FAILURE TO THRIVE

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

1. d-Xylose absorption test (malabsorption syndrome)
2. Stool for ova and parasites (intestinal parasites)
3. Serum growth hormone (pituitary insufficiency)
4. Somatomedin-C level (pituitary insufficiency)
5. Overnight dexamethasone suppression test (adrenogenital syndrome)
6. Thyroid profile (myxedema)
7. CT scan of the brain (hydrocephalus, etc.)
8. MRI of the brain (hydrocephalus)
9. Neurology consult
10. Orthopedic consult
11. Endocrinology consult
12. Buccal smear for Barr bodies (Turner syndrome)
13. 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.

Other Book Chapters Related to Poor feeding

Read excerpts from these other book chapters related to Poor feeding:

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Poor feeding

• Back to symptom: Poor feeding: Introduction (review 247 causes)
• Next Book Extract About Poor feeding: Feeding Disorders (The 5-Minute Pediatric Consult)
• All Book Extracts: All Online Book Extracts for Poor feeding

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Feeding Disorders (The 5-Minute Pediatric Consult)
• Videos relating to Poor feeding
• Diagnosis Checklist for Poor feeding
• Symptom combinations for Poor feeding
• Common causes of Poor feeding

Tools & Services:

• Bookmark this page
• Take a survey relating to Poor feeding
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com