Some children fail to thrive despite apparently adequate intakes and no evidence of underlying illness. Some are subject to physical and/or emotional abuse and have psychosocial deprivation (PSD), 'non-organic failure to thrive,' or 'emotional deprivation syndrome.' If children are not stimulated by face to face contact and communication with parents and carers, if they are verbally and/or physically abused, or if they are neglected and ignored, the silent response may be growth failure. Affected children may show other signs of emotional distress. They are withdrawn, devel-opmentally delayed, rarely smile, and avoid eye to eye contact. Sometimes they seek attention through destructive, aggressive, and disturbing behavior or steal food, raid dustbins for food, or eat the leftovers on their schoolmates' plates, and yet show no weight gain.
The process inhibiting normal growth in PSD is likely to be multifactorial and to vary with individual circumstances. In some cases, affected children have not received sufficient food for normal growth. In other cases, food may have been offered but misery and fear prevented the children eating it thus subjecting them to further ridicule or punishment because of unfinished meals. Some children, who appear to have been given adequate food and yet fail to grow, may have elevated metabolic rates and increased energy needs secondary to anxiety and stress. A few studies suggest the growth problem in PSD can be linked to neuroendocrine abnormalities secondary to stress. Levels of growth hormone and adrenocorticotrophic hormone have been low in some children studied in their adverse environments. Changes to loving, caring, and stimulating environments result in rapid resolution of the endocrine abnormalities.
The treatment of nonorganic failure to thrive is to change the caring environment either by support and help for affected families or, in difficult cases, removal of affected children from their homes on a temporary or permanent basis. Proof of the diagnosis comes with rapid onset of vigorous catch up growth and positive changes in behavior following improvement in the home environment without other specific treatment.
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