Carla Veiga Rodrigues, Sara Rocha, Ana Lima, Ana Marques Pinho, Marisa Santos, Teresa Botelho Patrício and Gabriela Pereira
Introduction: Failure to thrive (FT) is a condition often seen by General Practitioners, characterized by a weight below the 5th percentile repeatedly or a weight deceleration crossing 2 major percentile lines. The majority of FT is due to inadequate caloric intake, mostly caused by behavioural/social issues. The diagnosis is clinical and demands thorough investigation of feeding habits and exclusion of other organic causes. Differential diagnosis includes prenatal or chronic illness, infections or digestive disorders, which should be investigated and sought on physical examination and additional testing.
Case description: 3 year old girl with FT and microcephaly. History of social problems that caused visits from Social Services. Support from Nutrition Department was provided. The physical examination was consistently normal and other symptoms were denied, without improvement on the weight. The initial investigation was normal, but, on a secondary level, sweat testing showed high Chloride (66 mEq/L) levels.
Discussion: The prognosis of FT depends on its severity, duration and subjacent cause. In this case, the biggest suspicion is malnourishment due to social problems. The positive chloride value often diagnoses Cystic Fibrosis, but it can also be a false positive caused by anorexia/bad nutrition. Malnourishment is a double-edged sword because of its ability to mask chronic illness, meaning either a cause or a result of it.
Conclusion: Identifying the problem underneath remains challenging due to our lack of control or knowledge of the real eating habits of our patients. A multidisciplinary approach is mandatory, as the effects of FT on cognitive development are unclear.