As many as one in twenty children under five experience distressing feeding problems that can affect their development yet the treatment they receive often fails to meet their needs.
New research by The Children's Society shows that many of these babies undergo inconclusive medical tests and stays in hospital while parents can reach crisis point without receiving the help they need.
The publication of the report - When Feeding Fails - coincides with the launch of a Children's Society National Development Centre offering training and consultancy services to health and social care professionals. The campaign includes an advice leaflet for parents and briefing paper for health professionals produced in partnership with the Community Practitioners and Health Visitors Association and the Paediatric Group of the British Dietetic Association.
When Feeding Fails highlights the strain on families whose children suffer the condition known as faltering growth, formerly known as failure to thrive. Babies suffer from faltering growth when their refusal to eat results in them failing to gain sufficient weight for normal healthy development.
The impact of feeding difficulties causes enormous strain on families and the resulting stress at mealtimes means that the problem gets worse. Children are often then channelled into the medical system. Their growth, development and behaviour can be affected and parents often lose all confidence in themselves.
The Children's Society has two specialist projects which successfully work with families in their homes. By videoing mealtimes and helping parents manage difficulties they can resolve their baby's feeding problems and rebuild parents' confidence.
1Failure to Find Failure to Thrive, Batchelor and Kerslake 1990
When Feeding Fails, records the experiences of 30 parents caring for a child with faltering growth and includes the findings from an omnibus survey of 500 health visitors on the extent of the problem. It shows that:
64% of health visitors have infants with faltering growth on their casebooks2
All parents described feelings of total frustration, while many reported feeling hopelessness and guilt and said the problem impacted on everyone in the family including other children
Several parents resorted to force-feeding their babies in a desperate attempt to ensure they ate
Some parents reported feeling guilty, and very isolated by a complete lack of understanding among family and friends
Many parents wished health professionals could have spent more time with them, particularly to observe mealtimes, to properly understand the problem. Several parents said they would have liked to receive help from health visitors without having to have so many inconclusive hospital visits
18 of the 30 children underwent medical tests to identify reasons for their faltering growth, but of those fourteen reported there were no findings from any of the tests, while tests on two of the remaining four found only anaemia, which is a symptom of poor diet rather than a cause
Ten children were admitted to hospital because of concerns about their weight loss or feeding
21 of the 30 families said they were unhappy about the services provided and the support received from health professionals
Parents said they were not being taken seriously, that they had to repeat their child's history to several different health professionals and then were given inconsistent advice which was sometimes hard to follow
Key issues raised by parents to improve services included extra training for health professionals to fully understand the problem and more support from health visitors at home rather than hospital visits.
"Children with faltering growth are not simply 'faddy' eaters. It is distressing to parents and damaging to children if they are not eating enough to grow and develop as they should," says Di Hampton, Manager of The Children's Society's Feeding Matters National Development Centre.
"The traditional medical approach often tries to eliminate any health reasons for the faltering growth before
considering 'social or emotional' reasons. Of course it is crucial that no medical conditions are overlooked,
but it is also important that traumatic medical tests are not carried out unnecessarily. Figures show that the number of children with physical illnesses causing their weight to falter is very small1. For too long these children have been directed
towards the medical or social services systems despite all of the evidence that these routes are unlikely to offer the solutions they need3.
2Durdle Davies, Health Visitors Omnibus Survey, 1999
3Figures show that the number of children with physical illnesses causes their weight to falter is very small; Wright and Talbot (1996) quote 5% of all children with poor growth. Frank and Zeisel (1998 p 1193 -4) had similar conclusions.
"Faltering growth can affect children from any family but by working with parents and by listening to their anxieties, there are answers. However, these are not quick-fix solutions and they require time.
"Health visitors are the key to resolving this issue because they have the trust and confidence of families. But they need the time, the resources and the training to deal with this issue. We also believe that the Department of Health must introduce guidelines that put an end to the postcode lottery where families can reach crisis point before receiving the help they need."
Director of the Community Practitioners' and Health Visitors' Association, Jackie Carnell, said: "The CPHVA welcomes the new research by The Children's Society highlighting the issue of children under five with feeding problems. Health visitors have long recognised this as a major area of concern and are keen to play their part in new initiatives that assist health professionals - and parents - to understand better the problems of faltering growth."
The Children's Society recommendations include:
The Department of Health to introduce guidelines to ensure standardised services in all areas and a consistent approach to the problem between social services and health.
A more 'joined up' approach to dealing with family problems to include listening to parents and more support for families in their own homes.
The inclusion of children's health issues, and in particular faltering growth which affects one in twenty under fives, included in all Health Improvement Plans (HIMPS).
More training for health professionals on faltering growth.
More research into faltering growth including racial aspects and long-term effects on children.
Parents who are worried their child may have faltering growth should contact their health visitor (details from their GP surgery) and ask them for a copy of our parents leaflet. Copies of the leaflet are also available by calling 0845 600 4400, though we do recommend that this is worked through with a trained health professional.
The new report, When Feeding Fails (£5.95) is available from The Children's Society, Publishing Department. Tel 020 7841 4415.
Health and Social Services professionals can contact The Children's Society's National Development Centre at Brook House, Pennywell Road, Bristol BS5 0TX telephone 0117 941 5432.
John Fulcher 020 7841 4420 or 07949 111866 (out of hours).
Tim Linehan 020 7841 4419 or 020 8800 8830(h).
Sam Brooks 020 7841 4424.