ORIGINAL ARTICLES Prospective study failure to thrive of antecedents for nonorganic The cause of nonorganic failure to thrive (NFT) was studied prospectively in 274 low-income pregnant mothers by interviewing them for characteristics that retrospective studies indicated were associated with child maltreatment. After delivery, medical charts of mothers and infants were reviewed for complications of pregnancy, delivery, and postdelivery hospitalization, and the infants were observed for growth failure. The characteristics of 15 families with infants who developed NFT were compared with those of 86 selected randomly from the remaining families. Interview results suggest that NFT correlates significantly with aberrant nurture during the mother's childhood and with conflicts between the parents of the infants. Perinatal events correlating significantly with NFT include complications of pregnancy, short gestation, and residual minor medical problems at discharge from the nursery. We speculate that these events predispose to NFT by disturbing the development of the mother-infant relationship. (J PEDIATR 106:360, i985) William A. Altemeier III, M.D., Susan M. O'Connor, M.D., Kathryn B. Sherrod, Ph.D., and Peter M. Vietze, Ph.D. Nashville, Tennessee, and Bethesda, Maryland NONORGANIC FAILURE TO THRIVE is defined as growth failure without an adequate organic explanation. Children with NFT are almost always younger than 2 years, and in most the onset is within the first few months after birth, v3 At diagnosis, patients often have some degree of develop- mental retardation and withdrawn social behavior.2'4-6 If the problem is not corrected early in infancy, some of these children remain small t, 2.7and have persistent cognitive and behavioral disorders. ~' s.9NFT is considered to be a form of From the Department of Pediatrics, Vanderbilt University Hospi- tal; the Department of Psychology, Peabody College/Vanderbilt University; and the Mental Retardation Research Centers, National !nstitute of Child Health and Human Development. Supported by the National Center On Child Abuse and Neglect; Children's Bureau Administration on Children, Youth and Fam- ilies; Office Of Human Development Services, U.S. Department Of Health, Education and Welfare (Grants 90-C-419 and 90-CA- 2138); William T. Grant Foundation; the National Institute of Mental Health (Grant RO1 MH31195-01); and John F. Kennedy Center for Research in Mental Retardation and Human Develop- ment (Grant HD 15052). Submitted for publication May 4, 1984; accepted Aug. 17, 1984. Reprint requests: William A. Altemeier III, M.D., Department of Pediatrics, Metropolitan Nashville General Hospital, 72 Her- mitage Ave., Nashville, TN 37210. maternal neglect, because rapid improvement in both growth and development follows adequate nutrition and emotional support in the hospital4' ~0; however, why some mothers fail to provide these basic needs has not been established. Retrospective studies have described many characteris- tics within families of infants with NFT, but findings have not always been uniform. Most of the mothers live in suboptimal environments, 8'H'~2 although some are from middle or upper economic strata. 1'3 Many are depressed 6' ~3 and isolated,2 although some may be aggressive and NFT Nonorganic failure to thrive manipulative. ~3 These women may have increased family stress,3, t3. ~4 psychiatric disorders, 6 and decreased support from family, friends, and the fathers of their children.2,6,~5 However, when examined by Mitchell et al., 7differences in marital status, household composition, or maternal employment were not found, and Pollitt et al. 16could not identify differences in psychiatric status. Much of the existing research is retrospective and consequently is deficient, depending on data collected from families already identified. This introduces the question of whether unique characteristics of the mother preceded or 360 TheJournalofPEDIATRICS