The Diagnostic Accuracy of In-Hospital Weight Gain for Differentiating Neglect From Other Failure to Thrive Etiologies.

OBJECTIVES: To investigate the association of in-hospital weight gain with failure to thrive (FTT) etiologies. METHODS: With this retrospective cross-sectional study, we included children <2 years of age hospitalized for FTT between 2009 and 2012 at a tertiary care children's hospital. We excluded children with a gestational age <37 weeks, intrauterine growth restriction, acute illness, or preexisting complex chronic conditions. Average daily in-hospital weight gain was categorized as (1) below average or (2) average or greater for age. χ2, Fisher's exact test, and 1-way analysis of variance tests were used to compare patient demographics, therapies, and FTT etiologies with categorical weight gain; multivariable logistic regression models tested for associations. RESULTS: There were 331 children included. The primary etiologies of FTT were neglect (30.5%), gastroesophageal reflux disease (GERD) (28.1%), child-centered feeding difficulties (22.4%), and organic pathology (19.0%). Average or greater weight gain for age had a specificity of 22.2% and positive predictive value of 33.9% for differentiating neglect from other FTT etiologies. However, sensitivity and negative predictive value were 91.1% and 85.0%, respectively. After adjusting for demographics and therapies received, neglect (P = .02) and child-centered feeding difficulties (P = .01) were more likely to have average or greater weight gain for age compared with organic pathology. Children with GERD gained similarly (P = .11) to children with organic pathology. CONCLUSIONS: In-hospital weight gain was nonspecific for differentiating neglect from other FTT etiologies. Clinicians should exercise caution when using weight gain alone to confirm neglect. Conversely, below average weight gain may be more useful in supporting GERD or organic pathologies but cannot fully rule out neglect.

A review of empirical support for differential reinforcement of alternative behavior.

Differential reinforcement of alternative behavior (DRA) is one of the most common behavior analytic interventions used to decrease unwanted behavior. We reviewed the DRA literature from the past 30 years to identify the aspects that are thoroughly researched and those that would benefit from further emphasis. We found and coded 116 empirical studies that used DRA, later grouping them into categories that met APA Division 12 Task Force criteria. We found that DRA has been successful at reducing behaviors on a continuum from relatively minor problems like prelinguistic communication to life-threatening failure to thrive. DRA with and without extinction is well established for treating destructive behavior of those with developmental disabilities, and to combat food refusal.

Growth of preterm infants with cystic periventricular leukomalacia.

Etiology of the high rates of growth failure in children with cerebral palsy (CP) remains unclear. The purpose of this study was to evaluate the relation between growth failure in preterm infants with cystic periventricular leukomalacia (CPVL) and neonatal health complications. The population consisted of all preterm infants (51) with a gestational age of <33 weeks who were admitted to the Children's Hospital of Buffalo from 1988 to 1993 and who had CPVL. Out of the 41 survivors with CPVL who were followed, 39 developed CP and 18 developed growth failure during infancy. At the time of greatest growth failure, the majority (72%) of infants had signs of undernutrition as defined by the Waterlow (1972) classification. Oral feeding impairment was the sole risk factor for the occurrence of growth failure. Undernutrition appears to be important in the occurrence of growth failure in preterm infants with CPVL and CP.

[Child abuse--diagnostic methods and therapy. Diagnosis of neglect, deprivation and psychosocial short stature--therapeutic consequences]. / Kindsmisshandlung--Wege zu Diagnose und Therapie: Diagnostik von Vernachlässigung, Deprivation und psychosozialem Minderwuchs--therapeutische Konsequenzen.

The terms child abuse, neglect and sexual abuse overlap; while child abuse, neglect and sexual abuse can often be diagnosed on the basis of somatic symptoms, deprivation and other psychological sequelae can be identified only in interviews and by observing the interaction of children with their mothers/fathers. Social difficulties are reflected in a disturbance of the mother/doctor interaction in the doctor's office. The main task of the physician is to establish contact with the family and gain the parents' trust. An important aspect is expressing appreciation of the positive characteristics and achievements of both the child and its parents. In addition, provision of concrete information and counseling can be useful.

Some educational implications for students with profound disabilities at risk for inadequate nutrition and the nontherapeutic effects of medication.

The educational relevance for students with profound disabilities of being at risk for poor nutrition and the potential problems caused by the nontherapeutic effects of some medications were examined, examples of their significance presented, some reasons for their occurrence discussed, and some suggestions for instructional personnel offered. Two classroom-based cases were included that described the resolution of a nutritional and a medication problem, including the role of the teacher and health-related personnel.

Substance abuse in adolescent mothers: strategies for diagnosis, treatment and prevention.

Adolescent drug addiction and alcohol abuse are on the rise in this country. Teenagers of all races, socioeconomic groups and both genders have become avid experimenters with a full spectrum of substances, including alcohol, marijuana, stimulants, cocaine and hallucinogens. A diagnosis of addiction requires familiarity with the normative trends of adolescent behavior, as well as deviations from these trends. Moreover, an adolescent mother with a drug addiction problem confronts the additional burden of fostering adaptive developmental patterns in her infant. Treatment techniques such as previewing, which empowers through the representation and enactment of future outcomes, have helped addicted teenage mothers relinquish drug use and adopt more mature caregiving behaviors.

Growth patterns in child abuse.

This study reports clinical details and statistical analysis of linear and body mass growth retardation in a cohort of 260 abused children. Seventy-one children (26%) showed impairment of growth for weight or height; 21 out of 92 children who spent time in foster homes showed catch-up growth whereas only 5 out of 168 never separated from their parents demonstrated improvement in height or weight centiles. Out of 11 children placed in foster care who were more than 2 SD below the mean for height, 10 demonstrated significant catch-up whereas only 4 out of 28 children who remained in their natural homes did so. Catch-up growth among children who remained at home was generally less than that which occurred in foster homes. In 17 cases diagnosis of growth impairment preceded nonaccidental injury. Growth of growth-retarded children in natural homes was poor. Because of the relationship between poor growth and other parameters of development, children who show catch-up growth in foster homes should probably not be 'rehabilitated' with their natural parents.

Non-organic failure to thrive: decision for placement and videotaped evaluations.

Infants hospitalized for non-organic failure to thrive in the first six months of life are in a life-threatening situation and are already at risk for poor bonding with mother. In light of this, the meaning and use of foster care and how this separation affects the developing mother-child relationship are the issues addressed through examination of 16 cases in which 8 of the infants were placed in foster care and 8 discharged home after the failure to thrive hospitalization. This paper examines (1) maternal histories of pregnancy, labor and delivery and the neonatal status of placed and non-placed infants; (2) the developmental and weight status of placed children; (3) the nature of the decision criteria for after-hospital care; and (4) the mother-infant relationship at initial intake in terms of mother's report of events and observations of feeding and play interactions during a videotaped assessment process. The study found that the interactions between mother and infant in those situations which required foster care were clearly more dysfunctional when compared to those in which the baby was discharged home to mother. Babies in the two groups were comparable in weight status at the time of hospitalization although babies in foster placement had slightly lower scores on the Bayley Scales. Maternal histories of pregnancy, labor, and delivery were similar for the two groups as were the birth and neonatal histories of the infants.

Non-organic failure to thrive: implications of placement through analysis of videotaped interactions.

This paper presents 6-month follow-up on a group of 16 infants hospitalized during the first months of life for non-organic failure to thrive (N-O FTT) and their mothers. Eight of these infants were placed in foster care and eight were returned home with their parents following hospitalization. The effects of placement on infant outcomes were examined through comparison of developmental scores and weight percentile changes, and the implications of foster care placements for mother-infant interactions were examined through analysis of patterns of interaction in videotaped sessions of feeding and play six months after hospital discharge. This analysis showed that (1) mothers in both groups failed to make significant progress in resolving their own emotional or psychological conflicts through treatment available; (2) weight and developmental status of the infants did not improve as expected in either group, and finally that (3) the patterns of interaction between mother and infant showed little change over time, and, regardless of placement at home or in foster care, remained concerning.