Failure to thrive laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]


Lab investigations are ordered based on the initial history and physical examination may be ordered to uncover conditions such as iron deficiency anemia secondary to malabsorption, hyperthyroidism, renal failure or an underlying malignancy.

Laboratory Findings

  • There is no fixed protocol followed for failure to thrive patients. [1]
  • Given the myriad of risk factors involved, each case is different and lab investigations are ordered based on clues obtained from an initial history and physical examination.
  • The significance of commonly employed investigations are as follows: [2][2]
    1. Complete blood count – anemia, leukemia, lymphoma
    2. Iron panel – iron deficiency anemia
    3. Urine microscopy and culture– pyuria in urinary tract infections, brown granular casts – acute tubular necrosis, renal infection
    4. Renal function tests and serum electrolytes – renal failure, renal tubular acidosis
    5. HIV screening (serum antibody, ELISA)
    6. Erythrocyte sedimentation rate and C- Reactive protein
    7. Thyroid function tests – hyperthyroidism
    8. Liver function tests – Biliary atresia, cirrhosis of liver
    9. Maternal quadruple serum screening tests – neural tube defects, Down’s syndrome, trisomy 13, trisomy 18
    10. Sweat chloride concentration – cystic fibrosis
    11. Stool guaiac, microscopy and culture – steatorrhea secondary to pancreatic insufficiency, giardiasis and other malabsorption syndromes.
  • Blood sugar levels, glycosylated hemoglobin – diabetes mellitus
    1. Sputum/gastric aspirate for acid fast bacilli
    2. Urine for organic and amino acids – inborn errors of metabolism
    3. Mantoux test – tuberculosis
    4. Specific tests for subtle malnutrition– pre-albumin, retinol binding protein, insulin growth factor-1, erythrocyte sodium potassium ATPase.


  1. Nangia S, Tiwari S (2013). "Failure to thrive". Indian J Pediatr. 80 (7): 585–9. doi:10.1007/s12098-013-1003-1. PMID 23604606.
  2. 2.0 2.1 Venkateshwar V, Raghu Raman TS (2000). "FAILURE TO THRIVE". Med J Armed Forces India. 56 (3): 219–224. doi:10.1016/S0377-1237(17)30171-5. PMC 5532051. PMID 28790712.

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