FAILURE TO THRIVE
Ask the Following Questions:
- Is there a history of an abnormal gestation? There may be a history that the mother was a chronic alcoholic or ingested such drugs as phenytoin, trimethadione, or narcotics. The mother may have had toxoplasmosis, rubella, herpes simplex, or other diseases during her gestation.
- Is the child's environment abnormal? Careful investigation may disclose that the child has been neglected or that there are economic circumstances to indicate that the child is not getting enough food. Investigation may also indicate that the child is not getting adequate love or practicing good hygiene.
- Are there abnormalities found on the neurologic examination? Neurologic examination may reveal findings to suggest microcephaly, muscular atrophy, hydrocephalus, spastic diplegia, and other neurologic causes of mental retardation.
- Are there endocrine abnormalities? Cretinism, pituitary tumors, and genital abnormalities may be suggested from the endocrine examination.
- Are there findings to suggest a GI disorder? Wasting and a distended abdomen may suggest a malabsorption syndrome. The history of frequent pneumonia may indicate fibrocystic disease. Cataracts may suggest galactosemia.
DIAGNOSTIC WORKUP
The routine diagnostic workup should include a CBC, sedimentation rate, urinalysis, urine culture, chemistry panel, thyroid profile, sweat test, stool for quantitative fat, chest x-ray, and an EKG. Bone age x-rays are often helpful in indicating a growth delay.
If there are focal neurologic signs or a pituitary tumor is suspected, a CT scan of the brain may be necessary. Additional endocrinologic tests include serum growth hormone level before and after exercise, somatomedin-C level, and overnight dexamethasone suppression test. However, an endocrinologist, pediatrician, or orthopedic surgeon should be consulted before ordering expensive diagnostic tests.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Developmental problems
Read excerpts from these other book chapters related to Developmental problems:
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Developmental problems
» Next page: Failure to Thrive (In A Page: Pediatric Signs and Symptoms)
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