Failure to Thrive Workup

  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Nov 28, 2011
 

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
    • 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
    • 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
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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.
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Other Tests

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

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Procedures

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

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Contributor Information and Disclosures
Author

Andrew P Sirotnak, MD  Department Head, Child Abuse and Neglect, Director, Kempe Child Protection Team

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

Disclosure: Nothing to disclose.

Coauthor(s)

Antonia Chiesa, MD  Senior Instructor of Pediatrics, University of Colorado at Denver Health Sciences Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Carol Diane Berkowitz, MD  Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center

Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

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.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

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

Disclosure: Nothing to disclose.

References

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  2. Black MM, Dubowitz H, Casey PH, et al. Failure to thrive as distinct from child neglect. Pediatrics. Apr 2006;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. Nov 2005;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. Feb 23 2011;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. Jan 2000;26(1):73-82. [Medline].

  7. Altemeir WA. What is happening to children with failure to thrive?. Pediatr Ann. Sep 2000;29(9):531, 534. [Medline].

  8. Boddy J, Skuse D, Andrews B. The developmental sequelae of nonorganic failure to thrive. J Child Psychol Psychiatry. Nov 2000;41(8):1003-14. [Medline].

  9. Botero D, Lifshitz F. Intrauterine growth retardation and long-term effects on growth. Curr Opin Pediatr. Aug 1999;11(4):340-7. [Medline].

  10. Careaga MG, Kerner JA. A gastroenterologist's approach to failure to thrive. Pediatr Ann. Sep 2000;29(9):558-67. [Medline].

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

  12. Schwartz ID. Failure to thrive: an old nemesis in the new millennium. Pediatr Rev. Aug 2000;21(8):257-64; quiz 264. [Medline].

  13. Sidebotham P. Failure to thrive. Arch Dis Child. May 2000;82(5):428. [Medline].

  14. Smith Z. Failure to thrive: early intervention to address dietary issues is vital. Community Nurse. Oct 1999;5(9):S3-4, S6. [Medline].

  15. Wright CM. Identification and management of failure to thrive: a community perspective. Arch Dis Child. Jan 2000;82(1):5-9. [Medline].

 
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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.
 
 
 
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