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.
FAILURE TO THRIVE
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 disorder. Finally, the patient may not eat because of a neurologic disorder such as microcephaly, hydrocephalus, cerebral palsy, and other disorders associated with mental retardation (see page 362).
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)
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- 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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FAILURE TO THRIVE (Differential Diagnosis in Primary Care)
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