Death caused by "Failure to Thrive" (FTT)

Question

This question, whilst to a degree can be seen as "common sense" in some respects, has puzzled me in other ways.

Looking at the situations where Failure to Thrive (FTT) can cause death, even the Wikipedia article for it mentions mental issues as an endogenous cause, while there can also be one or more of both endogenous and exogenous causes.

I am intrigued by the mental issues for FTT deaths. What kind of mental issues, other than the obvious such as anorexia, can cause death due to FTT.

I am particularly interested in the cases where babies die due to FTT even though they have been fed, such as in orphanages.

Looking at a situation in Romania, I remember news reports during the dictatorship of Nicolae Ceaușescu, where there were large numbers of young children under 5 dying in orphanages due to FTT. I cannot find any reference to this online, however there is an APA report (Weir, 2014) which mentions institutional neglect causing developmental delays.

As well as developmental delays, can neglect through lack of emotional care be the cause of death through FTT? If so, how does the death occur even if nutritional needs are met?

References

Weir, K. (2014). The lasting impact of neglect. Monitor on Psychology 45(6), 36. Retrieved from: https://www.apa.org/monitor/2014/06/neglect

Answer 1

The reason for failure to thrive other than insufficient nutrition, can be suppressed growth hormone secretion due to emotional neglect. In the following example, both the emotional neglect and insufficient nutrition were combined, though:

Psychosocially stunted growth masked as growth hormone deficiency, (Klinische Pediatrie, 1999):

Short stature is a common reason for presenting a child to the pediatrician. Emotional deprivation may cause short stature and may simulate growth hormone deficiency. Diagnosis of emotional deprivation as the cause of growth retardation is difficult and misdiagnosed frequently despite of suspicious clinical signs. We report on 2 patients with growth retardation because of emotional deprivation. At the age of 5 years both children had a severe growth hormone deficiency. They received therapy with growth hormone and showed an increase of growth velocity to > or = 8 cm in the first year of treatment. But in the third year of treatment both patients showed a diminished response to the growth hormone therapy. During the period of observation the features of emotional deprivation became obvious through the extreme behavioural abnormalities. Both children showed disturbances in their social behaviour, and striking disorders concerning eating and digestion. The families of these children had severe social problems; alcoholism, low income and rejection of the child were risk factors. Removal from the current environment led to a characteristic increase of the growth velocity. Growth hormone deficiency was spontaneously reversible, so that treatment with growth hormone was terminated. The social environment and the psychical prosperity are essential growth factors in childhood and adolescence. The common features and risk factors of emotional deprivation are described. Spontaneous catch-up growth after removal from the current environment distinguishes this form of short stature from the other organic growth disorders.

Hopkins Medicine says that:

Other factors that may lead to failure to thrive:

• Emotional deprivation as a result of parental withdrawal, rejection or hostility

and

Problems with the endocrine system, such as thyroid hormone deficiency, growth hormone deficiency or other hormone deficiencies...

...some of which might be triggered by emotional neglect despite proper nutrition:

Failure to grow: lack of food or lack of love? (Professional Care of Mother and Child, 1994):

One of the most important criteria for good health in childhood is normal growth. Taking regular accurate measurements of length and plotting them on a centile chart is essential to spot early signs of growth disorders. Be alert for a "zig-zag" pattern on the chart: it could indicate psychosocial dwarfism (see opposite). Length is more important than weight for identifying growth disorders. Lack of love, or an adverse emotional or social environment, can cause growth failure even in a child who is eating enough. Such children have a condition called psychosocial dwarfism, which is due to hypopituitarism (too little growth hormone secretion from the pituitary gland). This condition does not respond to growth hormone treatment. Once the child is placed in an alternative environment, eg a good foster home, the hypopituitarism is reversed and rapid "catch-up" growth takes place. It often emerges that such children have been physically, emotionally or sexually abused.

I'm not aware of any case in which psychological reasons alone in a properly fed child would result in death associated with failure to thrive. When it comes to failure to thrive in certain orphanges, I would not ascribe it solely to psychological reasons...