eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Failure to Thrive: Differential Diagnoses & Workup

Author: Mohammad F El-Baba, MD, Assistant Professor of Pediatrics, Division of Pediatric Gastroenterology, Wayne State University School of Medicine; Division Chief of Pediatric Gastroenterology, Children's Hospital of Michigan
Coauthor(s): Reda W Bassali, MBChB, Associate Professor, Departments of General Pediatrics and Adolescent Medicine, Medical College of Georgia; John Benjamin, MD, Chief, General Section of Pediatrics and Adolescent Medicine, Vice Chair for Clinical Activities, Professor, Department of General Pediatrics, Medical College of Georgia; Ruby Mehta, MD, Fellow, Division of Pediatric Gastroenterology, Children's Hospital of Michigan
Contributor Information and Disclosures

Updated: May 4, 2009

Differential Diagnoses

Child Abuse & Neglect: Failure to Thrive
Constitutional Growth Delay
Eating Disorder: Anorexia
Eating Disorder: Bulimia
Fetal Alcohol Syndrome

Other Problems to Be Considered

Isolated growth hormone deficiency
Other causes for intrauterine growth retardation (IUGR)
Other chromosomal/genetic causes of delayed growth

Workup

Laboratory Studies

  • If a diagnosis can be made and a cause for failure to thrive (FTT) can be identified, the history and physical examination usually supply the answer. Laboratory assessment has a limited value in determining the etiology of failure to thrive. Occasionally, laboratory test results are unexpectedly abnormal. For instance, blood dyscrasias, chronic urinary tract infections, chronic acidosis, and renal failure all can be diagnosed using these screening tests. However, only about 1% of the tests ordered produce abnormal results and help identify the etiology of failure to thrive.
  • Children diagnosed with failure to thrive usually undergo certain screening tests, including the following:
    • CBC count
    • Urinalysis
    • Urine culture
    • Electrolytes, including creatinine and BUN
    • Liver function tests, including total protein and albumin
  • Prealbumin may be used as a nutritional marker.
  • More specific tests may be indicated (depending on findings from the history and physical examination), including the following:
    • Human immunodeficiency virus (HIV) testing
    • Sweat chloride test
    • Thyroid function tests
    • Stool studies for parasites or malabsorption
    • Immunoglobulins
    • Purified protein derivative (PPD) skin test
    • Radiological studies
  • If concern surrounds possible growth hormone deficiency, the following may be obtained:
    • Serum insulinlike growth factor I (IGF-I)
    • Insulinlike growth factor binding protein (IGF-BP3)
  • Serum immunoglobulin A tissue transglutaminase antibody (TTG-IgA), IgA-endomysial antibody (IgA-EMA), and immunoglobulin G antigliadin antibodies (AGA-IgG) may be used to screen for celiac disease when clinically indicated.

Imaging Studies

  • A bone age may be helpful to distinguish genetic short stature from constitutional delay of growth.

Procedures

  • Other diagnostic procedures may be appropriate and are performed as indicated.

More on Failure to Thrive

Overview: Failure to Thrive
Differential Diagnoses & Workup: Failure to Thrive
Treatment & Medication: Failure to Thrive
Follow-up: Failure to Thrive
Multimedia: Failure to Thrive
References
Further Reading
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References

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Keywords

failure to thrive, FTT, growth failure, failure of growth, malnutrition, delayed growth, growth charts, infant growth, normal growth, growth in infants, normal weight in infants, normal height in infants, head circumference in infants, Down syndrome, Turner syndrome, malnutrition, diarrhea, cerebral palsy, seizure, hepatomegaly, marasmus, maternal eating disorders, anorexia, bulimia, psychosocial deprivation, neglect, emotional deprivation syndrome, prematurity, placental insufficiency, alcohol ingestion, hypertension, preeclampsia, heart disease, diabetes mellitus, short stature, Prader-Willi syndrome, craniofacial abnormalities, congestive heart failure, chronic lung disease, bronchopulmonary dysplasia, gastroesophageal reflux, esophagitis, cystic fibrosis, CF, hyperthyroidism, milk protein allergy, Celiac disease, protein-losing enteropathies, Shwachman-Diamond syndrome, renal failure, renal tubular acidosis, hypothyroidism, systemic lupus erythematosus, treatment, diagnosis

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Contributor Information and Disclosures

Author

Mohammad F El-Baba, MD, Assistant Professor of Pediatrics, Division of Pediatric Gastroenterology, Wayne State University School of Medicine; Division Chief of Pediatric Gastroenterology, Children's Hospital of Michigan
Mohammad F El-Baba, MD is a member of the following medical societies: American Gastroenterological Association and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Coauthor(s)

Reda W Bassali, MBChB, Associate Professor, Departments of General Pediatrics and Adolescent Medicine, Medical College of Georgia
Reda W Bassali, MBChB is a member of the following medical societies: Ambulatory Pediatric Association and American Academy of Pediatrics
Disclosure: Nothing to disclose.

John Benjamin, MD, Chief, General Section of Pediatrics and Adolescent Medicine, Vice Chair for Clinical Activities, Professor, Department of General Pediatrics, Medical College of Georgia
John Benjamin, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Ruby Mehta, MD, Fellow, Division of Pediatric Gastroenterology, Children's Hospital of Michigan
Disclosure: Nothing to disclose.

Medical Editor

Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia
Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Ovation Honoraria Speaking and teaching

CME Editor

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 Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Ovation Honoraria Speaking and teaching

 
 
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