FAILURE TO THRIVE
Evaluation
Failure-to-thrive should be differentiated from the following conditions:
- genetic short stature
- constitutional growth delay
- short stature resulting from prematurity or intrauterine growth retardation
The evaluation of a child with failure-to-thrive requires several critical steps:
- An accurate growth curve (height, weight, head circumference and weight for height) with multiple points over time. (The weight-for-height chart can be found below the head circumference chart on most standardized growth charts.) In general, even children with genetic short stature, constitutional growth delay, or short stature as a result of prematurity or intrauterine growth retardation are height/weight proportionate when plotted on a weight for height chart. Babies who are failing to thrive, are disproportionate. They lose weight percentiles first, followed by height percentiles, with head growth spared except in extreme cases.
- Complete past medical history including birth history
- Developmental history
- Family history, including heights of both parents
- A thorough social history to assess sources of parental stress, parent-child interaction, child temperament, and signs of potential physical, mental or sexual abuse or neglect.
- A few basic laboratory tests may be important for determining the etiology of failure to thrive.
- A complete blood count can determine if the child has anemia or certain malignancies.
- A urinalysis with a urine culture, serum electrolytes, BUN and creatinine can help determine if the urinary tract is involved in the disease process.
- Studies such as an erythrocyte sedimentation rate, liver function tests or thyroid functions tests are as often misleading as they are helpful. These tests are often ordered but, should be interpreted carefully.
- Evaluation for cystic fibrosis, celiac disease, human immunodeficiency virus, tuberculosis, and radiological examinations, although not routine, should be considered if there are reasons for concern based upon history or physical examination.
Hospitalization is usually not required except in children who show evidence of chronic or severe malnutrition, children who continue to show poor weight gain despite aggressive outpatient evaluation and therapy, and children who may be in an environment that suggests maltreatment or danger to the child.
