Categorization of etiology of failure to thrive

To develop predictors of organic vs nonorganic causes of failure to thrive, we performed a retrospective chart analysis of 82 hospitalized children. We evaluated predictors by using decision analysis. We estimated potential cost reduction that would have resulted from early categorization of these patients. Twenty-one cases had organic causes, 34 had nonorganic causes, and 19 had both organic and nonorganic causes. Physical examination proved to be a sensitive indicator of an organic component. The composite psychosocial and clinical history, together with the physical examination, accurately predicted the final category. The use of laboratory tests was primarily for confirmation. The use of these factors to identify purely nonorganic growth failure and an evaluation of such cases in an intermediate care facility could save almost $8-- per patient. In-depth psychosocial evaluation is important in all cases of failure to thrive.