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What Causes Elevated ESR Levels In A Child?

Posted on Mon, 19 Dec 2016

Question: My 15 month olds pediatrician noted at her 15 month check up that my daughter has failed to grow in height and weight since she was 9 months old. She labeled her as a failure to thrive, and sent us out for blood work and had us write a food journal. She tested her on normal blood counts and for Celiac Disease. All results came back normal but her ESR was elevated. The pediatrician doesn't know what to do from here, and I'm confused on what to do next. She hasn't had an illness in over 2 months, and eats amazingly. All other aspects she is doing great, she just isn't growing, at all.

Answered by Dr. Prof. Kunal Saha (2 hours later)

Brief Answer:
Weight needs to be plotted on a growth chart.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone through your query and understand your concerns. The diagnosis of failure to thrive (now known as faltering growth) cannot be made on the basis of one single weight observation. The weights and heights need to be measured periodically (possibly every three months) and plotted on a growth chart appropriate for age and sex. I would insist you to google out for WHO growth chart 0-36 months and to plot the weights taken earlier, and continue the plot. Unless the child is losing percentiles you need not get concerned.

You need not grow apprehensive. Periods of stagnancy are often seen and that is not a cause for concern. All you have to do feed the child wholesome food and maintain periods of regular playing (physical activity).

Let me know if I could help further.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (1 hour later)

Thank you. She has dropped 4 lines of the growth chart in the past 6 months. We've measured her 1x per month within that time frame. I've looked at her blood count and her ESR is 17, she has a creatine of .21, Eosinophils 4.0, lymphocytes 68.0, neutrophils 22.0, and smudge cells are listed as Slight (A) for abnormal. The pediatrician said these things are all fine, and I guess I just need reassurance.

Answered by Dr. Prof. Kunal Saha (9 hours later)

Brief Answer:
The blood parameters are fine.

Detailed Answer:
Thanks for writing back. In that case it indeed is a cause for concern. I would recommend:
* Increasing the number of calories and amount of fluid the child receives.
* Correction of any vitamin or mineral deficiencies.
* Get her evaluated by the doctor to identify and treat any other medical conditions.

Please go through the following:
http://www.uptodate.com/contents/failure-to-thrive-undernutrition-in-children-younger-than-two-years-management
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
http://www.aafp.org/afp/2011/0401/p829.html

Feel free to write back.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar