This is a pediatric patient presentation. More often than not, parents bring up low weight, poor growth, or weight loss as a patient presentation, but in some situations a clinician notes poor weight gain on a physical exam without an accompanying concern brought up by the parents. After ruling out abuse (which is an urgent/emergent situation), probable diagnoses are divided based upon 1) inadequate intake which may be related to parent/caregiver causes or infant/child causes, 2) poor absorption, increased loss and 3) metabolic pathologies.
Urgent/emergent situations can be identified by looking for signs of abuse or neglect, or an extremely poor weight, which may pose a risk to sustain life. Signs of abuse are not necessarily particular to poor weight gain, as these can exist in children not suffering from poor gain, and therefore should be a part of any pediatric patient presentation.
Weighing and remove anchor bias involves a complete history, including a time-line of weight gain or loss, and questions to differentiate among all diagnoses. History related questions can be designed to determine from which of the three categories a patient’s pathology is arising.
Most parent/caregiver related causes involve social factors. Infant/child related causes resulting in inadequate intake typically involve mechanical/developmental challenges and can usually be diagnosed based upon a brief history and/or a physical exam. Most pathologies belonging to inadequate absorption arise from the gastrointestinal system. A mnemonic GLMP-PICNIC can be used to memorize these diagnoses. A clinician must perform a thorough history and physical exam focused on the gastrointestinal system to evaluate this category. Metabolic pathologies include in-born errors of metabolism and systemic/chronic medical conditions. Most in-born errors of metabolism are identified with screening exams done at birth. Chronic/systemic medical conditions which develop during infancy/childhood can be challenging to diagnose because these involve multiple systems, may present with overlapping features, and patients may or may not develop typical symptoms/signs related to chronic conditions. A complete review of systems including high yield questions and medium yield questions listed in this clinical mind map should help a clinician arrive at a narrow set of differentials or probable diagnoses. A mnemonic Chronic MAT can be used to memorize chronic/systemic conditions.
A physical exam and lab tests provide additional information to help a clinician arrive at a working and then