P3C176: Malnutrition and Failure to Thrive in African American Children: A Retrospective Study from an Urban Underserved Community Hospital

Background: Failure to thrive (FTT) is a descriptive term for insufficient growth and could be the first sign of an occult organic disease in asymptomatic children. A routine set of laboratory workups is commonly performed in clinical practice to screen for the underlying pathology of FTT. The aim of our study was to determine the prevalence of malnutrition and estimate the yield of diagnostic investigations done on African American children with FTT.

Methods: In this retrospective study, clinical data was collected on children ages 0–19 years seen in the pediatric gastroenterology clinic on their initial visit for evaluation of FTT, between January 2017 to August 2022. Children in whom the cause of FTT was already known at the time of referral were excluded from this study. A total of 192 medical records were reviewed, out of which 115 patients met the inclusion criteria. The malnutrition rate and the percentage of diagnostic investigations (laboratory workup, imaging, and procedures) that turned out to be positive and resulted in a diagnosis of the cause of FTT were determined.

Results: In the study population, 56 (48.6 %) cases were male, and 59 (51.3%) children were less than 2 years old. Acute malnutrition was considered if the weight-for-age z score < - 2 and the height-for-age z score > -2, and it was diagnosed in 31 (27 %) cases. Chronic malnutrition was defined as a height-for-age z score < -2 and was found in 32 (27.8 %) cases. Regarding malnutrition based on the Z score (Table 1), 48.7 % had moderate or severe FTT (n = 42/115 and n = 14/115, respectively) based on the weight-for-age Z scores, while 28.7 % had moderate or severe FTT (n = 15/115 and n = 18/115, respectively) based on the height/length-for-age Z scores.

A total of 450 tests were performed in 80 patients (69.6%) out of the study population, with a median of 5 tests (IQR 2–9) per patient. Out of these, 11 (2.4 %) tests led to a diagnosis. The percentage of laboratory tests that yielded a diagnosis was 1.5 %. The percentage of imaging and endoscopic procedures that resulted in a diagnosis was 9.1 % and 6.7 % respectively, while colonoscopies yielded a 50 % diagnosis (Table 2).

Conclusion: The majority of African American children seen in the Pediatric Gastroenterology Clinic for failure to thrive had a nutritional cause for their FTT. The yield of imaging and endoscopy procedures, when indicated, was higher compared to the laboratory evaluation. In most cases, laboratory evaluation does not change the diagnosis and hence should be used judiciously.