Hơn nữa hấp thụ các nghiên cứu đã được tiến hành và nặng thần kinh cơ mất phối hợp của thực quản WS Được thể hiện. Phẫu thuật thành công Thực hiện WS, sau đó hy vọng và Nó Was Điều đó sẽ cải thiện tâm lý Rebecca như bộ nhớ của sự khó chịu sớm và ăn | 46 CHILDREN WHO FAIL TO THRIVE Further absorptive studies were carried out and severe neuromuscular incoordination of the oesophagus was demonstrated. Surgery was carried out successfully and it was then hoped that Rebecca would improve psychologically as the memory of the early discomfort when eating and being force-fed faded but unfortunately this was not the case. After being told that there was no longer anything wrong with Rebecca the parents began to be more firm with her expecting a quick improvement in eating behaviour with subsequent weight gain. She refused to take food and her physical appearance deteriorated although her psychosocial development was within norms. Feeding-time became a major battle and feeding interaction fluctuated between an angry anxious and at times forceful feeding style to begging the child to eat encouraging bribing giving up running after her with the spoon or allowing Rebecca to do anything she wanted in order to get some food into her. As a result of faulty interaction and desperation to feed Rebecca she became extremely manipulative and oppositional as she learnt how to get what she wanted. Since there was no improvement in weight-gain and the intake of food was insufficient for the child s age in spite of determined efforts to feed her the mother became totally demoralised and depressed. She began to believe very strongly that she was inadequate as a carer and that she could not do anything right her selfesteem was at rock bottom. The situation became so serious that the father asked for urgent help for his wife and daughter after the wife left the house one night and was found wandering along the streets confused and very depressed. To ease the situation at home Rebecca attended nursery where the feeding programme was introduced and then extended at home. Rebecca reached the 25th percentile within seven months and her general behaviour became less manipulative and more compliant as a result of treatment see Chapter 12 for .
