Maria Ramsay

The Improving Outlook for the Small Prematurely Born Infant

A group of 32 children (20 boys, 12 girls) who weighed less than 1251g at birth and whose gestation was 31 weeks or less was followed‐up for a minimum of five years. In all cases the birth weight was appropriate for gestational age.

NON‐ORGANIC FALURE TO THRIVE; GROWTH FAILURE SECONDARY TO FEEDING‐SKILLS DISRODER

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.

Infant sucking ability, non‐organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study

This prospective study examined the relation of neonatal sucking to later feeding, postnatal growth, maternal postpartum depression, and feeding practices. Healthy infants of at least 37 weeks gestational age were recruited. At 1 week of age, a strain-gage device was attached to the infants cheeks during sucking to identify sucking efficiency. Two-hundred and two infants (100 males, 102 females; mean age 39.6 weeks, SD 1.1 weeks) with efficient sucking and 207 (101 males, 106 females; mean gestational age 39.4 weeks, SD 1.2 weeks) with inefficient sucking were identified. Growth was measured at 2, 6, 10, and 14 months. Mothers completed a feeding questionnaire and the Edinburgh Postnatal Depression Scale at the same testing points. While 18 infants (5%) showed a downward shift in growth, their clinical picture did not present as non-organic failure to thrive (NFTT). Inefficient neonatal sucking did not predict postnatal growth, later feeding difficulties, nor maternal feeding practices, but concurrent inefficient feeding did. Maternal depression did not affect feeding practices, infant feeding abilities, nor growth, suggesting that the importance of maternal postpartum depression in association with feeding may be less than previously assumed. The term NFTT, therefore, merits reexamination and a more focused definition.

Resolution of neurological symptoms in high-risk infants during the first two years of life.

115 high‐risk infants were identified and followed prospectively over the first 24 months of life. All infants underwent neurological assessments at 12 and 24 months and developmental assessments at six and 12 months. Approximately one‐quarter of the infants were considered to be ‘neurologically suspicious’ at 12 months of age, of whom slighly more than one‐half were deemed normal by 24 months. Children who were classified as being either normal or abnormal at 12 months were highly likely to have their classification confirmed at 24 months. Abnormal and suspicious neurological outcomes at 12 and 24 months were inversely correlated with birthweight and were not affected by the infants being given early physical therapy. Children who were suspicious at 12 months and who either remained suspicious or became abnormal at 24 months had lower personal–social quotients at six and 12 months and lower hearing–speech quotients at 12 months than the suspicious children who became normal.

Developmental outcome in very low birth weight infants 6 to 36 months old.

A cohort of 78 infants weighing less than 1500 g at birth was followed prospectively to determine the impact of birth weight, age of assessment, and skill area on their developmental performance. Five skill areas were tested using the Griffiths Mental Scales of Development at 6, 12, 24, and 36 months of age. Infants were divided into three birth weight groups: <750 g, 750–1000 g, and 1001–1500 g. A significant age and skill interaction was found, with the locomotor and eye-hand skills decreasing consistently over time, and the personal-social and hearing and speech skills initially decreasing and then rising from 12 to 36 months. Infants born at <1000 g consistently performed more poorly than those born at 1001–1500 g. Explanations for the variation in scores and the implications of these findings to the evaluation of low birth weight infants are discussed.

The Montreal Children's Hospital Feeding Scale: Relationships with parental report of child eating behaviours and observed feeding interactions.

Feeding problems are common, with implications for nutrition, growth and family stress, placing burden on primary care services. The Montreal Childrens Hospital Feeding Scale (MCHFS) is a quick and reliable measure of feeding problems for clinical settings, but there is little examination of its relationship to commonly used research measures of parental feeding practice, child eating behaviour and observations of parent-infant interaction at mealtimes. We examined the relationships between the MCHFS, demographics and early feeding history, weight across the first year, parental report of feeding practices and child eating behaviours, and observations of maternal-infant feeding interaction at 1 year. The MCHFS, Comprehensive Feeding Practices Questionnaire (CFPQ) and Child Eating Behaviour Questionnaire (CEBQ) were completed by 69 mothers when their infants were 1-year-old (37 male, 32 female). Infant weight was measured at 1 week, 1 month, 6 months and 1 year. Mothers were observed feeding their infants at 1 year. The MCHFS was reliable (Cronbachs alpha = .90) and showed significant overlap with other measures of feeding and eating. Potential feeding problems were identified in 10 of the children (14%) reflecting similar rates in other community samples. Higher MCHFS scores were associated with lower birthweight and weight across the first year, greater satiety responsiveness, fussiness and slowness in eating, lower enjoyment of food and food responsiveness, and less observed infant food acceptance. Parents of infants with more feeding problems reported less encouragement of balance and variety in their childrens diets. CONCLUSION MCHFS showed good criterion validity with other parental report measures of eating and observations of mealtime interactions. MCHFS may be a useful tool for researching feeding problems in community samples.