Answer to Case File #2

The patient has Failure to Thrive. Most likely of "nonorganic" in etiology.

Next Step: Gather more information, including birth, past medical, family, social, and developmental histories. A dietary history is especially important.

Definitions:

Failure to Thrive(FTT): A physical sign, not a final diagnosis. It is suspected when growth is below the third or fifth percentile or crosses more than two major growth percentiles in a short time frame. Usually seen in children younger than 5 years whose physical growth is significantly less than that of their peers.

Nonorganic FTT: Poor growth without a medical etiology. Nonorganic FTT often is related to poverty or poor caregiver-child interaction. It constitutes one-third to one-half of FTT cases identified in tertiary care settings and nearly all cases in primary care settings.

Organic FTT: Poor growth caused by an underlying medical condition, such as inflammatory bowel disease, renal disease, or congenital heart conditions.

A nonorganic FTT diagnosis is made after organic etiologies are excluded. After adequate nutrition and an adequate environment is assured, growth resumes normally after catch-up growth is demonstrated.

Patients with poor caloric intake usually fail to gain weight but maintain length and head circumference. As nutrition remains poor, length becomes affected next and then ultimately head circumference.

Thanks to everyone who participated.