Written by Hallie Mullane
November 13, 2024
Whom of these people do you think is a “failure to thrive"1?
A. A convicted felon who is performing a 5 year jail sentence for stealing cars.
B. A few days old newborn baby who is not gaining adequate weight.
C. A high school sophomore who consistently gets poor grades in school and is not reading at grade level.
D. An adult who lost their job in the pandemic, cannot find work, and is currently unhoused.
E. An international student who struggles to adapt to life in the US.
F. None of the above.
In my opinion, using the empathy facet of the entrepreneurial mindset, and guided by our Jesuit values, the answer is F - none of the above. Our society needs to look upon each of these people using empathy to address their challenges. We must provide a little more support, and if given a real chance, they all can and will improve their lives and enrich our community.
In the medical world though, the term "at risk of failure to thrive" or “failure to thrive” has definitive meaning. It is used to describe “B” - newborns and infants who are not meeting expected growth milestones. That’s right - newborn infants still in the hospital, who are only a few days old and who following birth can solely breathe, eat, poop, and sleep, are deemed failures.
At birth, infants lose weight. It is “normal” for newborns to lose up to 10% of their birth weight. Beyond that infants are “at risk of failure to thrive”, and infants become “failures” to thrive, if they do not regain their lost weight by the time they are two weeks old.
"Applying empathy to how we talk about and treat infants who are struggling to grow and their families who are trying to help them, we must shift our language to be more supportive and empowering."
It is horrifying that anyone would call a human being that is only a few days old, a failure to thrive. It is unbelievable to me that this term is unquestioned and still regularly used in mother/baby units in hospital maternity wards and in pediatrician offices. While the term “failure to thrive” has a clinical purpose, it also carries a significant negative connotation that can impact how these newborns are perceived and treated as well as how their new parents and families feel and recover, particularly, their mothers. From an entrepreneurial mindset perspective, this terminology represents an empathy failure—labeling newborns (and by association their mothers and caregivers) in a way that frames them as deficient rather than recognizing their potential and the challenges they face.
The entrepreneurial mindset emphasizes empathy as a key part of solving problems. For these infants, the problem is really around weight loss and weight gain. Applying empathy to how we talk about and treat infants who are struggling to grow and their families who are trying to help them, we must shift our language to be more supportive and empowering. Instead of naming our infants "failures", I encourage the medical field to adopt or use a phrase like "in need of nutritional support” or “undergoing growth monitoring.” This can change the narrative to one of proactive care and a treatment oriented approach rather than a focus on the infant or mother’s deficit.
As a first-time mom, I experienced this firsthand. My newborn at two days old was labeled "at risk of failure to thrive" after losing 12% of his birth weight. The stress following a C-section was already overwhelming, and this diagnosis added another layer of anxiety as I was told repeatedly that my C-section was partly to blame for my delayed milk and thus - my baby’s failure to regain weight. No amount of milk and formula seemed to be enough. This term was used again and again to describe my beautiful infant. Every 45 minutes, I was told he must eat or else. There was no encouragement, no recognition of my own challenges and family’s challenges, just a constant barrage of concern for what this would mean for his future. At the time, I felt horrible. Looking back, I wonder - if it was *that* bad, why wasn’t he in the NICU? Why weren’t other options available? What really was the point of all the pressure?
"Terms like 'at risk' have been replaced with language that emphasizes potential and strengths, as the former only serves to further our societal inequalities."
Through significant stress and effort, my mother, husband and I were able to help my baby regain his weight before he was two weeks old and thus, he is not a “failure to thrive”, but the experience of being told again and again that he was at risk of being a failure to thrive - left a lasting impression on me during what should have also been my own period of physical healing. It traumatized both my mother and husband as well as new caregivers. My husband who was unable to take time off of work had colleagues tell him that he looked ghastly. My mother nearly 10 weeks later still says she cannot believe our hospital experience.
This highlighted how the language used in medical contexts can significantly impact the emotional well-being of parents and caregivers. From my personal experience, I know a different term certainly would have impacted my entry to motherhood and likely - would have made me and my family more equipped to support my son at feedings (thus, making us better at solving the actual problem).
I am not a medical practitioner, I’m an educator. In the field of education, our scholars have recognized the detrimental impact of such deficit-based terms and moved away from using them to describe students and their families. Terms like "at risk" have been replaced with language that emphasizes potential and strengths, as the former only serves to further our societal inequalities. This shift acknowledges the power of language in shaping expectations and outcomes, and it underscores the importance of empathy in supporting all individuals, especially those who face additional challenges. These language shifts directly impact whether students complete college.
Reframing how we think and talk about "failure to thrive" could have a profound impact on how we support the development of every newborn and their caregivers. Having empathy is especially crucial for our youngest humans who cannot advocate for themselves - our newborns are quite literally without words. All the more reason for us, as well as our nurses and doctors to protect them and empathize with them.
As a social justice-oriented Jesuit university, Santa Clara University, challenges its students to critically examine and question terms like these. We have the power to build a better world, one where language fosters support and growth rather than stigma and limitation. There are plenty of better terms that can be used—phrases like "early weight loss" or "early growth monitoring" that reflect the situation without the negative connotations. As we develop students who enter the field of medicine, I hope that they go on to lead with more empathy and are able to eradicate terms like this.
1 This newsletter article was drafted with the support of OpenAI’s ChatGPT software