A legacy of violence in nonorganic failure to thrive

Breastfeeding as the Foundation of Care

Breastfeeding, which unites food, health, and care, enhances the child's abilities to elicit good care through superior attachment, rhythmic synchrony, and vision and brain development. Parental responsiveness is increased by bonding, child spacing, and time with the baby Breastfeeding and other forms of care for nutrition share the aspects of interaction, cultural mediation, erosion of traditions, endemic misinformation, small-scale decision-making, and vulnerability to institutional mismanagement. Breastfeeding differs in requiring continuity of the caretaker and in facing social and profit-motivated opposition. Research is needed on adequate care for siblings, effective help for high-risk infants, improved duration, and nutrition of both mother and child in the second year of breastfeeding Despite effective strategies, such as the baby-friendly hospital initiative and community support groups, the challenge remains to move from motivating women to ensuring access to practical and confidence-building support.

Correlates of Child Maltreatment Among Adolescent Mothers With Young Children

Child maltreatment and teen pregnancy are serious social problems facing America today. In 2010, 3.3 million referrals of child abuse and neglect resulted in approximately 461,297 confirmed victims. Teen pregnancy has similarly been a cause of serious political and social concern. Although the teen birth rate has declined overall during the last half century, the United States still has a higher teen birth rate than other industrialized countries. Young maternal age is generally considered a risk factor for child maltreatment. What is not known is what separates adolescent mothers who maltreat their children and those who do not. This study compares the ecological correlates of adolescent mothers who maltreat their children to adolescent mothers who do not maltreat. Implications for practice and future research are discussed.

Psychosocial predictors of being an underweight infant differ by racial group: a prospective study of Louisiana WIC program participants

OBJECTIVES

In order to prospectively identify psychosocial predictors of infants being underweight, we followed 3,302 low-income infants. These infants received well-baby care in health departments and were enrolled in the Women, Infants, and Children (WIC) Supplemental Food Program from the newborn period to 12 months of age.

METHODS

We linked risk factor data collected from newborn medical history records to anthropometric data from a WIC database. The unadjusted relative risk of being underweight at 12 months of age, defined as weight for recumbent length below the 5th percentile, according to current Centers for Disease Control and Prevention growth charts, for each group was calculated for the study population and for black and white racial groups. Using logistic regression, we calculated odds ratios measuring the effect of the newborn risk factors on underweight status at 12 months of age.

RESULTS

There were no psychosocial risk factors that were significantly associated with being underweight simultaneously in both racial groups. Among black infants, those whose mothers had an eighth grade education or lower were at greater risk of being underweight at 12 months of age (OR=3.7, CI=1.5-4.8), as were those whose mothers were married (OR=2.7, CI=1.5-4.8). Among white infants, those whose mothers initiated prenatal care in the third trimester were significantly more likely to have underweight infants at 12 months of age (OR=4.5, CI=1.6-12.4).

CONCLUSIONS

Predictors of being underweight at 12 months of age in a low-income population differ by racial group. Further research of public health interventions targeting families of infants with the significant psychosocial risk factors is needed.

Ecological correlates of neglect in infants and toddlers

Infants and toddlers are more likely to be victims of neglect than any other form of maltreatment. Infants and toddlers are at highest risk of fatality because of maltreatment and experience behavioral, social, academic, medical, and cognitive consequences of neglect during their most formative years. Within an ecological framework, this study examines the correlates of the substantiation of neglect in children 0 to 36 months of age. Using an ex post facto design and a random sample of 148 child protective services cases, bivariate analysis revealed significant differences in families who were substantiated for neglect in the areas of child characteristics, home environment, social environment, caregiver, and maltreatment situations. Multivariate analysis found children who were substantiated for neglect were exposed to greater environmental dangers and had caregivers who had poor parenting skills. Implications for practice and future research are discussed.

Physical health outcomes of childhood exposure to intimate partner violence: a systematic review

BACKGROUND

Children exposed to intimate partner violence (IPV) are at increased risk for adverse mental and behavioral health sequelae, as has been documented by both systematic reviews and meta-analyses. Studies addressing the physical health impact of childhood IPV exposure, however, have not been summarized in a manner that might facilitate additional hypothesis-driven research and accelerate the development of targeted interventions.

METHODS

To identify a comprehensive set of articles examining the association between childhood IPV exposure and physical health, we searched online bibliographic databases including Medline, CINAHL, PsychInfo, and Sociological Abstracts using the keywords "domestic" or "intimate partner violence" and "infant," "child," or "pediatric." From >2000 articles retrieved in the initial search, we used online abstract and bibliographic information to identify 94 articles potentially meeting the inclusion criteria of studies that (1) examined a postnatal physical health outcome related to IPV exposure and (2) had a contemporaneous control group. Thorough review of these 94 published studies yielded 22 that met these inclusion criteria. The data then were abstracted independently by 2 of the authors, and differences were settled with the assistance of a third author.

RESULTS

Childhood exposure to IPV increases the likelihood of risk-taking behaviors during adolescence and adulthood and is likely associated with underimmunization. Minimal data and study limitations preclude establishing a clear connection between IPV exposure and general health and use of health services, breastfeeding, or weight gain.

CONCLUSIONS

The impact on physical health from exposure to IPV during childhood is still uncertain. Future studies should be grounded in a theoretical model that specifies how IPV exposure can affect child health, should adjust for confounders adequately, should include a community-based sample, and should be of larger scale.

Failure to thrive as a manifestation of child neglect

Failure to thrive is a common problem in infancy and childhood. It is most often multifactorial in origin. Inadequate nutrition and disturbed social interactions contribute to poor weight gain, delayed development, and abnormal behavior. The syndrome develops in a significant number of children as a consequence of child neglect. This clinical report is intended to focus the pediatrician on the consideration, evaluation, and management of failure to thrive when child neglect may be present. Child protective services agencies should be notified when the evaluation leads to a suspicion of abuse or neglect.

Salutogenesis as a framework for child protection: literature review

AIM

The aim of this paper is to demonstrate the usefulness of salutogenesis in work relating to child protection.

METHODS

A systematic review to explore the links between parenting, social factors and failure to thrive was carried out using 17 CD ROM and online databases using keywords in appropriate medical subject headings (MeSH terms) and Boolean operators refined for the studies. The salutogenic framework was then used as a way of clarifying what benefit particular research findings may have in identifying and using factors which can be associated with protection, safety and well being of children. Cross-referencing the evidence from the systematic review against Antonovsky's generalized resistance resources created a salutogenic matrix.

FINDINGS

Four factors in the systematic review were found crucially important: parent factors; parenting factors; child factors; and social factors. However, it is probable that these are useful within all child protection research and the evidence gathered in particular cases (here failure to thrive) could be plotted against each factor. Application of a salutogenic framework to the results was further illuminating and has utility for both systematic review methodology and other child protection explorations. The matrix created a warp and weft effect that identified gaps in current evidence and practice and was able to disentangle some of the complexities inherent within failure to thrive situations. By beginning to shed understanding on such processes, the concept of salutogenesis added further depth and rigour to the analysis.

CONCLUSIONS

The concept of salutogenesis is widely used in some areas of nursing practice and research, and can also be regarded as a theoretical tool that has potential in child care and protection research, development and practice. The paper also illustrates the importance of a sound theoretical framework in ensuring depth and rigour in analyses of literature review findings.

Feeding disorders in infants and toddlers: diagnosis and treatment

Each of the six feeding disorders described presents with specific symptoms, has a different origin, and responds to different interventions. Consequently, it is important to establish an accurate diagnosis and use the appropriate intervention for the specific feeding disorder. As the study by Benoit et al [7] demonstrates, an intervention that may be helpful for one feeding disorder can be completely ineffective for another.

Fütter- und Gedeihstörungen bei kleinen und/oder behinderten Kindern

Zusammenfassung Behandlungsbedürftige Fütter- und Gedeihstörungen (Prävalenz 2-4%) haben selten eine isolierte Ursache, meist ist ein Bündel von ungünstigen Bedingungen an der Entstehung und vor allem Aufrechterhaltung der Störung beteiligt. Das können organische Ursachen wie chronische Erkrankungen, Auffälligkeiten in der Person oder dem Verhalten des Kindes oder der Bezugsperson oder in der Interaktion sein. Fütter- und Gedeihstörungen können eine längerdauernde Zusatz- oder Vollsondierung erfordern, oder das Kind lehnt altersgemäß grobe Kost ab, hat ein sehr selektives Essverhalten oder es gibt massive Interaktionsstörungen während des Fütterns. Fütter- und Gedeihstörungen können neben den direkten körperlichen Auswirkungen auch längerdauernde ungünstige Einflüsse auf andere Verhaltensbereiche und auf mentale Fähigkeiten haben. Die Diagnostik der Fütter- und Gedeihstörungen umfasst neben der Abklärung einer organischen Grunderkrankung die Klärung der Schluck- und der oralmotorischen Fähigkeiten sowie den Ausschluss eines gastroösophagealen Refluxes. Das differenzierte Fütterprotokoll muss die orale und die Sondenernährung umfassen. Die Verhaltensbeobachtung umfasst die Füttersituation und wenn nötig auch breitere Interaktionsbereiche. Neben einer Therapie der Grunderkankung steht die direkte Anleitung der Bezugspersonen in der Füttersituation im Vordergrund. Daneben können eine Therapie der Oralmotorik sowie der Bezugsperson und Interaktionsanleitungen in verschiedenen Verhaltensbereichen erforderlich sein.

Abnormal corticosterone regulation in an immature rat model of continuous chronic stress

Neuroendocrine correlates of chronic stress in human infants have not been established. The goal of the present study was to create an animal model of continuous chronic stress using the immature rat to measure basal plasma corticosterone, and secretion of plasma corticosterone in response to an acute stress. This was achieved by modulation of the cage environment for rat pups and their mothers. During postnatal days 2-9, pups were maintained in three groups: (1) handled, (2) not handled and with ample bedding; and (3) not handled with limited bedding. On postnatal day 9, some pups from each group were subjected to acute cold-separation stress and were killed 90, 240, or 360 min later along with unstressed controls. The group not handled and with limited bedding manifested increased plasma corticosterone output even without cold exposure and a sustained increase of plasma corticosterone after cold-separation stress. Plasma corticosterone interanimal variability was increased and body weight was decreased in these pups, typical of a state of chronic stress. The first model of continuous stress in infant rats in which upregulation of hypothalamic-pituitary-adrenal axis is achieved without maternal separation is presented. This paradigm may more closely approximate the human situation of chronically stressed, neglected infants.

A clinical tool for nonorganic failure-to-thrive feeding interactions

An interdisciplinary team of professionals developed and piloted a clinical tool, the Feeding Checklist, for assisting observations of feeding interactions with nonorganic failure-to-thrive (NOFTT) clients. The piloting process involved two phases. During the development phase, content validity and reliability were established with three NOFTT experts. The tool was compared with a standardized feeding interaction assessment instrument to determine concurrent validity. Both tools revealed similar behavior patterns significantly differentiating between NOFTT and Thriving dyads. The results also concurred with NOFTT literature findings. During the second phase of the study, pediatric nursing staff significantly improved the nursing documentation of NOFTT feeding interactions when using the Feeding Checklist.