Haynes C F, Cutler C, Gray J, Kempe R S
Child Abuse Negl. 1984;8(2):229-42. doi: 10.1016/0145-2134(84)90012-7.
This paper describes the characteristics of thriving and failure to thrive (FTT) children and their mothers and examines the effect of short-term lay health visitor intervention in cases of nonorganic failure to thrive (NO FTT). Twenty-five FTT children and mothers received lay health visitor (LHV) intervention in addition to other community and medical treatment; 25 other FTT children and mothers did not receive the LHV intervention but did receive all other medical and community treatment. Twenty-five thriving children and mothers were matched with the FTT children and mothers in the LHV group on the child's age at intake, sex, birth weight, and the mother's age, ethnicity, and number of living children. At initial assessment, the FTT and thriving groups were found to be comparable on demographic factors, infant birth weight percentiles, apgar scores, complications of pregnancy or delivery, and separations in the newborn period. There were more premature births in the LHV group although the proportion of premature births for the FTT and thriving groups overall were similar. A majority of mothers in the FTT groups had negative memories of childhood in contrast to more positive memories in the thriving group. At initial assessment, the majority of thriving children were developmentally normal and had increased from their birth weight percentiles whereas all of the FTT children had decreased from their birthweight percentiles and over half were developmentally delayed. There were clear differences in mother-child interaction patterns in the thriving and FTT groups. Three patterns of interaction were identified in the FTT group: benign neglect, incoordination, and overt hostility. Intervention had no measurable effect on the child's weight, development, or interaction patterns. Only 8 of 37 FTT children reevaluated 6 months later showed "catch up" growth and only 7 had improved in developmental score category. Patterns of interaction were found to persist over the 6 months in all cases. One to three year follow-up of 44 families emphasized the severity of the condition and the need for differentiation of the severity of the disturbance in the mother-child relationship and for more intensive intervention than was available in this study. Of these 44 cases, 2 children had died, 5 had been physically abused or further neglected, and 10 were in alternative care arrangements.
本文描述了发育良好和发育迟缓（FTT）儿童及其母亲的特征，并研究了短期非专业健康访视员干预对非器质性发育迟缓（NO FTT）病例的影响。25名发育迟缓儿童及其母亲除接受其他社区和医疗治疗外，还接受了非专业健康访视员（LHV）的干预；另外25名发育迟缓儿童及其母亲未接受LHV干预，但接受了所有其他医疗和社区治疗。25名发育良好的儿童及其母亲在儿童入院时的年龄、性别、出生体重以及母亲的年龄、种族和子女数量方面与LHV组的发育迟缓儿童及其母亲相匹配。在初始评估中，发现发育迟缓组和发育良好组在人口统计学因素、婴儿出生体重百分位数、阿氏评分、妊娠或分娩并发症以及新生儿期分离情况方面具有可比性。LHV组的早产情况较多，不过发育迟缓组和发育良好组总体上的早产比例相似。与发育良好组母亲更多积极的童年记忆相比，发育迟缓组的大多数母亲对童年有负面记忆。在初始评估中，大多数发育良好儿童发育正常，出生体重百分位数有所增加，而所有发育迟缓儿童的出生体重百分位数均下降，且超过一半发育迟缓。发育良好组和发育迟缓组的母婴互动模式存在明显差异。在发育迟缓组中识别出三种互动模式：良性忽视、不协调和明显敌意。干预对儿童的体重、发育或互动模式没有可测量的影响。6个月后重新评估的37名发育迟缓儿童中只有8名显示出“追赶”生长，只有7名在发育评分类别上有所改善。在所有病例中，互动模式在6个月内持续存在。对44个家庭进行的1至3年随访强调了该病症的严重性，以及区分母婴关系障碍严重程度的必要性，还强调了需要比本研究中提供的更强化的干预措施。在这44个病例中，2名儿童死亡，5名遭受身体虐待或进一步被忽视，10名被安置在替代照料安排中。
