Page 208 - Encyclopedia of Nursing Research

FAILurE TO THrIVE (CHILd) n 175

Infant nutrition has long been the focus families. These case studies were the first
of pediatric research. Holt (1897) was one of to report feeding and interactional difficul-
the first to describe marasmus, a significant ties between the mothers and their infants. F
infant nutrition problem, and a condition Feeding episodes for the mothers were anx-
similar to the FTT syndrome described in iety-provoking, which led the mothers to
contemporary literature. It was in 1915 that decrease both the frequency of infant feed-
the term FTT was first used in the pediat- ings as well as their contact with the infants.
ric literature to describe rapid weight loss, Ethnologists and child development experts
listlessness, and subsequent death in insti- began studying institutionalized and nonin-
tutionalized infants. In the early 1900s, the stitutionalized infants to further define the
mortality rate for institutionalized infants concepts of maternal deprivation and FTT.
was near 100%, and few realized the impor- On the basis of several studies, researchers
tance of environmental stimulation and then concluded that decreased maternal con-
social contact for infant growth and develop- tact directly lead to FTT in the infants. From
ment. It was during this time that the first fos- these works, the maternal deprivation frame-
ter home care program for institutionalized work for FTT was established, and the moth-
marasmic infants was developed. The home er’s role in the infant’s well-being became a
care program involved the identification and central focus. Support for this framework
training of families, by nurses, to care for the grew, as data accumulated documenting the
ill infants, and included a significant amount association between maternal neglect and
of nursing intervention to monitor the pro- FTT in infants.
gress of the infants. unfortunately, this early The maternal deprivation framework
work was not recognized by the pediatric dominated the literature until the late 1970s,
community, despite a 60% drop in the mor- when a transactional framework was devel-
tality rate of marasmic infants cared for in oped to explain the psychosocial correlates of
the foster homes. FTT. The transactional framework proposes
It was not until 1945 that the concept of that an infant’s growth and development is
FTT captured the attention of the psychiatric contingent on the quality of parental care,
and pediatric communities. In a classic study, the nature of parent and infant interactions,
Spitz (1945) described depression, growth fail- and the ecological conditions impinging on
ure, and malnutrition in 61 foundling home the family. Furthermore, the transactional
infants. He used the term hospitalism to model recognizes that the quality of the par-
describe the syndrome that he observed, and ent/infant interaction reflects infant char-
he proposed that a lack of emotional stimula- acteristics as well as parent characteristics
tion and the absence of a mother figure were (Bithoney & Newberger, 1987). Historically,
the main contributors to infant growth fail- the emotional deprivation component of FTT
ure. Spitz postulated that with adequate love, has been investigated more than the nutri-
affection, and stimulation, the infants would tional deprivation component. Although
grow. researchers demonstrated weight gain FTT experts would agree that undernutri-
in infants with hospitalism when stimula- tion is the primary biological insult, system-
tion and affection were provided. Thus, these atic studies investigating this element are
findings provided a foundation for an FTT lacking.
theoretical framework on the basis of mater- Nutritional deprivation again became the
nal deprivation in institutionalized infants. focus of FTT research in the early 1970s, when
In the mid 1950s, a number of case reports some researchers disputed the hypothesis
were published in the psychiatric literature that maternal deprivation was the principal
that documented depression, malnutrition, cause of FTT. More recent evidence suggests
and growth failure in infants living in intact that the environmental deprivation may