Non‐organic Falure to Thrive; Growth Failure Secondary to Feeding‐skills Disroder

Abstract

SUMMARY In this article the authors propose that non‐organic failure to thrive (FTT) is a growth failure secondary to feeding‐skills disorder, and that this disorder is neurophysiological in origin. The symptoms of feeding‐skills disorder were suggestive of an oral sensorimotor impairment which is usually present from birth or early life, but tends to go unrecognized. Data from 38 infants with non‐organic and 22 infants with organic FTT demonstrated that early clinical symptoms of feeding impairment, and observed maternal and infant feeding behaviours and interactions, were similar for both groups, suggesting a need to redefine the term ‘non‐organic. RÉSUMÉ Défaut non organique de croissance: déficit de croissance seconduire à des troubles du comportement alimentaire Dans cet article les auteurs suggerent que le defaut non organique de croissance (FTT) peut ětre lié à un déficit de croissance provoque par un trouble du comportement alimentaire, et que le trouble est neurophysiotogique a I'origine. Les symptǒmes du trouble des conduite alimentaires suggèrent un trouble sensori‐moteur oral, habituellement presént à la naissance ou dans les premiers mois, et qui tend à ětre méconnu. Les données provenant de 38 nourrissons avec FFT non organique et de 22 nourrissons avec FFT organique démontrent que les symptǒmes cliniques du trouble alimentaire. les comportements alimentaires observés chez les mères et les nourrissons sont sernblables dans les deux, groupes, suggérant une nécessité de redéfinir le terme ‘non‐organique. ZUSAMMENFASSUNG Nicht‐organische Gedeihstörung: Wachstunssiörung durch Fütterungsschwierighkeiten In dieser Arbeit vertreten die Autoren die Meinung, daβ die nich‐organische Geihstörung (FTT) eine Waschstumsstörung durch Fütterngesschwierigkeiten ist und daβ dises Erkrankung eine neurophysiologische ursache hat. Die Symptome der Fütterungsschwierigkeiten seien ein Hinweis auf eine orale sensomotorische Störung, die in the Regel von Geburt ordervom frühen Lebensalter and besteht, aber häfing nicht rekannt wird. Die Daten von 38 Kindern mit nicht‐organischer und 22 Kindern mit organischer FTT zeigten daβ die frühen klinischen symptome der Fütterungsschwierigkeiten und das beobachtete Fütterungsverhalten und ide Interaktionen zwischen Mutter und Kind ür beide Gruppen ähnlich Waren, was bedeutet, daβ der Begriff ‘nicht‐organisch’ neu definiert werden muβ. RESUMEN Fallo no orgánico en el crecimiento: fallo secundario a alteraciones en las formas de alimentacióon En est articulo los autores proponen que el fallo no orgánico del crecimiento (FNOC) es secundario a alteraciones en las formas de alimentación y que esta alteración es neurofisiológica en su origen. Los sintomas de una alteractón en la forma de alimentarse eran sugestivos de una alteractón oral sensorio‐motora, generalmente ya presente en el nacimiento o en los primeron tiempos de la vida, pero que tiende a ser no reconocida. Los datas recogidos en 38 lactantes con FNOC no orgánico y de 22 con sindrome orgánico demost...

Oral‐motor dysfunction in children who fail to thrive: organic or non‐organic?

“…However, our results did not reveal any differences in developmental factors as measured by the Bayley Scales (Bayley 1969). Some clinicians and researchers (for example, Ramsey et al 1993) have suggested that OMD might occur as an isolated neurological sign that only becomes apparent in some children when solids are introduced, requiring a more organized and mature feeding pattern. Such difficulties could affect the child's ability to achieve an adequate intake and presumably result in FTT.…”

“…Feeding is the first 'joint task' of the mother-infant relationship and any interruption of this delicate relationship, such as a 'difficult feeder' may place extra demands and stresses on both the child and mother and so affect interactional style. Ramsey et al (1993) found that almost half the mothers of children with FTT exhibited negative effect and interactions during feeding time and suggested that the early feeding impairments may trigger the development of maladaptive interactional patterns. Lindberg et al (1996) studied mother-child interaction when children refuse food and found that the more difficult the infant, the less responsive the mother was to the child's cues.…”

“…Therefore, it seems reasonable to ask if the minor congenital anomalies identified could be consistent with a subtle neurodevelopmental problem. Ramsey et al (1993) suggested that almost half the children they assessed with NOFT had a history of questionable 'neurological involvement' in the absence of any diagnosable condition. Recently Wilensky et al (1996) found that significantly more of the children they studied with FTT had a history of hypotonia reported in the first year of life compared with normal infants.…”

“…Undernutrition has been proposed as a common causal factor (Skuse 1985, Ramsey et al 1993, although it has become increasingly clear that the causal mechanisms vary. While undernutrition may result from failure to offer adequate calories, it may also occur because of inadequate ingestion of food by the infant.…”

“…Approximately half the 4 year olds with chronic growth retardation studied by Heptinstall et al (1987) had some disorder of OMD and had begun to fail to thrive in the first year of life. Ramsey et al (1993) saw 38 infants with NOFT and 22 with organic FTT. The histories of the children with so-called NOFT were suggestive of an oral-sensorimotor impairment reported to be present from birth or early infancy.…”