‘Failure to Thrive,’ or a Failure to Investigate?

The word “failure” is rampant in medicine. Hearts, livers, lungs, and kidneys all “fail,” which simply means they cease to do their job. But the failures that patients tend to remember are the ones that seem to indict not an organ but an entire person. Just ask anyone who has been told that they have “failed” vaginal delivery (meaning that labor was slow or the cervix didn’t dilate) or “failed” chemotherapy (meaning that the tumor didn’t respond to treatment).

Worst among these phrases, many doctors say, is a common diagnosis for both infants and older adults: “failure to thrive.”

In pediatrics, the term refers to infants who struggle to hit key milestones in size, weight and cognitive development. When Dr. Deborah Frank, a retired pediatrician, was in medical school in the 1970s, the diagnosis meant one of two things: “Either you had major congenital heart disease or cystic fibrosis, or you had a bad mother,” she said. “Or maybe you had both.”

If the term sounds slightly accusatory, that’s because it is. It arose from the idea that struggling infants were ailing not because of any underlying disease or lack of nutrients but because of poor parenting.

The first known appearance of “failure to thrive” was in the 1933 edition of a medical textbook, “The Diseases of Infancy and Childhood.” An explanation for the condition came near the end of World War II, when René Spitz, an Austrian psychoanalyst, observed that infants in a Mexican orphanage tended to be listless, scrawny and slow to develop.

This concerning syndrome, Spitz surmised, resulted from a lack of “maternal affection, maternal care and maternal love.” Pediatrics took the idea and ran with it​ — “in the fine old tradition of mother-blaming,” Dr. Frank said. (A similar psychoanalytic idea that became popular around this time was “refrigerator mother theory,” which posited, incorrectly, that autism was caused by “cold mothering.”)

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