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LABORATORY: Failure to Thrive

The most common cause of failure to thrive is poor nutrition combined with environmental factors. The diagnosis can generally be made based on the physical examination, review of the growth curves, and parental heights. However, there are medical causes of growth deficiency that should be considered. In most cases, a thorough history and physical can screen for these causes.

The following tests are recommended for an initial laboratory evaluation of failure to thrive:

  • CBC and differential - chronic bleeding, iron deficiency anemia, lead toxicity, malignancy, and infection
  • Urinalysis, urine culture - kidney or bladder infection or renal disease
  • Serum electrolytes - renal tubular acidosis and other causes of acidosis
  • T4, TSH - hyperthyroidism, hypothyroidism
  • PPD - tuberculosis screening
  • Other serum chemistries, such as serum albumin, calcium, phosphorus, liver function tests - malnutrition, rickets, liver disease
  • Erythrocyte sedimentation rate - chronic illness
  • Stool tests - guaiac, culture, fat, ova, and parasites
  • HIV testing - dependent on risk, newborn screen results, and historical information

If any of the above tests are abnormal, hospital admission and further testing may be necessary. Hospital admission is often useful in assisting in the diagnosis of nutritional failure to thrive. A baby who gains weight with adequate nutrition as documented in the hospital does not generally have an underlying medical or organic reason for poor weight gain.

In all cases of failure to thrive, review the New York State Newborn Screening Program test results. In addition, many experts recommend a chest radiograph to look for occult findings, such as rib fractures. A skeletal survey also may be indicated. For more information about radiograph recommendations, see RADIOLOGY: Skeletal Survey.

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Laboratory: Overview  Laboratory: Testing for Sexually Transmitted Diseases  Laboratory: Testing for Pregnancy  Laboratory: Evaluation for Suspected Physical Injuries  Laboratory: Failure to Thrive  Laboratory: Toxicology Testing  Laboratory: Additional Resources 

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