Failure to Thrive: Crohn’s Disease Presenting as Avoidant/Restrictive Food Intake Disorder (ARFID) in a Young Child

Abstract

Failure to thrive (FTT) is a state of insufficient nutritional intake that limits growth and development in children. FTT can be a diagnostic challenge for pediatricians. In the United States, FTT is prevalent in 5 to 10 percent of children in primary care settings.1 With a broad differential diagnosis causing FTT, including both organic and inorganic causes,2 pediatricians can have difficulty diagnosing and treating children with mixed etiologies. This report highlights how delays in obtaining the correct diagnoses and performing appropriate interventions can have significant consequences, including malnutrition, developmental delay, and psychosocial sequelae in a child. In this case, a child with FTT was initially diagnosed and treated for an inorganic cause, anorexia nervosa (AN), with an additional etiology of Crohn’s disease not recognized until several years of unsuccessful treatment for the AN. This report highlights the fact that behavioral and psychological components, including a fear of eating and refusal to try a variety of foods, may be consistent with a presentation of Crohn’s disease. It also emphasizes the need to continually re-evaluate diagnoses in young children, particularly when they are not responding to prescribed interventions.