Pediatrics
Growth Problems: Failure to Thrive and Short Stature
Failure to thrive and short stature for MBBS pediatrics: four pathways of growth faltering, familial versus endocrine short stature and referral criteria, mapped to NMC codes PE2.1 to PE2.6.
MedNext Academy | 3 min read
Growth Problems: Failure to Thrive and Short Stature
Failure to thrive and short stature for MBBS pediatrics: four pathways of growth faltering, familial versus endocrine short stature and referral criteria, mapped to NMC codes PE2.1 to PE2.6.
This chapter covers the assessment and management of the child who fails to thrive and the child with short stature, including a four-pathway approach to growth faltering and the distinction between normal variants and pathological short stature. It emphasises measurement, trajectory and referral criteria.
High-yield: Growth Problems: Failure to Thrive and Short Stature
- Failure to thrive (growth faltering) means weight below the 3rd centile or below minus 2 standard deviations, or downward crossing of two major centile spaces on a reliable chart.
- In failure to thrive, weight is affected first, then length, and finally head circumference, so a falling head circumference or regression is an urgent red flag.
- Failure to thrive is grouped into four overlapping pathways: inadequate intake, malabsorption or increased losses, increased requirement, and defective utilisation or endocrine and metabolic disease.
- Cereal-heavy Indian complementary feeding such as thin rice gruel fills the stomach but provides little energy or protein, a common cause of inadequate intake.
- The old organic versus non-organic split is only a teaching frame; the safe bedside phrase is multifactorial until proven otherwise.
- Bulky stools with blood, mucus or abdominal distension suggest malabsorption such as celiac disease, which needs serology after gluten exposure.
- Tachypnoea, sweating during feeds and cyanosis point to congenital heart disease as a cause of increased requirement.
- Familial short stature shows short parents, normal growth velocity and bone age near chronological age.
- Constitutional delay of growth and puberty shows normal childhood growth velocity with delayed bone age and a family history of late puberty.
- Endocrine short stature such as hypothyroidism or growth hormone deficiency typically shows poor linear growth with relatively preserved or increased weight for height.
- Systemic disease and undernutrition usually reduce weight before height velocity falls.
- Assessment must combine plotting weight, length, weight-for-length and head circumference with a feeding, illness and social history rather than a single measurement.
- Counselling of parents should avoid blaming the mother's milk and instead give a measurable feeding plan with a follow-up weight check.
- Height velocity below 4 centimetres per year after age 3, crossing down centiles, or delayed puberty are referral indications for growth-related problems.
Four pathways of failure to thrive
- **Inadequate intake:** Poor latch, delayed or dilute complementary feeding, food insecurity, feeding aversion.
- **Malabsorption or losses:** Celiac disease, chronic diarrhoea, giardiasis, pancreatic insufficiency.
- **Increased requirement:** Congenital heart disease, chronic lung disease, tuberculosis, chronic infection.
- **Defective utilisation:** Hypothyroidism, diabetes, renal tubular acidosis, inborn errors, chromosomal syndromes.
NMC competencies in this chapter
- **PE2.1:** Etiopathogenesis, clinical features and management of a child who fails to thrive
- **PE2.2:** Assessment of a child failing to thrive including history and examination
- **PE2.3:** Counselling a parent of a child failing to thrive
- **PE2.4:** Etiopathogenesis, clinical features and management of a child with short stature
- **PE2.5:** Assessment of a child with short stature: history, examination, documentation and presentation
- **PE2.6:** Referral criteria for growth-related problems
Frequently Asked Questions
How is failure to thrive defined?
Failure to thrive, also called growth faltering, is inadequate physical growth shown by weight below the 3rd or 5th centile, weight-for-age or weight-for-length below minus 2 standard deviations, or a downward crossing of two major centile spaces on repeated accurate measurements.
What are the four pathways of failure to thrive?
The four overlapping pathways are inadequate intake, malabsorption or increased losses, increased metabolic requirement, and defective utilisation from endocrine or metabolic disease. Most real cases are multifactorial until proven otherwise.
How do you distinguish familial short stature from endocrine short stature?
Familial short stature has short parents, normal growth velocity and a bone age close to chronological age, whereas endocrine causes such as hypothyroidism show poor linear growth with relatively preserved or increased weight for height and delayed bone age.
When should a short child be referred?
Referral is warranted for height velocity below 4 centimetres per year after age 3, crossing down centiles, disproportion, dysmorphism, signs of systemic or endocrine disease, or delayed puberty beyond accepted limits.
Continue reading
MBBSAll Pediatrics chapters
Continue through the Pediatrics chapter map.
Continue studying Pediatrics
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans