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Growth charts

Measurements, including those taken at birth if possible, should be examined to determine the trend in growth rate. Because of wide normal variations, diagnosis of failure to thrive should not be based on a single measurement, except when undernutrition is obvious.

Diet history (3 days)

Diet history should be detailed, including feeding schedule and techniques for the preparation and feeding of formula or adequacy of breast milk supply.

As soon as possible, parents should be observed feeding the infant to evaluate their technique and the infant’s vigor of sucking. An infant who tires easily during feeding may have underlying cardiac or pulmonary disease. Enthusiastic burping or rapid rocking of the infant during feeding may result in excessive regurgitation or even vomiting.

A disinterested parent may be depressed or apathetic, suggesting a psychosocial environment that is lacking stimulation for and interaction with the infant.

Assessment of the child’s elimination pattern

Abnormalities of urine or stool and frequent emesis should trigger an investigation to detect underlying renal disease, malabsorption syndrome, pyloric stenosis, or gastroesophageal reflux.

Medical history and birth history

Of concern is any evidence of intrauterine growth restriction or prematurity with growth delay that has not been compensated; developmental delay; unusual, prolonged, or chronic infections (eg, tuberculosis, parasitic, HIV); neurologic, cardiac, pulmonary, or renal disease; illness or hospitalization; and possible food intolerance.

Family history

Included is information about familial growth patterns, especially in parents and siblings; the occurrence of diseases known to affect growth (eg, cystic fibrosis); and a parent’s recent physical or psychiatric illness resulting in inability to provide consistent stimulation and nurturance.

Social history

Attention is focused on family composition, socioeconomic status, desire for pregnancy with and acceptance of the child, and stresses (eg, job changes, family moves, separation, divorce, deaths, other losses).