FAILURE TO THRIVE
FAILURE TO THRIVE: Excerpt from Differential Diagnosis in Primary Care
Failure to thrive is germane to the pediatric patient who is not
growing adequately or fails to gain weight and appears emaciated. The
physiologic model of intake, absorption, transport, and utilization will
help develop a differential diagnosis.
Intake. Intake of food may be impaired by social conditions of
poverty, malnutrition, and child abuse. It may also be impaired by chronic
anxiety and depression or other psychiatric disorders. Finally, the patient
may not eat because of a neurologic disorder such as microcephaly,
hydrocephalus, cerebral palsy, or other disorders associated with mental
retardation .
Absorption. Absorption of food may be impaired by malabsorption
syndrome and fibrocystic disease.
Transport. This topic brings to mind chronic anemia and
congenital heart disease especially when associated with hypoxemia.
Utilization. Utilization of food is impaired in diabetes
mellitus, hypothyroidism, pituitary insufficiency, galactosemia, and uremia.
Several chronic infectious diseases are associated with failure to thrive.
The child may also come from an abnormal gestation where the mother suffered
alcoholism, drug abuse, or chronic illness.
Approach to the Diagnosis
Routine diagnostic workup should include a CBC, sedimentation rate,
urinalysis, urine culture, chemistry panel, sweat test, stool for
quantitative fat, chest x-ray, and electrocardiogram (ECG). Bone age x-rays
are helpful in determining growth retardation. At this point, it is helpful
to consult a pediatrician before ordering expensive diagnostic tests.
Other Useful Tests
-
d-Xylose absorption test (malabsorption syndrome)
-
Stool for ova and parasites (intestinal parasites)
-
Serum growth hormone (pituitary insufficiency)
-
Somatomedin-C level (pituitary insufficiency)
-
Overnight dexamethasone suppression test (adrenogenital syndrome)
-
Thyroid profile (myxedema)
-
CT scan of the brain (hydrocephalus, etc.)
-
MRI of the brain (hydrocephalus)
-
Neurology consult
-
Orthopedic consult
-
Endocrinology consult
-
Buccal smear for Barr bodies (Turner syndrome)
-
Karyotyping (Turner syndrome)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Do not perform an extensivelaboratory or radiographic evaluation for failure to thrive (FTT) (Avoiding Common Pediatric Errors)
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