Public zyxwvutsrqpo Health Nursing Val. 12 No. zyxwvutsr 4, pp. 262-268 zyxwvut 0 Blackwell Science, Inc. 0737- 1209/95/$10.50 The Use of Human Ecology and Epidemiology in Nonorganic Failure to Thrive Elizabeth Reifsnider, Ph.D., R.N.C., WHCNP Abstract Children with nonorganic failure to thrive (NOFTT) comprise a population at risk for small stature, poor growth, slower development, and lower intellectual outcomes. These chil- dren are often seen in the Women, Infants, and Children Supple- mental Nutrition Program (WIC) and child health clinics and in caseloads of high-risk families. Public health nurses may not be sure how to intervene in the problem of NOFTT because of its multifactorial etiology. zyxwvutsr A model of nursing care that addresses the many factors that affect the development of NOFTT can enable the public health nurse to appropriately care for the child with NOFTT. The Eco-Epi model, a combination of human ecol- ogy and epidemiology, is a conceptual model that can provide a framework for the public health nurse to plan interventions. Even though children with NOFTT are the target population for this model, it can be applied to other public health nursing populations at risk for multifactorial problems. In the Eco-Epi model, the epidemiological concepts of agent (food), host (child), and environment (home) are examined in the context of the microsystem (parent-child interaction, daily activities of the fam- ily), the mesosystem (interactions between different environ- ments), and the exosystem (the child’s community). The concepts of microsystem, mesosystem, and exosystem are from the theory of human ecology. Examples of how the model works to assess a family and design interventions are provided. zyxwvutsr Elizabeth Reifsnider is an Assistant Professor at The University of Texas at Austin, School of Nursing, Austin, Texas. Address correspondence to Elizabeth Reifsnide6 Ph.D., R.N.C., WHCNP, UTA School of Nursing, I700 Red River; Austin, zyxwvu TX 78701. INTRODUCTION The health of future populations in our country depends on the health of our children today. Predictable growth along established parameters is one characteristic of healthy children. But some children are vulnerable to ill health, and one marker of their vulnerability is their poor growth pattern. Nonorganic failure to thrive (NOFTT) is growth failure when no organic cause can be found for lack of growth. It is common among children in underdeveloped countries and in low-income populations in the United States (USDHHS, 1991; Barrett zyx & Frank, 1987). Growth failure in infancy and early childhood is associated with small stature and lower intelligence when the child is an adolescent (Mitchell, Gorrell, & Greenberg, 1980; Oates, Peacock, & Forrest, 1985).Clearly NOFTT can be consid- ered a threat to optimal health for many children. Research- ers are interested in testing interventions for NOFTT that can be applied in practice by clinicians. In order to over- come NOFTT, clinicians and researchers need a model to guide the development and testing of interventions that will improve the growth of children with NOFTT. One such model is elaborated in this article. Although nonorganic failure to thrive (NOFTT) affects one in seven black children from low-income families who are less than one year of age, and one in six Hispanic children year of age from low-income families, health pro- fessionals know little of its origins or how best to intervene (USDHHS, 1991). Available data point to the mother’s psychosocial history, family support, and the family life- style as potential triggering events (Altemeier, 0’ Connor, Sherrod, & Vietze, 1985). Researchers also note the simi- larity between failure to thrive and chronic childhood mal- nutrition, as seen in many parts of the developing world (Barrett & Frank, 1987; Bithoney et al., 1989). Children who fail to thrive due to nonorganic causes are a concern for public health nurses because NOFTT is often 262