Diagnostic workup and micronutrient deficiencies in children with failure to thrive without underlying diseases.
Kansu Tanca, Aydan
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Objectives and study: Failure to thrive (FTT) is an interruption in the normal pattern of growth. We aimed to evaluate the clinicalcharacteristics, underlying etiologies, diagnostic workup, and frequency of micronutrient deciencies (MDs) in children with FTT.Methods: This retrospective study was done with 729 children (319 male, mean age 6.8 ± 5.5 years) with FTT (weight for age <3rdpercentile) who had visited the Pediatric Gastroenterology outpatient clinic between 2011 and 2016. Children who had previouslyknown chronic diseases, inadequate intake, or inadequate absorption were excluded. Acute malnutrition was considered if weight-for-age z-scores were below −2 and height-for-age z-scores were above −2, and chronic malnutrition was dened if height-for-agez-scores were below −2. Results: The malnutrition rate was 57.1% (acute: 37.8%, chronic: 19.3%). Of children, 98.7% had laboratoryevaluation. We found that 1.1% of laboratory tests, 0.4% of imaging studies, 27% of endoscopic ndings, and biopsy results led to aspecic diagnosis, equating to a total of 1.3% of diagnostic workup leading to a diagnosis related to FTT. The causes of FTT wereinadequate nutrition (61.4%), psychiatric and behavioral disorders (17.2%), endocrinologic disorders (9%), recurrent infections(6.4%), gastrointestinal diseases (1.9%), and cardiac disorders (0.1%). Vitamin A and D deciencies were the most common MD.Conclusion: We showed that the most common cause of FTT is “purely nutrition” FFT because of inadequate caloric intake, andextensive diagnostic workup is rarely helpful to reveal the etiology. These results implicate the importance of clinical evaluationand anthropometry to evaluate a child with FTT.