Gastrostomy dependence in two constitutionally short children

G. B. Stickler
Department of Pediatrics, Mayo Clinic, Rochester, Minn. 55905.

We describe the medical odyssey of two infants who turned out to be constitutionally short. The measurements of length gradually came to rank below the fifth percentile during the first 18 months of life. Numerous tests were performed, and the diagnosis of gastroesophageal reflux led to fundoplication. The concept that higher energy intakes result in greater increases in length led eventually to gastrostomy. Increases in weight during gastrostomy feedings had no effect on growth in length. It was very difficult to convince the parents that the gastrostomies were not necessary. The parents had in fact become "gastrostomy dependent." The vague concept of "failure to thrive" proved to be misleading and obscured the knowledge that constitutionally short children can fall below the fifth percentile in length at any time before the age of 2 or 3 years.