Failure to Thrive

Inpatient investigation and initial treatment is warranted for infants under a year in the following cases: when the infant is suffering from more severe growth failure; when there are signs of emotional deprivation; when the parents have not sought medical intervention; when the infant shows signs of physical abuse; when the infant's hygiene has been seriously neglected; when the mother appears severely disturbed or is abusing drugs or alcohol or is living a chaotic lifestyle overwhelmed with stresses; or when the mother-infant interaction appears uncaring and includes feelings of anger.

During hospitalization, a primary-care nurse is assigned to establish a warm and nurturing relationship with the baby. The baby typically begins to blossom in its social interactions and rapidly gains weight. As the baby begins to improve both in terms of weight gain and psychosocially, hospital personnel can help the mother engage with her baby, teaching her to receive and express the mutual signals of mother-infant bonding. Understanding and addressing the mother's needs for emotional support and encouragement is essential to rehabilitating the mother-infant relationship. The degree to which parents are aware of the cause of the problem and actively cooperate in their baby's reattachment has been found to be predictive of the long-term outcome. Appropriate referrals to child protective services agencies must be made both to ensure the child's continued safety and to monitor the efforts to help the parents learn needed skills.