Failure to thrive: diagnostic yield of hospitalisation

Review of hospital records of 122 infants, aged between 1 and 25 months, admitted to a teaching hospital with the diagnosis of failure to thrive but without an underlying disease apparent at admission, showed that about one-third of them had no diagnosis after evaluation. Thirty-two per cent were thought to have a social or environmental explantation for poor growth, and 31% were given a specific organic or physiological diagnosis. Of the last group, 2 out 3 were diagnosed as having either gastro-oesophageal reflux or non-specific chronic diarrhoea. Vomiting was often associated with organic or structural disease. On average about 40 laboratory tests and x-ray films were performed per infant, but only 0.8% of all tests showed an abnormality which contributed to the diagnosis of the cause of failure to thrive. Our results stress the importance of social and environmental factors as basic causes of failure to thrive, and suggest that admission to hospital and laboratory testing is unlikely to lead to a specific organic diagnose in a child whose failure to thrive is unexplained after careful history taking and a physical examination.