Am Fam Physician. 1999 Feb 15;59(4):785-786.
to the editor: I found the article by Drs. Legler and Rose1 on the assessment of abnormal growth curves to be quite interesting. One of the most common abnormalities we see in our practice is poor weight gain in children. Legler and Rose recommend that children who have poor weight and height gain and decreased growth of head size undergo laboratory evaluation, including evaluation for inborn errors of metabolism.
I would like to know specifically which tests should be ordered to screen for inborn errors of metabolism and which diseases are common causes of decreased growth.
Is there a reference containing this information that the author could suggest?
1. Legler JD, Rose LC. Assessment of abnormal growth curves. Am Fam Physician. 1998;58:153–8.
in reply: I wish to thank Dr. Spencer for her inquiry concerning the role of inborn errors of metabolism as etiologies of growth failure in children. I would refer Dr. Spencer to a general pediatric reference such as the 20th edition of Rudolph's Pediatrics.1 In particular, Chapter 6 contains lists and descriptions of the multitude of metabolic disorders that have been described in the literature. Growth retardation (that is, “failure to thrive”) is listed as a potential component in a number of these metabolic disorders. Figure 6–12 outlines a sequence of laboratory studies that may be used to approach this large group of diseases. On the basis of this diagram, the family physician can begin the initial work-up with a complete blood count, serum chemistry profile (to include serum bicarbonate, glucose, liver function tests and bilirubin), serum ketones, serum ammonium and urine reducing substances. Abnormalities in these initial findings lead to further testing with serum and urine metabolic screens. Further specialized testing at referral centers may be required.
1. Rudolph AM, Hoffman JI, Rudolph CD, eds. Rudolph's pediatrics. 20th ed. Stamford, Conn.: Appleton & Lange, 1996.
Send letters to firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.
Copyright © 1999 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions