Pediatrics in Review
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(Pediatrics in Review. 2000;21:315-320. doi:10.1542/10.1542/pir.21-9-315)
© 2000 American Academy of Pediatrics
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Index of Suspicion




   Case 1 Presentation
 
A 12-month-old Caucasian boy is referred because of failure to thrive. Born at term weighing 2,688 g, he had no prenatal complications. He was fed formula and had a variable eating pattern with early satiety, consuming approximately 90 kcal/kg per day. He remained at the 5th percentile of growth until approximately 6 months of age, when both his weight and height percentiles declined significantly. Despite ingestion of high-calorie supplements, his growth velocity has continued to be poor. He has had no vomiting or diarrhea and has been healthy. Motor, language, and cognitive development have been normal. Both parents are 172.5 cm (5 ft 9 in) tall, and there is no family history of growth failure.

Prior laboratory evaluation included measurement of electrolytes, complete blood count, erythrocyte sedimentation rate, albumin level, thyroid and liver function tests, immunoglobulin levels, and endomysial antibodies, all of which were normal. Urinalysis, fecal fat assay, and sweat test gave normal results.

On physical examination, the patient is a well-appearing, charming child, obviously small for his age. His weight is 6.43 kg (50th percentile for a 4-month-old), height is 67 cm (50th percentile for a 5-month-old), and head circumference 44.5 cm (5th percentile). He has a triangular face, with a prominent forehead, slight hypertelorism, and turned-down mouth corners (FigureGo ). Bilateral syndactyly of the second and third toes is noted. Findings on the remainder of the physical examination are normal. His chromosomal pattern is normal, and his insulin-like growth factor (IGF-1) level is 59 ng/mL (normal, 17 to 248 ng/mL). His bone age is delayed by 1.5 standard deviations of normal.



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  		Figure 1. A 12-month-boy who is small for his age and has a triangular face with a prominent forehead and turned-down mouth corners.

At follow-up at 18 months of age, the boy’s growth parameters are unchanged despite being . . . [Full Text of this Article]


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