Manifestations of Gastrointestinal Disease in the Child

Gastrointestinal Disease in the Child 707
FIGURE 1. Type I failure to thrive. W refers to weight, H to height or length, HC to head circumference.
to (or only slightly more) than the reduction in height velocity (Figure 2). This
pattern is representative of children with normal variant growth patterns such
as constitutional growth delay and familial short stature. It may also be seen
in endocrinopathies as well as when there is chronic undernutrition and/or
chronic disease such as celiac disease or Crohn’s disease.
Type III
Head circumference, weight and height are all proportionally subnormal
(Figure 3). Patients in this category may have chromosomal abnormalities,
intrauterine or perinatal insults, or CNS abnormalities.
When it has been determined that the growth pattern is of concern and is
not a physiological variant, evaluation should focus on a careful history and
physical examination. Where the growth pattern is consistent with undernutrition
(Type I) the aim should be to identify factors which are contributing
to the imbalance between caloric intake and requirements. Many times the etiology
is multifactorial and includes both medical and psychosocial/behavioral