Psychotherapy with Parent and Child in Failure-To-Thrive—Analogies to the Treatment of Severely Disturbed Adults

INFANTS AND CHILDREN WITH FAILURE-TO-THRIVE HAVE A HEIGHT and weight below the third percentile of normal for their age and sex. On physical examination and laboratory investigation, doctors find no organic disease or genetic defect to account for the problem. The children commonly show developmental delays in areas of motoric, cognitive, language, and/or personalsocial skills. Babies so affected are frequently rather uninterested in things and people; solemn or irritable. They may be inactive—or, instead, always restlessly on the go. They may refuse or regurgitate much of their food. Poor appetite and poor growth may be chronic—or may begin rather suddenly, tumbling them down the growth chart between two visits to the pediatrician.

In an outpatient project organized in 1978 at the Yale Child Study Center for the treatment of failure-to-thrive, it was the hypothesis of our therapy team that the central difficulty for each failure-to-thrive child lies in the impairment of a normal, mutually nourishing flow of communication and satisfactions between him and his primary caretaker. This had been described previously by several other clinicians. Some of our own clinical findings are described in the following pages. The giving