Organic Failure to Thrive
This 10-month-old infant has organic failure to thrive (Option C), as evidenced by the specific gastrointestinal symptoms (irritability during feeding and multiple vomiting episodes) combined with disproportionate growth failure affecting weight primarily while height and head circumference remain relatively preserved. 1
Key Diagnostic Features Supporting Organic Etiology
The growth pattern is pathognomonic for acute malnutrition from an organic cause:
- Weight below the 3rd percentile with height and head circumference at the 25th percentile indicates acute malnutrition affecting weight first, which is the critical distinguishing feature of organic failure to thrive 1
- This disproportionate growth failure pattern, rather than global growth delay affecting all parameters equally, strongly points to an organic etiology 1
The clinical presentation confirms a specific organic pathology:
- Irritability during feeding combined with multiple vomiting episodes indicates a gastrointestinal pathology such as gastroesophageal reflux disease (GERD), feeding/swallowing dysfunction, or other GI disorder 1
- These are not simply behavioral feeding issues or decreased intake from psychosocial factors 1
Why Other Options Are Incorrect
Option A (Normal development) is clearly wrong:
- Weight below the 3rd percentile represents significant growth failure requiring immediate evaluation 1, 2
Option B (Non-organic failure to thrive) is excluded by multiple factors:
- Non-organic FTT typically presents with psychosocial deprivation and behavioral feeding problems without specific GI symptoms 1, 3
- The presence of specific symptoms (vomiting and feeding irritability) rather than simple decreased intake argues against non-organic etiology 1
- Two healthy older siblings make environmental/psychosocial causes less likely 1
Option D (Chromosomal abnormalities) is unlikely:
- Normal birth history with two healthy siblings makes chromosomal abnormalities improbable 1
- Chromosomal abnormalities typically present with global growth delay affecting height and head circumference proportionately, not isolated weight faltering 4, 2
Immediate Clinical Approach Required
Gastroenterology referral is essential:
- Immediate evaluation to identify the organic cause, including gastroenterology consultation for GERD, swallowing dysfunction, or other GI pathology given the vomiting and feeding irritability 1
Initial diagnostic workup should include:
- Basic laboratory screening: CBC, comprehensive metabolic panel, and thyroid function to exclude systemic disease 1
- Consider upper GI series or pH probe studies based on gastroenterology recommendations 5
Common Pitfalls to Avoid
- Do not dismiss specific GI symptoms as "just reflux" without thorough evaluation—the severity of growth failure warrants aggressive investigation 1, 2
- Do not delay referral waiting for outpatient nutritional intervention alone when organic pathology is suspected 6
- Inadequate caloric intake is the most common mechanism, but in this case it results from an underlying organic process requiring specific treatment 4, 2