Substance Abuse : Failure To Thrive, Growth Retardation, Central Nervous System Disorders

by Child Welfare Information Gateway

(Page 6 of 10)

Failure To Thrive (FTT)

FTT is a syndrome of disordered growth and development characterized by a marked deceleration in weight gain and a slowing in acquisition of developmental milestones. There are many reasons why an infant may not gain weight. Medical reasons resulting from biological causes include vomiting, excessive diarrhea, poor swallowing, cystic fibrosis, and congenital heart disease. Of course, infants also will fail to gain weight if they are given insufficient protein and calories. This may occur if the caregiver mixes formula improperly, does not feed frequently enough, or fails to respond to the infant's signals when he/she is hungry. FTT can also result from psychosocial deficits in the caregiver-infant relationship, such as failure to provide adequate physical nurturing in the form of contact comfort (holding, cuddling, or touching).

In infants who were prenatally exposed to drugs and alcohol, FTT may be due to both medical and environmental factors. A pattern of poor sucking, swallowing difficulties, and distractibility has been observed in many of these infants. In addition, children who live in dysfunctional, chemically involved families are at increased risk for parental neglect and for receiving inadequate nutrition on a consistent basis. Furthermore, some infants prenatally exposed to drugs are born very small for gestational age and, in spite of adequate caloric intake, may never attain average growth parameters.

Accurate diagnosis of FTT often entails hospitalization in order to determine the exact causes. In cases of environmental FTT, once adequate calories and/or appropriate nurturing care are offered, weight gain usually occurs immediately. Unfortunately, this simple medical treatment cannot be effective on a long-term basis unless a thorough evaluation is made to determine the reasons for the child's poor weight gain.

In cases of environmental FTT, an individualized, interdisciplinary treatment program should be developed to address the interrelated needs of both the parent and the child. Such a program may include any or all of the following: parent education; individual, conjoint, and/or family counseling; medical services; and substance abuse treatment. Close in-home monitoring also can be an important support for the family as well as an essential safeguard when the child remains within the parental home.

Intrauterine Growth Retardation (IUGR)

The term IUGR is used interchangeably with small for gestational age (SGA) to describe fetuses with suboptimal growth (generally with birth weight below the 3rd percentile for age). Causes for IUGR vary. It often is associated with congenital infections (that is, infections that are present during pregnancy and passed on to the fetus) such as rubella, cytomegalic virus (CMV), or HIV. Genetic abnormalities, such as those seen in rather rare chromosomal disorders (trisomy 13 and 18), also may result in IUGR. However, the most common causes of IUGR are related to conditions that result in reduced transport of nutrients from mother to fetus via the placenta during pregnancy. Hypertension (high blood pressure), for instance, frequently causes constriction of the blood vessels, including those that lead from the placenta to the fetus, thus restricting the transport of nutrients that are important for growth. Although many individuals suffer from hypertension because of a genetic predisposition, obesity, and/or stress, drugs such as cocaine, methamphetamine, and PCP also may bring about this condition. Further, IUGR may be seen in cases of insufficient maternal caloric intake. Depending on the cause, interference with fetal growth may begin during the first trimester, or its onset can occur later, during the second or third trimester of pregnancy.

Central Nervous System (CNS) Disorders

A CNS disorder is any condition or malformation that affects the brain. These disorders may originate in utero, or they may be caused by postnatal factors. Prenatal CNS disorders include viral infections [e.g., HIV, rubella, CMV, or toxoplasmosis] or congenital malformations of the brain (e.g., hydrocephalus, microcephaly, or porencephalic cysts). During delivery, certain conditions, including severe perinatal asphyxia, in some cases may lead to CNS impairment that results in physical disabilities such as cerebral palsy or vision and hearing deficits. Postnatal events may also lead to CNS disorders. These include bacterial or viral infections (e.g., meningitis or encephalitis), tumors (malignant or benign), and intracranial bleeds (usually seen in preterm infants).

Specific to children who have been exposed prenatally to alcohol and/or other drugs, reports have shown an increased incidence of decreased brain growth in utero in newborns, in some cases leading to microcephaly. Some infants who were exposed to cocaine and methamphetamine have been reported to have experienced three separate CNS lesions prenatally-hemorrhage into the ventricles, areas of necrosis in the brain matter, and cavitary lesions. In a few cocaine-exposed newborns, there have been reports of infarctions, or severe constrictions of major blood vessels, that have resulted in damage to certain areas of the brain.

A very important CNS condition that is seen in children under 2 years of age is inflicted trauma to the head, sometimes including skull fractures. In infants younger than 4 months of age, when children have only minimal head control, cases of Shaken Baby Syndrome are sometimes observed. This syndrome has been noted to occur when a caregiver is under stress, becomes frustrated with an irritable baby, and holds the infant by the shoulders or arms, shaking or forcibly slamming the child against a surface, such as a crib mattress. Only rarely are there obvious physical signs of abuse. However, resulting injuries may include intracranial bleeding, retinal hemorrhages, or occasional skull fractures, with long-term consequences that may include cerebral palsy, blindness, seizure disorders, or even death.

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