Medscape is available in 5 Language Editions – Choose your Edition here.


Failure to Thrive Workup

  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD  more...
Updated: Nov 04, 2015

Laboratory Studies

The history and physical examination should guide any laboratory or ancillary testing. Most infants and children with growth failure related to environmental factors need very limited laboratory screenings. In the young infant or child, a few prudent baseline tests maybe indicated.

Initial and follow-up newborn screening tests, as follows:

  • CBC count - WBC and RBC indices for possible indication of occult infection, microcytic or hemolytic anemias, or immune deficiency
  • Urinalysis and culture - Hydration status (if warranted) with specific gravity, evidence of infection, renal tubular acidosis
  • Renal function - Serum electrolytes, BUN, and creatinine levels
  • Liver function - Liver function tests considered in children with signs of protein wasting or organomegaly

Additional testing as needed or indicated, as follows:

  • Human immunodeficiency virus (HIV) testing if risk factors are noted or if history and examination are at all suggestive
  • Sweat test for cystic fibrosis
  • Zinc level reported to be low in malnourished infants and children
  • Metabolic and endocrinology screening (only as needed)
  • Tuberculosis testing
  • Stool studies

Imaging Studies

Imaging studies are not routinely needed.

Perform skeletal survey for occult trauma if physical abuse is suspected or signs are present upon examination.

Head CT scanning or MRI studies are indicated if examination reveals microcephaly, macrocephaly, or congenital malformation or if abusive head trauma is a concern.

Perform bone age studies of wrists in children who have constitutionally short stature or are extremely malnourished; in patients in whom bone density or ricks is a concern, perform knee studies, wrist studies, or both.


Other Tests

Most other tests are not indicated unless a specific disease process is suspected that warrants investigation.



Most other procedures, invasive or not, are not indicated unless a specific disease process is suspected that warrants investigation.

Contributor Information and Disclosures

Andrew P Sirotnak, MD Professor and Vice Chair of Faculty Affairs, Department of Pediatrics, University of Colorado School of Medicine; Department Head, Child Abuse and Neglect, Director, Child Protection Team, The Children's Hospital

Andrew P Sirotnak, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.


Antonia Chiesa, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine

Antonia Chiesa, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

  1. Cole SZ, Lanham JS. Failure to thrive: an update. Am Fam Physician. 2011 Apr 1. 83(7):829-34. [Medline].

  2. Black MM, Dubowitz H, Casey PH, et al. Failure to thrive as distinct from child neglect. Pediatrics. 2006 Apr. 117(4):1456-8; author reply 1458-9. [Medline].

  3. Block RW, Krebs NF, American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatrics Committee on Nutrition. Failure to thrive as a manifestation of child neglect. Pediatrics. 2005 Nov. 116(5):1234-7. [Medline].

  4. Brewster DR. Inpatient management of severe malnutrition: time for a change in protocol and practice. Ann Trop Paediatr. 2011. 31(2):97-107. [Medline].

  5. Wojcicki JM, Holbrook K, Lustig RH, Epel E, Caughey AB, Muñoz RF, et al. Chronic maternal depression is associated with reduced weight gain in latino infants from birth to 2 years of age. PLoS One. 2011 Feb 23. 6(2):e16737. [Medline]. [Full Text].

  6. Bambang S, Spencer NJ, Logan S, Gill L. Cause-specific perinatal death rates, birth weight and deprivation in the West Midlands, 1991-93. Child Care Health Dev. 2000 Jan. 26(1):73-82. [Medline].

  7. Frank D, et al. Failure To Thrive. Reece R, Christian C, eds. Child Abuse Medical Diagnosis and Management. 3rd ed. Chicago, Ill: American Academy of Pediatrics; 2009. 465-512.

  8. Gahagan S. Failure to thrive: a consequence of undernutrition. Pediatr Rev. 2006 Jan. 27(1):e1-11. [Medline].

  9. Lowen D. Failure to Thrive. Jenny C, ed. Child Abuse and Neglect Diagnosis, Treatment and Evidence. 1st ed. St. Louis, Mo: Elsevier Saunders; 2011. 547-62.

This 6-month-old infant was admitted with marasmus. The infant was born to a mother who did not bond effectively because of postpartum depression. He has evidence of severe wasting and neglectful care as also evidenced by the diaper excoriation. Weight gain was achieved by placement in foster home.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.