Initial work-up

• Urinalysis
• Stool MC&S
• Stool for fat and fatty acid crystals
• FBE with diff
• LFTs
• U&Es
• Weight and height evaluation.
  See  growth charts for girls and  growth charts for boys

If gluten in diet,

• Total IgA, Coeliac serology

Recommended pre-referral treatment

• If breast-fed baby, offer advice about technique
• Involve MCHN or breast-feeding consultant - consider mastitis
• Dietetic involvement for caloric supplement
• Do not stop gluten

When to refer

• If getting adequate calories for growth and FTT is not explained by underlying disease, refer for further evaluation.
• If there is abnormal coeliac serology, refer for further evaluation and a possible gastroscopy.

Resources

• Make a referral:Specialist Clinics
• Contacts
• RCH Primary Care Liaison (GP website)
• Kids HealthInfo (Parent information website)  

References and more reading

• Paediatric Handbook (2009). Gastrointestinal Conditions, Chapter 24 (pp369-389) Mark Oliver and Lionel Lubitz. Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Guideline developed by the RCH Department of Gastroenterology in consultation with a GP Review Group. Many thanks to the GPs involved in the review.  First published Jan 2008. Updated April 2010.
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