Assessment of nutritional status in the diagnostic evaluation of the child with growth failure

Current clinical guidelines provide information about the diagnostic work-up of children with growth failure. This mini-review focuses on the nutritional assessment, which has received relatively little attention in such guidelines. The past medical history, in particular a low birth size, early feeding problems and failure to thrive, can provide information that can increase the likelihood of nutritional deficits or several genetic causes. The current medical history should include a dietary history, and can thereby reveal a poorly-planned or severely restricted diet, which can be associated with nutritional deficiencies. Children on a vegan diet should receive various nutritional supplements, but insufficient compliance has been reported in one third of cases. While proper use of nutritional supplements in children consuming a vegan diet appears to be associated with normal growth and development, insufficient intake of supplements may impede growth and bone formation. Physical examination and analysis of the growth curve can help in differentiating endocrine causes, gastro-intestinal disorders, psychosocial problems or underlying genetic conditions that prevent adequate nutritional intake. Laboratory screening should be part of the work-up in every child with short stature, and further laboratory tests can be indicated if warranted by the dietary history, especially in children on a poorly-planned vegan diet.