Failure to Thrive

1945

John Bowlby (1907–1990)

During World War II, thousands of British infants and children were in hospitals and orphanages because of the loss of parents and other caregivers. Many of these children were passive, listless, and physically smaller than normal. Although these children received adequate amounts of food, it was noticed that there was often little physical contact from caregivers. Early explanations were that the children were depressed due to the loss of their caregivers. It was from these observations that psychiatrist John Bowlby began a series of studies that highlighted the importance of attachment for healthy development.

Since many of these institutionalized children were below expected weight and height, the term failure to thrive was coined, and by 1945 it was in wide medical use. But it soon became apparent that children who lived with their families could also fail to thrive. This was the period when psychoanalytic theory was in its heyday in North America. As a result, psychological or psychosocial theories were offered to explain the illness. For example, some argued that a child failed to thrive because of emotional withdrawal or rejection by one or both parents, though most put the focus on faulty mothering: either the mother didn’t know how to provide proper care or she harbored hostility toward the child. Because failure to thrive was found more often in homes below the poverty line, psychosocial explanations such as cultural deprivation were also offered.

By the 1970s, behavioral psychologists showed that there were ways to use incentives and rewards to reinforce eating behavior, regardless of any underlying psychological problem in parent or child. More important, health psychologists and other researchers began to show that the major determinant of failure to thrive is simply insufficient caloric intake. While there remain cases in which the condition is the result of psychological problems, the vast majority of cases today are treated successfully by providing appropriate amounts of food.

SEE ALSO (Surrogate) Mother Love (1958), Attachment Theory (1969), The Strange Situation (1969)

Abandoned boy holding a stuffed toy animal amid ruins, following German aerial bombing of London, England. Photograph by Toni Frisell, 1945. The first systematic studies on “failure to thrive” were done with children whose parents were killed in the WWII bombing of London.