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Advanced laboratory and imaging tests in the evaluation of poor weight gain in children younger than 2 years in resource-abundant countries

Advanced laboratory and imaging tests in the evaluation of poor weight gain in children younger than 2 years in resource-abundant countries
Suspected condition(s) Test(s)
Food allergy
  • Serum IgE, RAST, and skin tests to selected food antigens
Gastrointestinal disease
  • Celiac disease
  • Tissue transglutaminase-IgA and total IgA (if not done during the initial evaluation)
  • Helicobacter pylori
  • Stool antigen assay or 13C-urea breath test
  • Malabsorption
  • Carbohydrates – Stool reducing substances
  • Protein – Stool alpha-1 antitrypsin
  • Fat – Stool elastase
  • Inflammatory bowel disease
  • Stool guaiac and calprotectin (or leukocytes)
  • Small bowel imaging (MRE or UGI/SBFT)*
  • Advanced endoscopic studies
  • Gastroesophageal reflux disease
  • Esophageal pH and impedance monitoring
  • Advanced endoscopic studies
  • Swallowing dysfunction or aspiration
  • Swallowing function study
  • Vomiting or anorexia related to an intraabdominal or intracranial process
  • Possible studies include:
    • Abdominal ultrasonography
    • Radionuclide scans for gastric and biliary tract emptying
    • Abdominal and heat CT scans
Cystic fibrosis
  • Sweat chloride test
Inborn errors of metabolism or genetic syndromes
  • Possible studies include:
    • Serum amino acids
    • Urine organic acids
    • Urine reducing substances
    • Serum carnitine
    • Chromosome studies
Endocrine disorders
  • Hyperthyroidism
  • Serum TSH, free T4, and T3
  • Growth hormone deficiency
  • IGF-1 and IGFBP-3
Infectious diseases
  • HIV infection
  • Refer to UpToDate topics on HIV testing and diagnosis
  • Tuberculosis
  • TST or IGRA
  • CMV
  • CMV IgM and IgG
  • EBV
  • EBV IgM and IgG
  • Hepatitis A, B, or C
  • Hepatitis panel
Select advanced laboratory and imaging tests that may be performed in the evaluation of poor weight gain in children <2 years of age in resource-abundant countries. Advanced testing is warranted if specific diagnoses are suspected or if the diagnosis remains uncertain and the child has not responded to dietary and/or behavioral interventions. Testing should be targeted to clinical findings.

CMV: cytomegalovirus; CRP: C-reactive protein; CT: computed tomography; EBV: Epstein-Barr virus; ESR: erythrocyte sedimentation rate; HIV: human immunodeficiency virus; Ig: immunoglobulin; IGF-1: insulin-like growth factor 1; IGFBP-3: insulin-like growth factor-binding protein 3; IGRA: interferon-gamma release assay; MRE: magnetic resonance enterography; RAST: radioallergosorbent test; TSH: thyroid-stimulating hormone; TST: tuberculin skin test; T4: thyroxine; T3: triiodothyronine; UGI/SBFT: upper gastrointestinal series with small bowel follow-through.

* Small bowel imaging and endoscopy are indicated for children with significant clinical suspicion of inflammatory bowel disease (eg, persistent diarrhea and/or elevated ESR, CRP, or fecal calprotectin >200 mcg/g). For small bowel imaging, MRE is preferred. If this is not available, a fluoroscopic contrast study (UGI/SBFT) can be used.

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