Failure to Thrive: What Initial Investigation is Required? Má Progressão Ponderal: Que Avaliação Inicial é Necessária?

Abstract

INTRODUCTION: The objective was to characterize the failure to thrive causes in a group of children; analyse initial comple-mentary diagnostic exams; compare the children failure to thrive criteria included in the study with the new growth chart of World Health Organization (WHO).

METHODS: Retrospective study of clinical process of a child group (61 cases), with failure to thrive in their first two years of life, that had a paediatric appointment (January 2013 - December 2014). Failure to thrive was defined as weight loss across two major percentile lines, in more than two consecutive measures, for three months. It was divided in two groups: organic and nonorganic. The last one was further divided in feeding problems and constitutional/familiar. All cases were analysed based on the new WHO growth charts and performed a comparative analysis with the first evaluation.

RESULTS: The majority of the cases (70.5%) were nonorganic. Within this group, 67.6% were included in FP and 18.9% in constitutional/familiar. The organic group was more associated with the presence of at least one symptom or abnormal phy-sical examination (p < 0.001). Moreover, was more associated with abnormal initial laboratory evaluation, corresponding to 73.3 % (p < 0.001). With the new growth charts, the majority of the nonorganic group did not meet MPP criteria (67%) and all cases in the organic group maintained criteria.

DISCUSSION/CONCLUSION: The failure to thrive cases without suspicion of organic cause do not need a complementary in-vestigation. The investigation of alimentary history and failure to thrive familiar history may determinate the failure to thrive causes. The new growth charts are better to identify failure to thrive with underlying organic disease.