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In this paper we describe the treatment of an infant boy who was referred to our Infant Mental Health program at 5 months of age in a grave nutritional state. The baby was starving. His growth curve showed an ominous downward plunge which our pediatricians read as the profile of an infant who was moving toward the critical (and sometimes irreversible) state which is broadly covered by the term “failure to thrive.” The term “failure to thrive” describes those infants who show growth failure in the absence of any organic cause. In strict usage it is employed for infants whose weight has fallen below the third percentile. It is almost universally associated with the impairment of the mother's capacity to nourish both in the concrete and in the psychological sense of the word.
The typical course of medical treatment for a failure-to-thrive infant is hospitalization with intensive one-to-one nursing care. With nurse-mothering and the introduction of a good nutritional regime, the baby begins to thrive. When his nutritional state is stabilized, he returns to his home. Typically, these gains are lost within a few weeks and the baby may return to the hospital again - and the cycle renews itself.
It is the mother who is the key. Whether or not the baby will thrive outside of the hospital depends upon the mother's capacity to follow the medically prescribed regime to insure adequacy in caloric intake for her baby and to provide the psychological nutriments for growth and development. But the dietary advice given by the
hospital and the later guidance which focuses only on caloric intake and omits the developmental needs of infants are not successful (Whitten et al., 1969). All reports agree that families of failureto-thrive infants are difficult to reach and to engage in continuing contracts. However, a more favorable outcome is reported by Leonard et al. (1966) and Barbero and Shaheen (1967) when mothers were able to collaborate with the physician, social worker, or public