Related Experiment Videos
Gastrostomy dependence in two constitutionally short children
1Department of Pediatrics, Mayo Clinic, Rochester, Minn. 55905.
Insights
Many infants diagnosed with failure to thrive are actually constitutionally short. Early diagnosis is key, as interventions like gastrostomy may be unnecessary for healthy growth in length.
Area of Science:
- Pediatrics
- Endocrinology
- Genetics
Background:
- Constitutional short stature can be challenging to diagnose in infants.
- Early growth patterns are crucial for identifying potential growth disorders.
Observation:
- Two infants experienced length measurements falling below the fifth percentile within 18 months.
- Interventions for presumed gastroesophageal reflux and failure to thrive included fundoplication and gastrostomy.
Findings:
- Gastrostomy feedings did not improve linear growth despite weight gain.
- The diagnosis of "failure to thrive" was misleading, obscuring constitutional short stature.
Implications:
- Misdiagnosis can lead to unnecessary and invasive procedures.
- Recognizing constitutional short stature early prevents medical interventions not indicated for growth.
- Parental education is vital to avoid "gastrostomy dependence".
Abstract:
We describe the medical odyssey of two infants who turned out to be constitutionally short. The measurements of length gradually came to rank below the fifth percentile during the first 18 months of life. Numerous tests were performed, and the diagnosis of gastroesophageal reflux led to fundoplication. The concept that higher energy intakes result in greater increases in length led eventually to gastrostomy. Increases in weight during gastrostomy feedings had no effect on growth in length. It was very difficult to convince the parents that the gastrostomies were not necessary. The parents had in fact become "gastrostomy dependent." The vague concept of "failure to thrive" proved to be misleading and obscured the knowledge that constitutionally short children can fall below the fifth percentile in length at any time before the age of 2 or 3 years.