Susan O'Connor

Prospective study of antecedents for nonorganic failure to thrive

The cause of nonorganic failure to thrive (NFT) was studied prospectively in 274 low-income pregnant mothers by interviewing them for characteristics that retrospective studies indicated were associated with child maltreatment. After delivery, medical charts of mothers and infants were reviewed for complications of pregnancy, delivery, and postdelivery hospitalization, and the infants were observed for growth failure. The characteristics of 15 families with infants who developed NFT were compared with those of 86 selected randomly from the remaining families. Interview results suggest that NFT correlates significantly with aberrant nurture during the mothers childhood and with conflicts between the parents of the infants. Perinatal events correlating significantly with NFT include complications of pregnancy, short gestation, and residual minor medical problems at discharge from the nursery. We speculate that these events predispose to NFT by disturbing the development of the mother-infant relationship.

Prediction of child maltreatment during pregnancy.

Abstract Fourteen hundred expectant mothers volunteered to be interviewed about their attitudes, experiences, and knowledge of child rearing. The purpose of the interview was to identify parental predictors of child maltreatment. Based upon answers, 273 were expected to be at high risk for parenting disorders. After delivery, their infants and 225 selected randomly from all remaining mothers were followed in a double-blind fashion for evidence of child abuse, neglect, and nonorganic failure to thrive. All three parenting disorders were found significantly more often in the high-risk families.

Child health and maltreatment.

Children who are abused have been said to have more illnesses than children who are not maltreated. The relationship between abuse and illness has been hypothesized to function in 2 ways: (1) that abuse precedes the illnesses and children from abusive homes become ill because of the damaging environment they endure, or, conversely, (2) that the illnesses precede the abuse, with the fussy behavior of ill children eliciting abuse. This study was intended to clarify the temporal relationship between illnesses and maltreatment. Health data were collected on a sample of 80 children: 11 from abusive families, 31 with nonorganic failure to thrive (NOFT), 14 from neglectful families, and 24 from control families. Hospital records (both inpatient and outpatient) for these children from the time of birth until they were 3 years old were searched by data collectors unaware of the childs classification. Children from abusive families or with NOFT appeared to be ill more often than control children, particularly during the first few months after birth, before abuse had been reported, but not necessarily before NOFT had been discovered. Health records of neglected children were not significantly different from those of controls. In addition to the abused. These 6 children also had more illnesses than control children, again particularly during the first few months after birth. Having ill children is described as a source of stress that may trigger abuse in an already stressed family.

Management of Febrile Outpatient Neonates

To determine whether all febrile outpatients below the age of two months should be routinely hospitalized and given parenteral antibiotics because of the possibility of occult sepsis or meningitis, 147 such admissions were re viewed over four years. None of the neonates had occult bacterial meningitis, while one may have had occult sepsis. Because serious infections may have been missed in outpatients not hospitalized, the outcome of all such illnesses seen in the clinic during a subsequent six months was monitored; none of 17 hospitalized or 20 followed as outpatients experienced sepsis or meningitis. If our findings are confirmed in other studies, febrile outpatient neonates with a well appearance, normal cerebrospinal fluid and physical examination, and dependable follow-up may not require universal hospitalization and antibiotics.

Outcome of abuse during childhood among pregnant low income women

The outcome of experiencing abuse as a child was studied by comparing pregnant women who did recall versus those who did not recall this type of maltreatment. Fourteen hundred low income women were interviewed in prenatal clinic; those who said they were both punished by abuse and beaten by caretakers as children were considered abused. Abuse was recalled by more white than black women but families were followed after delivery and protective service reports of abuse for their offspring were equal. Because of low numbers, black subjects were dropped and the 95 white women who recalled abuse during childhood were compared to the remaining 832 white subjects. The groups did not differ in attitude about current pregnancy, age or marital status, and no differences were found for their children at birth. Abused mothers were more likely to have felt unwanted and unloved as children and to have lower self-images and more isolation than controls. Abused mothers had greater stress, and many of their stresses reflected disturbances in interpersonal relationships. Thus, women abused as children had some characteristics similar to those of known child abusers. Although abused women had more aggressive tendencies, their children were reported to protective services for abuse at the same frequency as control children. Intergenerational transmission of abuse was therefore not demonstrated prospectively. Classic theories of child abuse suggest a special child, special parent and stress act as independent agents to cause abuse. The above data suggest, alternatively, that abuse during childhood may lead to other risk characteristics and to greater stress. These may act together to increase risk for abuse. The special child may have an independent influence on abuse.

POST-FARTUM EXTENDED MATERNAL-INFANT CONTACT: SUBSEQUENT MOTHERING AND CHILD HEALTH

In a double-blind study, 301 low-income primiparous women were randomly assigned to rooming-in (RI) or control (C) post-partum (PP) beds. C mother-Infant dyads (N=158) were together for 20 minutes every 4 hours for feedings during the first 2 PP days; RI dyads (N=143) were together 6 additional hours each day. Duration of data collection from medical and agency records after delivery (12-21 months) is equivalent between the 2 groups, as are the descriptive data. Analysis is based upon 134 RI and 143 C dyads; 9 RI (6%) and 15 C (9.5%) were lost to follow-up.RI and C children did not differ in average age, frequency of outpatient visits, or frequency of well baby or acute illness diagnoses. No RI and 6 C (4%) were seen for either pertussis or the common exanthematous diseases of childhood (p < .0.05). One RI and 9 C (6%) experienced parenting failure (PF) (p<0.05); no RI and 8 C were hospitalized for PF (p < 0.01). No RI and 9 C experienced abuse, neglect, abandonment or nonorganic failure-to-thrive (p < 0.01). One RI and 5 C were referred to social agencies for possible child maltreatment. No RI and 5 C children either died (1) or experienced foster care (p < 0.05).Extended post-partum maternal-infant contact may benefit subsequent mothering and child health.

Social-psychological characteristics of adolescent mothers and behavioral characteristics of their first-born infants

This study examined the child-rearing attitudes perceptions of infant temperament and mother-infant interactional behaviour of primiparous adolescent mothers in comparison to mothers having their first infant post-adolescence as well as the newborn behaviour of the infants born to these women. The total number of mother-infant pairs in the study was 317. Measures were taken of maternal attitudes maternal perceptions of infant temperament and behavioural characteristics of the infant. An observational system was also used. The lack of differences between adolescent and post-adolescent mothers was attributed to the prescence of a comprehensive prenatal care program. (authors)

Transactional approach to prediction of child maltreatment

The transactional-developmental approach was applied to a prospective longitudinal study of child maltreatment. Maternal background, infant constitutional, mother-infant interactional and maternal perception of infant temperament measures were entered into a multiple linear regression equation to predict child maltreatment. The results provide support for the transactional perspective in understanding the multiple determinants of early child maltreatment.

23 PROSPECTIVE STUDY OF FACTORS PREDISPOSING TO NON-ORGANIC FAILURE-TO-THRIVE (NOFT)

A 40 minute standarized interview (INT) based on factors previously associated with child neglect and abuse, was given to 1400 consecutive low income prenatal patients after informed consent. Using arbitrary criteria, 273 were selected as high risk (HR). NOFT (< 2/3 average weight gain due to inadequate feeding) was diagnosed and managed without knowledge of HR status. The incidence of NOFT in 228 infants born to HR mothers was compared to 200 infants selected randomly from all remaining mothers (LR). NOFT occurred in: 20 of 197 HR and 5 of 180 LR infants at age 2-18 weeks (p < .01): 16 of 159 HR and 4 of 132 LR at 8-18 weeks (p < .05): 14 of 110 HR and 3 of 110 LR at 18-32 weeks (p < .01). The correlations (r) of individual INT parameters with NOFT were determined in 274 mothers selected randomly from all 1400. Family life stress, and maternal (MAT) nurturance as child, support from others and parenting discipline skills had highest r (p < .05): MAT pregnancy attitude, personality traits and child development knowledge had lower r (p < .05). Non-INT parameters with highest r were poor MAT child-rearing attitudes at 8 months gestation and perception of her child as difficult to care for a 1 and 3 months; r approached p .05 for low birth weight and female sex of infant, and low MAT education. MAT age parity race and pregnancy complications, and Brazelton scores, had low r (p > .05).

86 RESPONSIVITY OF MOTHER-INFANT INTERACTION (MIA) AFTER EXTENDED POSTPARTUM CONTACT (EPP)

Mother-infant EPP in other studies enhanced parenting quality. To study how EPP might do this, low-income women were randomly assigned to EPP (n=62) or control (C, n=90) postpartum (pp) beds. EPP pairs averaged 9.3 more hours together during the first 48 than C. MIA observation data collected @ 1,3,6,12 & 18 months (m) pp were examined for probability of transition @ 5 sec. intervals between 4 dyadic states of interaction: both (B), infant (I), mother (M), or neither (N) responding. 14 of 60 comparisons of EPP vs C response transition (RT) probabilities by ANOVA were reliably different @ .05 or less. RT more likely among C were: partner acting in isolation (M→I; 1,12 m), M dropping out (B→I; 3,6,12 m), M not responding (I→I; 3 m), cessation of exchange (B→N; 6,12 m) & M stops signaling (M→N; 6,12,18 m). RT more likely among EPP were continuation & initiation of coacting (B→B, 12 m; M→B, 12,18 m). Two prevalent C RT {B→I (M drops out), M→N (M ceases)} in this study characterized in other research early MIA of nonorganic failure-to-thrive dyads. Of the other RT distinguishing EPP & C dyadic exchange, the 2 (B→B, M→B) more prevalent in the EPP group reflect continuation of or transition into coacting. Conversely, RT more frequent in the C group were: partner acting in isolation (M→I), M failing to respond (I→I), & discontinuation of exchange (B→N). EPP appears to enhance parenting through an intermediary influence upon responsivity of MIA.