Non-organic failure to thrive: a reappraisal.

Non-organic failure to thrive has traditionally been regarded as due primarily to maternal rejection and neglect. A critical reappraisal of the evidence suggests a more balanced view of the mother-child relationship should be taken. A classification of the condition, founded on facts not concepts, is urgently required. Non-organic failure to thrive should be viewed in a multidimensional context, in which potential influences upon the symptomatic infant are considered. Inadequacy of nutrition is caused by both a failure of adequate provision of food and by inadequate intake. A vicious circle of maladaptive behavioural interaction between caregiver and infant is often present, sustained by high emotional tensions. Clinical intervention should aim to clarify the contributions made by both caregiver and infant to that interaction and thus break the cycle. The basis on which intervention is made should be direct observation of the parent and child relationship in as many different environmental contexts as feasible, especially during feeding. The multidisciplinary team has an important role to play in management. An emphasis on parental culpability in the aetiology of non-organic failure to thrive, in the absence of direct evidence of neglect, is wrong.