Abstract
M.Ed.
Failure-to-thrive syndrome presents itself as severely inadequate weight increase in
children under the age of five without any organic aetiology. It is found particularly in
developing countries, constituting about half the malnutrition figures for children under five.
Failure-to-thrive research has shown that this is a complex syndrome for which it is difficult
to find an aetiology. There are frequently signs of disrupted emotional bonding between
mother and child, as well as problematic mother-child interactions. However, the maternal
attributes which contribute to the phenomenon are not yet fully understood. Intervention is
usually unsuccessful. This study aims to investigate the role of the mother in order to
increase understanding of the failure-to-thrive phenomenon.
The research design is qualitative, explorative, descriptive and contextual. A multiple casestudy method was used. Three mothers were selected for the study. Data was gathered by means of interviews, supplemented by the observation of interactions and the researcher's own impressions. The interviews were videotaped in their entirety, and were transcribed verbatim afterwards. All data sources were synthesised in the form of case studies. Then the data was interpreted in the light of object-relation theory.
The results suggest the importance of several factors already present before the birth of
the child, including inadequate emotional care during the mothers' own childhood, and
maternal inability to control their emotions. In all the cases studied, the pregnancy was
unplanned and additional external stressors made the pregnancy more difficult. These
mothers experienced their children as a threat, as competition or as symbols of their
powerlessness. These mothers described their children as "wild" and demanding.
Observation of interactions indicated that this type of behaviour in the children may be an
attempt to attain affection from their mothers, or an anxious reaction to the mothers'
inability to set limits. The restlessness of these children exacerbated the mothers' sense of
inadequacy and contributed to a vicious cycle.
These mothers were unable to provide what Winnicott describes as "good enough
mothering". They were too emotionally needy themselves. Observations of interactions
revealed an inability to adjust to the needs relevant to the children's age groups,
inadequate responsiveness, inconsistency, instrumental care and a lack of involvement.
It appeared that these mothers had themselves not been mothered enough during their
own early development, so that they could not internalise these attributes. Their
descriptions suggest inadequate environmental provision for what babies need in their first
year of life to experience the world as a secure place, to reach personal integration and to
interact trustfully with others. This early deprivation of the mother obviously has implications for the way these women treat their own children at the age when these mothers themselves were neglected as children. Suggested intervention tends to focus on support and mothering for the mothers, but the most appropriate type of intervention is individual psychotherapy which allows adequate internalisation of the "good mother" image. This would facilitate personal integration, enabling the mother to focus on her child's needs, freed from her own.