in childhood temperament or mothers' satisfaction with children's appearance. Mothers with eating disorders had more difficulty maintaining breastfeeding and they made significantly fewer positive comments about food and eating than control mothers during the mealtime observation.

DISCUSSION

Feeding behavior in women with eating disorders appears to be problematic from pregnancy through the toddler years and has various manifestations from low birth weight, to difficulties with breast feeding, to detached and noninteractive mealtimes. Although these factors are unlikely to cause eating disorders, they may contribute to a permissive environment in which a genetic predisposition is more likely to be expressed.

Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women

A follow-up carried out on an average 12.5 years after hospital contact of 151 patients with a former diagnosis of anorexia nervosa (AN), aimed at reproduction outcome. None of the 11 males had children. Fifty of the 140 women had given birth to a total of 86 children, which is approximately one third of the expected fertility. Involuntary childlessness was of the same size as found in the background population. The rate of prematurity among the offspring was twice the expected and perinatal lethality six times the expected. Mentally the mothers did well, both during pregnancy and the post partum period. They breast-fed their children for the same mean time as did other women, and the development of the children did not differ from that found in a background population. More women in the group of mothers than in the group of non-mothers had better scores of all-round functioning at follow-up.

Epidemiology and family characteristics of severely-abused children

Severe child abuse in north-east Wiltshire was studied retrospectively during the period 1965-71, and prospectively for 18 months from January 1972, after a period of consultative activity with those actively involved to increase awareness of the phenomenon. Severe abuse was strictly defined. A rate of 1 per thousand children under four years old was obtained, together with a death rate of 0-1 per thousand. The families of the retrospective series of abused children were studied in detail and identifying characteristics of large family size, youthfulness, low social-class, instability, and gross psychiatric, medical, and social pathology described. The implications of the ascertainment and death rates are discussed in relation to data from some other studies, and the need emphasized for detailed studies of the apparent clustering of disorder in the families, using linked record systems.

134 battered children: a medical and psychological study

A controlled investigation of 134 battered children showed that nearly half had serious injuries and 21 died. Sixty-five had been battered more than once, 20 had permanent neurological sequelae, a quarter were low birth weight babies, and 10 had serious congenital defects. Twenty-three had been previously admitted to hospital with failure to thrive and the overlap with physical neglect was considerable. Mortality and morbidity among their siblings was also high. Difficulties with the child were attributable to interaction with neurotic mothers.The risk of battering diminishes after a child's second birthday. The establishment of specialized hospital teams to tackle the overall problem is suggested as a method of improving management. Prevention may lie in educating mothers in the basic physical and psychological requirements of children and overcoming their reluctance to avail themselves of medical care.

Parents of battered babies: a controlled study

A controlled investigation of 214 parents of battered babies shows that they were young and predominantly of lower social class. Premature parenthood is an associated feature. Among the mothers 76% had an abnormal personality and 48% were neurotic. Nearly half were of borderline or subnormal intelligence; 11% had a criminal record. Of the fathers 64% had an abnormal personality, more than half being psychopaths. Twenty-nine per cent. had a criminal record. Recidivism is an associated feature.The risk of battering possibly diminishes with time. The teaching of appropriate child-rearing skills, symptomatic relief, and social relearning are suggested as realistically based treatment methods and should be combined with a care order. When response to treatment appears unlikely permanent removal from parental care should be considered.