When Developmental Delay and Failure to Thrive Are Not Psychosocial

Case

A 5-month-old Caucasian male presented to the emergency department after his primary care physician referred him for workup of noted failure to thrive (FTT) and severe global developmental delay (DD) that did not respond to hypercaloric formula and physical therapy. The patient was born at 39 weeks’ gestation to a 26-year-old primigravida mother via spontaneous vaginal delivery. The mother had not received prenatal care until ∼33 weeks’ gestation and endorsed both alcohol and marijuana use throughout the pregnancy. An antenatal ultrasound was performed at that time and revealed polyhydramnios. His birth weight was 3290 g, which was appropriate for gestational age. Shortly after birth, the patient had hypotonia, nystagmus, and failed hearing screens both at birth and at 3 months of age. At 4 months of age, physical and occupational therapy were started. Additionally, he was started on a concentrated formula of Enfamil Premium 22 kcal/oz, which provided 115 calories/kg/day, considering catch-up growth requirement. Despite this, he was unable to appropriately gain weight.

In the emergency department, patient measurements were as follows: weight 5720 g (<5%), length 62 cm (<5%), and head circumference 43 cm (50%). Pertinent physical examination findings included generalized hypotonia, decreased deep tendon reflexes, marked scoliosis, and bilateral rotatory and horizontal nystagmus. The patient was unable to support his head or to track objects across the midline. He showed increased head lag in sitting position.

Family history was not significant for consanguinity.

What Is the Relationship Between FTT and DD? What Is the Initial Assessment of a Patient With These Characteristics?

Children with FTT have a higher incidence of developmental delay. FTT can result in severe short- and long-term sequelae on neurodevelopmental outcome. This leads to a higher risk of cognitive deficits and behavioral disorders.¹ Cognitive function is below normal in approximately half of children with FTT. This …