Failure to thrive
2009 © International Institute of Anthropology, Salt Lake City, Utah, USA
2009 © Lolita Nikolova, PhD
Created: 06-03-09
2009 © Lolita Nikolova, PhD
Created: 06-03-09
Case study submitted by Kelly Mcdonald for a group project at the Argosy University
Infants and toddlers: Sarah
Sarah is 13 months old. She was severely neglected by her mother and is
believed to have been physically abused. She was diagnosed as "failure to thrive"
at two months old, but went home under protective supervision. She was again
placed in foster care at 11 months, when her mother was hospitalized for heroin
addiction.
Sarah is very quiet most of the time. She does not coo or babble. She seems to
prefer to be left alone. When she does cry, she is very difficult to comfort. When
placed in her crib she often will rock herself to sleep. She bangs her head on the
mattress.
Sarah cannot stand, even if supported. Her legs are not strong enough to bear her
weight. She began to crawl at 12 months, but does so with great difficulty, and
does not move around a room very much. If placed in a sitting position, she will
often remain there, immobile, for up to an hour at a time.
Sarah does not look into people's eyes. She appears to be uninterested in her
surroundings. She does not hold toys in her hands or appear interested in playing
with toys.
Sarah can finger-feed herself Cheerios (cereal) and take sips of milk from a cup.
She has frequent digestive upsets and vomits almost every day.
Source: Placement, Module IV: Effects of Abuse and Neglect on Child
Development - Revised June, 2001. Prepared for the Ohio Child Welfare Training
Program by the Institute for Human Services.
Synopsis
"failure to thrive" - two months old
quit, no coo or babble, left alone, cry, rock to sleep, banging the head, cannot
stand, crawling 12 months old (not move around much), in a sitting position
immobile up to an hour, not look into people's eyes, disinterested, no interest in
toys, finger-feed, frequent digestive upsets and vomits
Theories to explain the problem
References:
Allbritten, B. (1998). Theories of Human Behavior.
http://campus.murraystate.edu/academic/faculty/rose.bogal/courses/Theories%
20of%20Human%20Behavior/index.htm
Failure to thrive (online). Last visited June 26th, 2009. http://kidshealth.
org/parent/food/weight/failure_thrive.html#
Harder, A.F. (2002). Erik Erikson's Stages Recognize Life as Opportunities to
Grow. http://www.childhoodaffirmations.com/general/parenting/erikson.html
Explanation theories (two theories should be selected according to the
assignment)
1 Framework of the problem.
Failure to thrive is a general diagnosis with different possible causes, the main
syndrome of which is the failure to gain weight and poor height growth
respectively.
In our cases the main cause is malnutrition, as a result of which the children “don't
receive or are unable to take in, retain, or utilize the calories needed to gain weight
and grow as expected” (Failure to thrive). This diagnosis completely explains the
condition of Sarah since there are most of the syndromes: Sarah is disinterested
in the surrounding, she avoids eye contact, she cannot stand since her legs are
not strong enough, she avoids contact with people, irritable, etc.
Failure to thrive explains only generally the condition of Sarah. Essential is that she
was diagnosed with “failure to thrive” at 2 months, although returned to her mother
and taken away at 11 month. As it is known “after birth, a child's brain grows as
much in the first year as it will grow during the rest of life” (Failure to thrive), so poor
nutrition could cause permanent negative effects on mental development. Of the
series of factors that cause failure to thrive (a chronic illness, an intolerance of milk
protein, infections, etc.), in Sarah’s case the main is the social factor – the
negligence and presumed abusive behavior of her mother.
Failure to thrive diagnosis helps to understand that Sarah needs a complex care –
from physical doctors to occupational and speech therapist, psychologist and
social workers in order to turn to successful feeding and social behavior. There is
a danger of chronic illness and disorder, so Sarah should be monitored regularly
because of the possible damage of her brain and chronic diseases that could
have long-life effect. Such children need a special social environment, so placing
at foster care at her 13th month means periodical consultation with her foster
parents about Sarah’s mental and physical condition and a development of a
special program for her socialization in environment with children that would not
cause addition stress and at school with all equipment of special education.
The condition of Sarah relates to a series of problems: child abuse, possible
chronic illness, depression, developmental disability, etc.
Of the numerous human behavior theories (see for example Allbritten 1998) we
chose two: psychosocial theory and cognitive development theory since failure to
thrive condition relates directly to possible life-long damage of brain and
development of mental disability.
2. Theories
2.1. Psychosocial theory
According to this theory, the human development is a product of “the interaction
between individual needs and abilities and societal needs and demands”. It
focuses on “stages of development and psychosocial crisis” (Allbritten 1998).
Harder (2002) explains the stages of development (after Erickson) that helps to
understand Sarah’s life-long problems from the first to the eight stage.
The first stage (Oral Sensory stage) (birth to 18th month) emphasizes on the
mother’s positive and loving care of the child, which failure to experience may end
with “deep-seated feeling of worthlessness and a mistrust of the world in general”
(Harder 2002). Since Sarah was given to foster parents at 13th month old, if her
health problems were resolved, there was opportunity by age 2 she to have
developed the basic belief about the world as trustworthy and respectively the
further normal interaction with world.
The theory is worth since helps to understand the main needs of the small child
and to direct it toward normal human development. At the same time it itself is less
helpful if Sarah had suffered from life-long brain damage, so it is unclear at age 13
whether Sarah would be able to go normally through the other stages according to
Erickson classification.
2.2. Cognitive development theory
This theory focuses on how a person organizes and makes meaning of
experience and the understanding of “knowing” as a product of continuous
interaction between the person and the environment. It is based on three basic
concepts – scheme, adaptation and stages of development that means
organization, modification and diachronic integration (Allbritten 1998). There are
four stages of development of the individual:
Sensorimotor intelligence (birth to 18 months)
Preoperational thought (18 months to 5/6 years)
Concrete operational thought (6/7 years to 11/12 year)
Formal operational thought (adolescence to adulthood)
This theory helps to understand the damages on Sarah in her earliest childhood
and their long-life consequences.
During the stage of sensorimotor intelligence the child forms concepts through
direct investigation of environment. Because of failure to thrive condition, Sarah
would not developed in direction of optimal cognitive interaction with environment.
This condition would reflect on the next stage when she would possibly have
problems with development of skills like imitation, creating mental images,
symbolic drawing, symbolic play and language. During the third stage Sarah
presumably should develop ability to solve problems tied to physical reality, and to
achieve three conceptual skills – conservation (identity, reversibility, reciprocity),
classification (size, shape, color) and combinatorial skills (ability to manipulate
numbers in addition, subtraction, multiplication and division). During the formal
operational thought the individual conceptualizes about many simultaneously
interacting variables and becomes “somewhat egocentric”.
Because of the possible severe damage of the brain it is unclear whether Sarah
would develop any of the skills presumed for the third stage and for the four stage.
2.3. Sufficiency and values of the theories
Since we have a case of complex, physical and mental, damage on the child, both
theories only partially help to understand the situation and to help. Sarah’s
treatment needs not only psychological therapist but also regular monitoring by
doctors for her physical development and especially for her brain development. At
the same time, both theories extremely help for monitoring eventual mental
disorder at early or later stage of development of Sarah and helping her in her
enculturation and socialization.
2.4 Practical values of the theories
If Sarah’s foster parents are able to fix the physical health of Sarah and there are
no fatal damages of her brain, the multiscale work of the psychotherapist may help
her by age 2 she to gain the abilities of all normally developed children.
Working with the child could return the joy of play with toys and development of
an attachment feeling to her foster parents by stressing of the foster mother’s love
to her and verbalizing how important is her mother Sarah to feel happy and save.
Work with the foster parents would help to explain them their role to make the
child trustful the life and to understand that being positively emotional with the child
helps Sarah to gain basic confidence in the future life which is one of the most
important abilities in her individual life. Monitoring the condition of Sarah through
contact with foster parents also would help to understand whether she develop the
future quality depending on the age (self-control, courage, will, etc.) during the
second stage when the relation with the parents are the most important since they
become micromodel of social relationships. We may guess that such regular
contact with the parents would be helpful for the other stages till her 18th age bur
will depend of the recovering from the initial damages during her 1st year. If the
child develops normally, the therapist would help in modeling non-conflict
relationships between the growing child and parents because of presumably
fragile physical and mental health.
At level of social group and community, the socialization of Sarah depends
completely on her physical and mental states. If she recovers from failure to thrive
by age 2, she probably would be able to attend kinder garden and to be integrated
into the educational system, which embodies the knowledge from the different
human behavior theories. If she develops as a disable child, then her socialization
should take place by integration with groups that have similar problems, while the
community would help eventually on development of her confidence that Sarah is
as valuable as the other members of society.
2.5. Conclusion
Since every individual develops a unique personality, any theory is limited only
to certain aspects of this personality. Psychosocial and cognitive theories help to
understand the damages in the small child and to evaluate its possible deviation
toward disability or the existence of slowing process of development, as well as to
actively assist the individual and parents in the socialization of the damaged child
through monitoring whether its development is according to the knowledge about
the characteristics of the different life stages of the individuals.
Infants and toddlers: Sarah
Sarah is 13 months old. She was severely neglected by her mother and is
believed to have been physically abused. She was diagnosed as "failure to thrive"
at two months old, but went home under protective supervision. She was again
placed in foster care at 11 months, when her mother was hospitalized for heroin
addiction.
Sarah is very quiet most of the time. She does not coo or babble. She seems to
prefer to be left alone. When she does cry, she is very difficult to comfort. When
placed in her crib she often will rock herself to sleep. She bangs her head on the
mattress.
Sarah cannot stand, even if supported. Her legs are not strong enough to bear her
weight. She began to crawl at 12 months, but does so with great difficulty, and
does not move around a room very much. If placed in a sitting position, she will
often remain there, immobile, for up to an hour at a time.
Sarah does not look into people's eyes. She appears to be uninterested in her
surroundings. She does not hold toys in her hands or appear interested in playing
with toys.
Sarah can finger-feed herself Cheerios (cereal) and take sips of milk from a cup.
She has frequent digestive upsets and vomits almost every day.
Source: Placement, Module IV: Effects of Abuse and Neglect on Child
Development - Revised June, 2001. Prepared for the Ohio Child Welfare Training
Program by the Institute for Human Services.
Synopsis
"failure to thrive" - two months old
quit, no coo or babble, left alone, cry, rock to sleep, banging the head, cannot
stand, crawling 12 months old (not move around much), in a sitting position
immobile up to an hour, not look into people's eyes, disinterested, no interest in
toys, finger-feed, frequent digestive upsets and vomits
Theories to explain the problem
References:
Allbritten, B. (1998). Theories of Human Behavior.
http://campus.murraystate.edu/academic/faculty/rose.bogal/courses/Theories%
20of%20Human%20Behavior/index.htm
Failure to thrive (online). Last visited June 26th, 2009. http://kidshealth.
org/parent/food/weight/failure_thrive.html#
Harder, A.F. (2002). Erik Erikson's Stages Recognize Life as Opportunities to
Grow. http://www.childhoodaffirmations.com/general/parenting/erikson.html
Explanation theories (two theories should be selected according to the
assignment)
1 Framework of the problem.
Failure to thrive is a general diagnosis with different possible causes, the main
syndrome of which is the failure to gain weight and poor height growth
respectively.
In our cases the main cause is malnutrition, as a result of which the children “don't
receive or are unable to take in, retain, or utilize the calories needed to gain weight
and grow as expected” (Failure to thrive). This diagnosis completely explains the
condition of Sarah since there are most of the syndromes: Sarah is disinterested
in the surrounding, she avoids eye contact, she cannot stand since her legs are
not strong enough, she avoids contact with people, irritable, etc.
Failure to thrive explains only generally the condition of Sarah. Essential is that she
was diagnosed with “failure to thrive” at 2 months, although returned to her mother
and taken away at 11 month. As it is known “after birth, a child's brain grows as
much in the first year as it will grow during the rest of life” (Failure to thrive), so poor
nutrition could cause permanent negative effects on mental development. Of the
series of factors that cause failure to thrive (a chronic illness, an intolerance of milk
protein, infections, etc.), in Sarah’s case the main is the social factor – the
negligence and presumed abusive behavior of her mother.
Failure to thrive diagnosis helps to understand that Sarah needs a complex care –
from physical doctors to occupational and speech therapist, psychologist and
social workers in order to turn to successful feeding and social behavior. There is
a danger of chronic illness and disorder, so Sarah should be monitored regularly
because of the possible damage of her brain and chronic diseases that could
have long-life effect. Such children need a special social environment, so placing
at foster care at her 13th month means periodical consultation with her foster
parents about Sarah’s mental and physical condition and a development of a
special program for her socialization in environment with children that would not
cause addition stress and at school with all equipment of special education.
The condition of Sarah relates to a series of problems: child abuse, possible
chronic illness, depression, developmental disability, etc.
Of the numerous human behavior theories (see for example Allbritten 1998) we
chose two: psychosocial theory and cognitive development theory since failure to
thrive condition relates directly to possible life-long damage of brain and
development of mental disability.
2. Theories
2.1. Psychosocial theory
According to this theory, the human development is a product of “the interaction
between individual needs and abilities and societal needs and demands”. It
focuses on “stages of development and psychosocial crisis” (Allbritten 1998).
Harder (2002) explains the stages of development (after Erickson) that helps to
understand Sarah’s life-long problems from the first to the eight stage.
The first stage (Oral Sensory stage) (birth to 18th month) emphasizes on the
mother’s positive and loving care of the child, which failure to experience may end
with “deep-seated feeling of worthlessness and a mistrust of the world in general”
(Harder 2002). Since Sarah was given to foster parents at 13th month old, if her
health problems were resolved, there was opportunity by age 2 she to have
developed the basic belief about the world as trustworthy and respectively the
further normal interaction with world.
The theory is worth since helps to understand the main needs of the small child
and to direct it toward normal human development. At the same time it itself is less
helpful if Sarah had suffered from life-long brain damage, so it is unclear at age 13
whether Sarah would be able to go normally through the other stages according to
Erickson classification.
2.2. Cognitive development theory
This theory focuses on how a person organizes and makes meaning of
experience and the understanding of “knowing” as a product of continuous
interaction between the person and the environment. It is based on three basic
concepts – scheme, adaptation and stages of development that means
organization, modification and diachronic integration (Allbritten 1998). There are
four stages of development of the individual:
Sensorimotor intelligence (birth to 18 months)
Preoperational thought (18 months to 5/6 years)
Concrete operational thought (6/7 years to 11/12 year)
Formal operational thought (adolescence to adulthood)
This theory helps to understand the damages on Sarah in her earliest childhood
and their long-life consequences.
During the stage of sensorimotor intelligence the child forms concepts through
direct investigation of environment. Because of failure to thrive condition, Sarah
would not developed in direction of optimal cognitive interaction with environment.
This condition would reflect on the next stage when she would possibly have
problems with development of skills like imitation, creating mental images,
symbolic drawing, symbolic play and language. During the third stage Sarah
presumably should develop ability to solve problems tied to physical reality, and to
achieve three conceptual skills – conservation (identity, reversibility, reciprocity),
classification (size, shape, color) and combinatorial skills (ability to manipulate
numbers in addition, subtraction, multiplication and division). During the formal
operational thought the individual conceptualizes about many simultaneously
interacting variables and becomes “somewhat egocentric”.
Because of the possible severe damage of the brain it is unclear whether Sarah
would develop any of the skills presumed for the third stage and for the four stage.
2.3. Sufficiency and values of the theories
Since we have a case of complex, physical and mental, damage on the child, both
theories only partially help to understand the situation and to help. Sarah’s
treatment needs not only psychological therapist but also regular monitoring by
doctors for her physical development and especially for her brain development. At
the same time, both theories extremely help for monitoring eventual mental
disorder at early or later stage of development of Sarah and helping her in her
enculturation and socialization.
2.4 Practical values of the theories
If Sarah’s foster parents are able to fix the physical health of Sarah and there are
no fatal damages of her brain, the multiscale work of the psychotherapist may help
her by age 2 she to gain the abilities of all normally developed children.
Working with the child could return the joy of play with toys and development of
an attachment feeling to her foster parents by stressing of the foster mother’s love
to her and verbalizing how important is her mother Sarah to feel happy and save.
Work with the foster parents would help to explain them their role to make the
child trustful the life and to understand that being positively emotional with the child
helps Sarah to gain basic confidence in the future life which is one of the most
important abilities in her individual life. Monitoring the condition of Sarah through
contact with foster parents also would help to understand whether she develop the
future quality depending on the age (self-control, courage, will, etc.) during the
second stage when the relation with the parents are the most important since they
become micromodel of social relationships. We may guess that such regular
contact with the parents would be helpful for the other stages till her 18th age bur
will depend of the recovering from the initial damages during her 1st year. If the
child develops normally, the therapist would help in modeling non-conflict
relationships between the growing child and parents because of presumably
fragile physical and mental health.
At level of social group and community, the socialization of Sarah depends
completely on her physical and mental states. If she recovers from failure to thrive
by age 2, she probably would be able to attend kinder garden and to be integrated
into the educational system, which embodies the knowledge from the different
human behavior theories. If she develops as a disable child, then her socialization
should take place by integration with groups that have similar problems, while the
community would help eventually on development of her confidence that Sarah is
as valuable as the other members of society.
2.5. Conclusion
Since every individual develops a unique personality, any theory is limited only
to certain aspects of this personality. Psychosocial and cognitive theories help to
understand the damages in the small child and to evaluate its possible deviation
toward disability or the existence of slowing process of development, as well as to
actively assist the individual and parents in the socialization of the damaged child
through monitoring whether its development is according to the knowledge about
the characteristics of the different life stages of the individuals.
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External links:
Brain disorders
Encyclopedia of Irish and World Art
Brain disorders
Encyclopedia of Irish and World Art