Chronic Conditions

Failure to Thrive

A child whose height and weight does not fall within the normal limits of children of comparable age and gender is diagnosed with failure to thrive. There may a great many causes for this condition, ranging from genetic defects to disease conditions to environmental inadequacies. Any child who fails to thrive needs to be thoroughly examined physically and if necessary, the home environment may be investigated and evaluated.

Diagnosis

Pediatricians usually diagnose failure to thrive through a combination of abnormally low weight and height measurements, observation of the child's abilities and discussions with the child's parents or caregivers. If the condition is suspected, other tests may be administered to confirm the diagnosis, including:

• Complete blood test (CBC)
• Hemoglobin tests for sickle cell disease
• Blood tests for electrolyte balance
• Hormone tests, especially for thyroid function
• Urinalysis
• X-rays to determine bone age

In addition to taking a careful family history, the doctor will most likely administer a Denver Developmental Screening Test.

Treatment

If the failure to thrive is the result of an underlying medical condition, once that condition is treated the child may regain normal growth patterns. If the child is not being fed a nourishing diet, parents and other caregivers are instructed in ways to provide a well-balanced diet with additional calories, and to correct any vitamin or mineral deficiencies. It is possible that the child will have to be hospitalized for a time in order to boost energy level and get the body back in balance.

If the environment the child is living in is impoverished, toxic or abusive, familial issues must be addressed to ensure the child's well-being. In this case, social workers, psychiatrists, and law enforcement officials may have to become involved. Whatever the cause, it is essential that any child's failure to thrive be addressed as quickly as possible to prevent permanently stunted mental, emotional, or physical development.

Autism

Autism, or autism spectrum disorder (ASD), encompasses a range of pervasive developmental disorders. These disorders vary in degree from mild forms like Asperger's syndrome to severe impairment.

Autism is characterized by difficulties with communication and social interaction and by repetitive behavior patterns. The disorder has become very common, occurring in more than 1 percent of children. Autism is four times more likely to occur in males. Besides Asperger's syndrome, there are several other types of ASD, including pervasive developmental disorder not otherwise specified, childhood disintegrative disorder, and Rett's syndrome.

Diagnosis

While parents, friends and teachers may observe behavior patterns consistent with autism, the disorder should always be diagnosed by a medical professional. Autism, like other psychiatric disorders, is diagnosed according to criteria set down by American Psychiatric Association that appear in the Diagnostic and Statistical Manual of Mental Disorders, or DSM.

Treatment

Autism is most often treated with a combination of applied behavioral analysis and medication. In some cases, alternative therapies are also used in an attempt to improve emotional stability and to normalize behavior.

Applied Behavioral Analysis
Applied behavioral analysis is a highly structured protocol designed to help improve language and social skills by dividing tasks into incremental steps and rewarding each small success. Typically administered by mental health care professionals, such techniques can also be taught to family members and teachers so the therapy is reinforced in all environments. Family therapy is also helpful in assisting family members as they cope with the emotional stresses of dealing with the autistic child.

Medications
While autism is not a curable condition, physicians may prescribe medications to treat symptoms related the disorder, such as obsessive-compulsive behavior, social anxiety, depression, sleep problems, and hyperactivity. In some cases, antipsychotic medications may also be used to treat severe behavioral problems. Since 20 to 30 percent of patients with autism will develop epilepsy, anti-seizural medication may also be administered.

Alternative Therapies
Some alternative therapies are being used to treat children with autism, including special diets, nutritional supplements, and chelation. Parents may try, for example, eliminating gluten from their child's diet. These therapies, found to be employed more often by more highly educated parents, are controversial, since there is little, if any, scientific proof that any of them are helpful. Nonetheless, there is anecdotal evidence that some of these complementary treatments may be helpful to some children.

The goal of treatment is to maximize the child's ability to function, reduce troublesome symptoms and support development and learning. Several different treatment methods may be necessary before finding the best combination of therapies for the child. Early diagnosis, intervention, and treatment are extremely important in helping children with autism develop to their full potential.