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Release: Immediate

UI research helps children attain normal growth

IOWA CITY, Iowa -- For many parents, getting children to eat certain foods can be a challenge. But what happens when a child refuses to eat just about everything, to the point where he or she falls behind in normal growth?

Researchers at the University of Iowa College of Medicine are studying behaviors associated with failure to thrive (FTT), a term applied when children do not gain weight at an expected rate and persistently weigh less than normal for their age. They hope to identify strategies that parents can use to keep their children's growth on track.

Much more than just finicky eating, the meal behaviors associated with FTT may require hospitalization to change. "When these children are admitted, their parents have tried everything," says Linda Cooper, a pediatric psychologist at the UI Hospitals and Clinics. "It usually takes 14 to 16 days to get a good handle on treatment."

Cooper's research, funded by the National Institute of Mental Health, centers on eight children hospitalized for FTT, ages 18 months to 4 years. Though each case is different, children with FTT often resist other parental demands in addition to eating. They may refuse to pick up toys or brush their teeth, suggesting a problem deeper than just aversion to food.

"More kids than expected showed problems outside of meal times," Cooper says, adding that only two children refused to comply almost exclusively at meals. Still, getting children to eat posed greater challenges than other activities in all cases.
"There may be factors unique to meals," Cooper says. "One direction for future research might be to focus on other reinforcers during meals or physiological interventions like appetite stimulants."

Working with parents, Cooper and other researchers sought strategies to increase children's compliance during meals and in other situations. They compared different degrees of positive reinforcement, from simple praise to play with favorite toys, when children obeyed requests.

Cooper found that children were more likely to comply with requests that carried a greater degree of positive reinforcement and that the strategies used at meal time were also effective with other tasks. Her study shows that effective reinforcers can be identified during meals and applied across situations.

The root causes of FTT remain elusive and are likely different for different children, but the problem can be treated. Cooper notes that of 22 children admitted to the UIHC, 20 showed catch-up growth while in the hospital. Of the 17 surveyed after discharge, 16 continued to show progress.

Cooper hopes to help parents keep using treatment strategies once their children go home from the hospital. "Once we have a plan in place, we have no mechanism of going into the homes," she says. Nevertheless, her research shows that parents can adopt methods that lead to greater compliance and improved growth.