234 Archives of Disease in Childhood 1994; 70: 234-236 Eating habits and attitudes of mothers of children with non-organic failure to thrive Arch Dis Child: first published as 10.1136/adc.70.3.234 on 1 March 1994. Downloaded from Jacinta B McCann, Alan Stein, Christopher G Fairburn, David B Dunger Abstract sidered whether particular diets (for example, a The eating habits and attitudes concern- macrobiotic diet), adversely influence the ing body shape and weight among 26 growth of young children.9 10 In one case mothers of children with non-organic series consisting of seven children, parental failure to thrive (the index group) were health beliefs appeared to lead to restriction of studied using the eating disorder exami- children's food intake."I nation. They were compared with equiva- Two case series have reported that the lent data on 26 individually matched children of mothers with eating disorders women who participated in a large com- (anorexia nervosa or bulimia nervosa) have munity survey. The index mothers' views feeding difficulties or poor weight gain.12 13 In oftheir child's weight and shape were also one, some mothers with bulimia nervosa studied. admitted to slimming their babies. 14 In a The principal findings were, firstly, that Danish retrospective study of mothers with when compared with the comparison anorexia nervosa a significant number recalled group, mothers of children with non- that their children had growth and/or feeding organic failure to thrive had higher levels difficulties in the first year of life.15 These of dietary restraint. Secondly, despite findings raise the question as to whether the their child's low weight, 50% of the index presence of eating disorder psychopathology in mothers were restricting their child's mothers may be an aetiological factor in the intake of 'sweet' foods, and a further 30% development of non-organic failure to thrive in were restricting foods they considered their children. 'fattening' or 'unhealthy'. The aim of this study was to determine These results raise the question of whether disturbed eating habits and attitudes whether maternal eating habits and atti- to body shape, weight, and food are more tudes have a causal role in the genesis of common among mothers of children with non- non-organic failure to thrive. They organic failure to thrive than among mothers suggest that carefui inquiry about the from the general population. http://adc.bmj.com/ mothers' eating habits and attitudes is needed when assessing children with non-organic failure to thrive. Subjects and methods (Arch Dis Child 1994; 70: 234-236) SUBJECTS Twenty six children with non-organic failure to thrive were identified from the patient lists of Failure to thrive in young children accounts for two Oxfordshire consultant paediatricians (the on September 30, 2021 by guest. Protected copyright. between 1% and 5% of paediatric admissions index group) having been referred by family to hospital.' Thirty to forty per cent of such doctors in the previous three years. The criteria children are given the diagnosis of 'non- for entry into the study were that the child's organic failure to thrive', with no sufficient weight at referral was at, or below, the third physiological cause being found.2 population centile.16 17 In addition, the study Section of Child and The aetiology of non-organic failure to was restricted to singleton children whose birth Adolescent Psychiatry, thrive has received much attention over recent weight was above 2500 g, with a gestation of Oxford University Department of years. It has sometimes been viewed as result- greater than 37 weeks. Psychiatry, Park ing from emotional deprivation,3 4 although Hospital for Children, this concept has increasingly been called into Old Road, Headington, ASSESSMENT Oxford OX3 7LQ question. The presence of adverse environ- Jacinta B McCann mental factors influencing non-organic failure Subjects were assessed by interview which Alan Stein to thrive has also been observed.5 Another comprised of two parts. The first consisted of from the that when an examination of the mothers' eating habits Oxford University viewpoint stems finding Department of children present with non-organic failure to and attitudes, using the eating disorder exami- Psychiatry, Warneford thrive, their nutritional intake appears to be nation. This is a validated investigator based Hospital, Oxford authors take the view that interview which assesses the clinical features of Fairbum deficient.6 Many Christopher G whatever the primary aetiology, inadequate eating disorders.18 Five subscales may be Department of energy intake is the final common pathway of derived from its ratings, the key ones being Paediatrics, John the growth failure in non-organic failure to eating restraint, shape concern, and weight Radcliffe Hospital, disorder examination also Oxford thrive.7 8 Some studies have focused on how concern. The eating David B Dunger the nutritional intake of children with non- generates operational Diagnostic and Statistical failure to thrive becomes inadequate, Manual of Mental Disorders, third edition, Correspondence to: organic Dr McCann. although no systematic research has been revised (DSM-III-R) eating disorder Accepted 3 November 1993 undertaken. In a Dutch study, researchers con- diagnoses. Eating habits and attitudes ofmothers ofchildren with non-organicfailure to thrive 235 For comparison purposes, equivalent data concern; 31% (eight mothers) were relieved were extracted on an individually matched that their child's difficulties with poor weight subgroup of mothers who participated in a gain were being acknowledged. The time Arch Dis Child: first published as 10.1136/adc.70.3.234 on 1 March 1994. Downloaded from large community based study ofthe prevalence interval between the child's poor weight gain of eating disorder features among women being first noted by the primary health care (C G Fairburn et al, unpublished). Each index team and subsequent referral ranged from one mother was paired with the mother who month to three years. The mothers who had to matched her most closely on the following wait longer for referral became particularly criteria: (i) number of children, (ii) social class, concerned about their child's poor weight gain. (iii) maternal age. Sixty one per cent (16 mothers) reported The second part of the interview addressed blaming themselves for their child's poor the following topics: (A) The events leading up weight gain, feeling that they had not done suf- to the referral to the paediatrician. (B) ficient to ensure adequate weight gain. They Attitudes and feelings of the mother towards recalled feeling angry towards their child, as the referral and the follow up procedure. (C) they had devoted much effort in attempting to The mother's views on her child's weight and increase their child's weight without success. shape: for example, they were asked specifi- After referral, 84% (22 mothers) believed that cally whether they considered their child of the greatest benefit was being reassured that normal weight and if not, what they felt the there was no underlying organic cause. Sixteen degree of underweight might be. per cent (four mothers) remained worried that Mann-Whimey U tests were carried out to 'something had been missed'. Some mothers compare the index and comparison mothers' felt that being asked to attend for follow up eating disorder examination scores. The paired t appointments at the hospital undermined the test was used to compare change between refer- previous reassurance given. ral and discharge measures of the childrens' weight deficit for height. MOTHERS ATTITUDES TO CHILD'S WEIGHT AND SHAPE Results Despite each child's weight being at the third CHARACTERISTICS OF THE SAMPLE centile or below, 58% (15 mothers) believed Of the 26 children identified, 10 were boys, 16 their child to be of normal weight or just were girls and their mean (SD) age was 3-8 slightly underweight. Thirty eight per cent (10 (2 0) years (range 0-9-9-6). The mean age of mothers) perceived their child's shape as the index mothers was 30 1 (4 0) years (range normal, with a further 34% (nine mothers) 24 3-38 8), while that of the comparison stating that their child was only slightly thin. group was 29-7 (3 5) years (range 24-1-38-0). Thirty eight per cent (10 mothers) described There was no significant difference between their child being a somewhat finicky eater, and the body mass index of the two groups (mean a further 23% (six mothers) reported that their http://adc.bmj.com/ (SD) 23-78 (3 30) in the index group v 23-87 child was extremely finicky. A wide range of (4.26) in the comparison group). foods were reported as being refused, particu- All birth weights were at or above the 10th larly foods that had a 'coarse' texture. As a centile (mean 25th centile, range lOth-75th result of their child's finicky eating, mothers centile). From birth to the referral, all demon- described mealtimes being mostly tense, as strated deteriorating growth and had crossed they 'battled' over food intake with their child. major centile lines. At referral, the mean Fifty per cent (13 mothers) stated that they on September 30, 2021 by guest. Protected copyright. weight deficit for height was 22-3% (range restricted their child's intake of 'sweet' foods 100/o-32%). All children were investigated and such as sweets, chocolate, and biscuits; 30% none were found to have an organic cause for (eight mothers) admitted to restricting other their failure to thrive. types of food (for example, fried foods, meat, nuts), as they considered them to be unhealthly and possibly fattening. After refer- EATING HABITS AND ATTITUDES OF THE ral, 54% (14 mothers) attempted to increase MOTHERS their child's food intake by having more fre- None of the mothers in either group fulfilled quent meals and increasing the quantity of DSM-III-R diagnostic criteria for anorexia food given.