Child Abuse and Failure to Thrive: Individual, Familial, and Environmental Characteristics
Dubowitz, Howard, Zuckerman, Diana M., Bithoney, William G., Newberger, Eli H., Violence and Victims
Similar theories of etiology have been postulated for child abuse and nonorganic failure to thrive (FTT). This study compared individual, familial, and environmental conditions in cases of child abuse to cases of FTT. Assessment of the mother's childhood home, supports, current living situation, attitudes toward her child, and child characteristics (such as temperament, social maturity, and complicating medical conditions) showed the groups to be remarkably alike. The major significant difference was that although both groups were poor, the abuse group was even more impoverished and lived in more crowded conditions than the families with a child with FTT. These data suggest a common etiologic context for different pediatric social illnesses and the need for a broad collaborative approach by pediatricians and colleagues in related disciplines.
Child abuse and nonorganic failure to thrive (FTT) have been described as two pediatric social illnesses (Newberger, Reed, Daniel, Hyde, 8c Kotelchuck, 1977). The former is understood as an act of commission, the latter as the result of acts of omission.
Nonorganic FTT refers to inadequate growth in infants and young children, in whom no organic basis is uncovered. Although the final pathway may involve a disturbance in the feeding-eating-digestion process, some researchers have stressed the contribution of child characteristics such as difficult temperament (Chess, Thomas, & Birch, 1978), others have emphasized negligent parenting (Pollitt, Eichler, 8c Chan, 1975), and other studies have concluded that stressful environmental circumstances compromise parents' abilities to nurture their children (Egeland, Breitenbucher, & Rosenberg, 1980; Gates 8c Yu, 1971).
More recently, a multifactorial FTT model has been conceptualized that integrates parent and child factors, a problematic parent-child relationship, and a difficult social environment (Bithoney & Dubowitz, 1985). Rather than a single causal factor, such as maternal depression, multiple and interacting contributors result in FTT.
Child abuse has been defined narrowly in some studies and broadly in others, but the common thread has been inflicted injury. As with FTT, many theories of the etiology of child abuse have been proposed. These implicate parental psychopathology (Kempe et al., 1962; Cohen, Raphling, 8c Green, 1966), poverty (Pelton, 1978), child factors (Friedrich & Boriskin, 1982), stress (Egeland, Breitenbucher, & Rosenberg, 1980), maternal rejection of her child (Rohner, 1975), and societal tolerance of violence (Gil, 1970). Similar to the multifactorial approach to FTT, variables associated with child abuse have been integrated into an ecological theory that incorporates a range of factors, including individual behavior and societal influences (Garbarino, 1982). Thus, child abuse and FTT can be understood as different symptom manifestations with many similar psychosocial underpinnings, such as poverty, stress, characteristics of a "difficult" child, and limited parental resources.
Based on previous research, one can postulate common patterns in the development of child abuse and FTT. Several studies have suggested an association between child abuse and FTT (Koel, 1969; Goldson, Cadol, & Fitch, 1976; Gates, 1984; Gates 8c Hufton, 1977), but few have directly compared the two phenomena. The goal of this study is to compare directly important individual, familial, and environmental similarities and differences between child abuse and FTT. The hypothesis, suggested by the work of Newberger, Hampton, Marx, and White (1986), is that considerable overlap exists between the etiologies of these two phenomena.
The data are drawn from a case-comparison study conducted at The Children's Hospital in Boston.1 All the children in the study were hospitalized and under 4 years of age. In previous reports based on this study population (Newberger et al. …