Krugman Scott D, Dubowitz Howard
Department of Pediatrics, Franklin Square Hospital Center, Baltimore, Maryland 21237, USA.
Am Fam Physician. 2003 Sep 1;68(5):879-84.
Failure to thrive is a condition commonly seen by primary care physicians. Prompt diagnosis and intervention are important for preventing malnutrition and developmental sequelae. Medical and social factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hypervigilance) can lead to failure to thrive. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, or premature birth follow different growth patterns than normal infants. Many infants with failure to thrive are not identified unless careful attention is paid to plotting growth parameters at routine checkups. A thorough history is the best guide to establishing the etiology of the failure to thrive and directing further evaluation and management. All children with failure to thrive need additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Few need laboratory evaluation. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe.
生长发育迟缓是初级保健医生常见的一种病症。及时诊断和干预对于预防营养不良及发育后遗症很重要。医学和社会因素常常导致生长发育迟缓。父母关注的两个极端情况（忽视或过度警觉）都可能导致生长发育迟缓。约25%的正常婴儿在出生后的头两年会转变为较低的生长百分位数，然后一直保持该百分位数；这不应该被诊断为生长发育迟缓。患有唐氏综合征、宫内生长受限或早产的婴儿与正常婴儿遵循不同的生长模式。除非在常规体检时仔细关注绘制生长参数，否则许多生长发育迟缓的婴儿不会被识别出来。详尽的病史是确定生长发育迟缓病因并指导进一步评估和管理的最佳指南。所有生长发育迟缓的儿童都需要额外的热量来实现追赶生长（通常为其预期体重而非实际体重所需热量的150%）。很少需要进行实验室评估。很少需要住院治疗，仅适用于严重的生长发育迟缓以及那些安全受到关注的患儿。当生长发育迟缓在干预后仍持续存在或病情严重时，建议采用多学科方法。
