Manifestations of Gastrointestinal Disease in the Child

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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
708 FIRST PRINCIPLES OF GASTROENTEROLOGY FIGURE 2. Type II failure to thrive. W refers to weight, H to height or length, HC to head circumference. factors. It is essential to begin nutritional rehabilitation as soon as possible and not delay while waiting for the results of any indicated tests. History should include a dietary and feeding history as well as past and current medical history. The dietary history should be as specific as possible, including quantities. For formula-fed infants it is possible to quantify the caloric intake. It is important to determine that formula is being prepared correctly. Points to cover in the feeding history include specifically, where, how and for how long the meals take place. Questions should be asked about whether the infant coughs or chokes with feeds and whether they seem to tire when feeding. Social and family history are essential, not only because they may have primary etiological significance, but also in order to prescribe and institute successful interventions. The goals of physical examination include: 1. Assessment of the severity of malnutrition and signs of possible micronutrient deficiencies 2. Identification of features suggesting a genetic cause for growth failure
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Manifestations of Gastrointestinal Disease in the Child

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