Diarrhoea (± blood)
Faltering linear growth
Delayed puberty Helicobacter pyloriVomiting
Nausea
Dyspepsia
Epigastric tenderness Coeliac diseasePresentation varies with age (see Chapter 12) and may include abdominal pain, vomiting, diarrhoea Eosinophilic oesophagitisDysphagia
Abdominal pain
Food impaction
Known allergy/atopy Eating disorder (see Information: Eating disorders)Loss of appetite
Altered body image
Cold peripheries
Lanugo
Bradycardia Autistic spectrum disorderFood restriction and ‘faddy’ eating
Sensory aversion Diabetes mellitusExcessive thirst
Increased urination
Abdominal pain Chronic liver disease (see Chapter 24)Poor weight gain
Pruritis
Fat-soluble vitamin deficiency
Bleeding from gums and bruising

Eating disorders in young children are uncommon (incidence 3 per 100 000).

Important features from history

Sudden weight loss
Drooling, coughing, choking, dysphagia and/or food impaction
Vomiting, abdominal pain, diarrhoea
Heartburn and dyspepsia
Fever
Thirst and increased urination
Known food allergy
Concerns about body image
Factitious illness may present with poor feeding
Liver disease

Examination

Jaundice, hepatosplenomegaly: liver disease
Fullness and tenderness in right iliac fossa: –terminal ileal Crohn’s, lymphoma
Epigastric tenderness: gastritis
Cold peripheries, lanugo, bradycardia, postural hypotension: eating disorder
Poor dentition: coeliac, bulimia nervosa
Marks on knuckles: evidence of self-induced vomiting
Hepatosplenomegaly, lymphadenopathy: malignancy, e.g. lymphoma, leukaemia

Investigations

Baseline nutrition screen: including U&E, calcium, phosphate, magnesium, CRP, trace elements (copper, selenium, zinc), fat-soluble vitamins (A, D, E, PT), ferritin, glucose
Urine for glucose, ketones
See Gastroenterology and Hepatology sections for named gastrointestinal/liver diseases
For immune deficiency disorders see Chapter 9