Failure to thrive: Difference between revisions
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* Classically divided into endogenous (medical) and exogenous (psychosocial or environmental) causes | * Classically divided into endogenous (medical) and exogenous (psychosocial or environmental) causes | ||
===Evaluation=== | ===Evaluation=== | ||
* A detailed history and physical examination are usually sufficient to establish a cause. | * A detailed history and physical examination (including accurate height and weight) are usually sufficient to establish a cause. Over 80% of cases are due to insufficient caloric intake from exogenous causes. | ||
** History should focus on breastfeeding technique, frequency, and duration, or amount of formula and method of preparation. | ** History should focus on breastfeeding technique, frequency, and duration, or amount of formula and method of preparation. | ||
** Observed feeds can often be useful to identify problems. | ** Observed feeds can often be useful to identify problems. | ||
* | * If an endogenous cause is suspected, specific lab tests or imaging studies may be helpful to evaluate for metabolic abnormalities, the presence of infections, malignancy, or anatomic malformations. Additional testing should be ordered on a case by case basis and is only recommended if a specific etiology is suspected. | ||
===Differential Diagnosis=== | ===Differential Diagnosis=== | ||
====Endogenous Causes==== | ====Endogenous Causes==== | ||
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* Child neglect or abuse | * Child neglect or abuse | ||
===Management=== | ===Management=== | ||
==Adult== | ==Adult== | ||
===Clinical Features=== | ===Clinical Features=== | ||
===Evaluation=== | ===Evaluation=== | ||
===Management=== | ===Management=== | ||
Revision as of 02:10, 16 October 2017
Background
- Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, caloric absorption, or excessive caloric demand.
- Separated into pediatric and adult (often seen in geriatric populations or in those with chronic illnesses).
Pediatric
- Defined as weighing <5th percentile for age and sex, or weight deceleration crossing two major growth lines on a growth chart.
- Does not imply a defect in social, intellectual, or emotional development, but if untreated may lead to any combination of those.
- Classically divided into endogenous (medical) and exogenous (psychosocial or environmental) causes
Evaluation
- A detailed history and physical examination (including accurate height and weight) are usually sufficient to establish a cause. Over 80% of cases are due to insufficient caloric intake from exogenous causes.
- History should focus on breastfeeding technique, frequency, and duration, or amount of formula and method of preparation.
- Observed feeds can often be useful to identify problems.
- If an endogenous cause is suspected, specific lab tests or imaging studies may be helpful to evaluate for metabolic abnormalities, the presence of infections, malignancy, or anatomic malformations. Additional testing should be ordered on a case by case basis and is only recommended if a specific etiology is suspected.
Differential Diagnosis
Endogenous Causes
- GERD
- IBS
- Food allergy
- Malabsorption
- Pyloric stenosis
- Gastrointestinal atresia or malformation
- Inborn error of metabolism
- Thyroid disorder
- Chronic infection or immunodeficiency
- Chronic pulmonary disease
- Congenital heart disease or heart failure
- Malignancy
- Celiac disease
- Inflammatory bowel disease
Exogenous Causes
- Breastfeeding problem (latching, suckling, or swallowing)
- Improper formula preparation
- Caregiver depression
- Lack of food availability
- Cleft lip/palate
- Mood disorder
- Eating disorder
- Child neglect or abuse