Conditions to consider when evaluating a pediatric patient with a failure to thrive:
(1) hyperthyroidism or hypothyroidism
(2) hyperaldosteronism
(3) inborn errors of amino acid metabolism (aminoacidopathies)
(4) inborn errors of carbohydrate metabolism
(5) excessive intake of thyroid hormone
(6) lead poisoning
(7) apathy
(8) rumination syndrome
(9) abnormal interactions between parent or caregiver and the child
(10) child abuse, including withholding of food
(11) inappropriate diet for age
(12) tracheoesophageal fistula
(13) gastroesophageal reflux disease or other esophageal disorder
(14) pyloric stenosis
(15) bowel obstruction (malrotation, etc)
(16) Hirschsprung's disease
(17) cleft lip and palate
(18) orofacialchoanal atresia
(19) other oropharyngeal disorder (micrognathia, glossoptosis other)
(20) inflammatory bowel disease
(21) malabsorption
(22) celiac disease
(23) cystic fibrosis
(24) chronic nausea or vomiting
(25) chronic diarrhea
(26) biliary atresia
(27) hepatitis
(28) cirrhosis
(29) heart disease
(30) chronic hypoxemia
(31) bronchopulmonary dysplasia
(32) chronic lung disease
(33) anemia, including iron deficiency anemia
(34) malignancy
(35) renal tubular acidosis
(36) chronic renal disease
(37) chronic infection (tuberculosis, recurrent urinary tract infection, etc)
(38) HIV disease
(39) hydrocephalus or other intracranial lesions
(40) muscle diseases resulting in weakness, hypertonia or hypotonia
(41) fetal alcohol syndrome
(42) Smith-Lemil-Opitz syndrome
(43) food allergy
It is essential to perform a complete evaluation of the patient. Some children may have more than one contributory factor, so it is important not to stop the assessment after one cause has been found.
