Which physical findings are characteristic of pediatric growth failure (failure to thrive)?

Updated: Nov 05, 2018
  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD  more...
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The following may be noted on physical examination:

  • Vital signs - Temperature, blood pressure (in 4 extremities in an infant or one arm and one leg in young child), pulse, respiration

  • General - Appearance, activity, affect

  • Skin and hair - Poor hair texture and amount, nails, alopecia, hygiene, rashes, birth marks, trauma (eg, bruises, burns, or scars as signs of physical abuse)

  • Head - Size, frontal bossing, fontanel size and patency, dysmorphia

  • Eyes - Dysmorphia, ptosis, sunset sign, palpebral fissures, pallor, trauma, optic discs, fundi for evidence of chorioretinitis (toxoplasmosis, other infections, rubella, cytomegalovirus infection, and herpes simplex [TORCH]), cataracts (TORCH or inborn errors of metabolism)

  • External ears - Size, shape, position, infection

  • Middle ears - Infection, acute or chronic

  • Mouth and pharynx - Palate deformity, submucous cleft, tongue, teeth, caries, glossitis, mucous membrane hydration or lesions, thrush, bleeding, unusual odors to the breath

  • Neck - Shape, web, masses, nodes, thyroid abnormalities

  • Chest - Breath sound, cardiac examination for murmurs or cardiomegaly or arrhythmias

  • Abdomen - Protuberance, organomegaly, masses, bowel sounds, normal umbilicus healing in infant

  • Genitalia - Normal for age, malformations, ambiguous in quality, hygiene, trauma

  • Extremities - Edema; digit malformations; examination of the nails, joints, spine, and back

  • Neurologic function - Cranial nerves, reflexes (increased or decreased), tone, infant reflexes present or extinguished at appropriate age, gait, suck/swallow coordination

  • Muscles - Muscle development and quality and texture of muscle mass

  • Adversive behaviors - Gaze avoidance, arching, hypertonicity, refusal to attach or respond appropriately, unusual body movements

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