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The principal theme of this paper concerns the relation between an infant's failure-to-thrive (hereafter referred to as FTT) and the capacity of the mother to be attentive to that infant (in the very specific senses which will be discussed). In the case that I will describe this capacity is determined partly by the mother's depression and partly by her marital problems.
FTT involves a failure to grow and gain weight either from birth or after a period of normal physical development There are standardized centile charts on which a child's growth can be compared with others of his age. Those who are consistently below the third centile in weight or have a reduction in growth weight are the ones who give rise to concern and might be diagnosed as FTT. The causes of FTT may be organic, non-organic or, more commonly, a mixture of the two. One feature which is common to all FTT cases, however, whether of organic or non-organic origin, is the occurrence of a feeding problem.
At this point we may usefully move on to examine several theoretical ideas which inform my work with children and parents and more specifically with FTT cases.
Melanie Klein (1952) said that the infant is a “human object related from birth”. Her view was that mental development started from the relationship between the instinctual needs of the baby, on the one hand, and the personality and caring capabilities of the mother, on the other. Winnicott (1965) defined the “good enough mother” in terms of her capacity for “maternal preoccupation”, which he considered to be a pre-condition for a baby's emotional and physical development. Bion (1962) termed this characteristic “reverie” and argued that its function was to “contain” the baby's undigested emotional and physical experiences.
These ideas, amongst others, were substantiated and elaborated when E. Bick introduced her method of direct mother-infant observation in the 1950s (Bick, 1964). Bick described how the mother's attention acts as a sort o