Maternal deprivation syndrome

Definition

Maternal deprivation syndrome is a form of failure to thrive that is caused by neglect (intentional or unintentional).

Alternative Names

Nonorganic failure to thrive

Causes, incidence, and risk factors

The majority of cases of failure to thrive in infants and young children (under 2 years old) are not caused by disease. Most cases are caused by dysfunctional caregiver interaction, poverty, child abuse, and parental ignorance about appropriate child care. Such cases are considered "nonorganic" failure to thrive. Failure to thrive in children less than 2 years old is defined as failure to gain adequate weight, failure of linear growth, and failure to achieve some or all developmental milestones.

In maternal deprivation syndrome, although the mother or other primary caregiver may appear concerned, the interplay and physical contact normally seen between mother and infant may be absent or distorted.

Factors that may contribute to maternal deprivation syndrome include:

• Young age of parent (teenage parents)
• Unplanned or unwanted pregnancy
• Lower levels of education (especially failure to complete high school)
• Lower socioeconomic status
• Absence of the father
• Absence of a support network (family, close friends, or other support)
• Mental illness, including severe postpartum depression

Symptoms

• Decreased or absent linear growth ("falling off" the growth chart)
• Lack of appropriate hygiene
• Interaction problems between mother and child
• Weight less than the 5th percentile, or an inadequate rate of weight gain

Signs and tests

Careful evaluation by a doctor is the first step. A physical exam, medical history, and simple laboratory tests can be used to rule out major medical illnesses as the cause. The doctor will closely examine the patient's growth chart.

The doctor should involve family members and social service agencies to help the mother. A child's feeding should be gradually increased to 150 calories/kg/day.

If the doctor is concerned for the child's safety or treatment has not been successful, the child may need to stay in the hospital.

Treatment

Treatment of failure to thrive is a major undertaking which requires the input of a multidisciplinary team including physicians, nutritionists, social workers, behavioral specialists, and visiting nurses.

Many programs are available for young parents, single parents, and parents having other problems. Referrals should be made as early as possible to appropriate programs.

Helping extended family members recognize that a problem exists and recruiting their help will provide increased support for the mother and infant.

Expectations (prognosis)

With adequate attention and care, full recovery is expected. However, neglect severe enough to cause failure to thrive can kill if it continues.

Complications

• Abandonment
• Developmental delay
• Abuse

Calling your health care provider

Call for an appointment with your health care provider if your child does not seem to be growing or developing normally. Also, ask for the provider's advice if you think you don't know how to properly care for your child, or if you are overwhelmed by feelings of sadness or other problems, and fear you may harm your baby.

Postpartum depression and other mental illnesses may make caregivers feel hopeless and unable to properly care for their children, but there are resources and help available -- there is no shame in asking for help.

Prevention

Education is an important part of prenatal care. Parenting classes and support groups are often available and should be strongly encouraged.

Early intervention programs are specifically designed to bring together the necessary resources to assist children with failure to thrive. The earlier high-risk parents become involved with such programs, the better the child does.

References

Bauchner H. Failure to thrive. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 37.