X-rays are useful in diagnosing organic causes of failure to thrive.

• X-rays are useful in diagnosing organic causes of failure to thrive.
• Listing down each organic cause is beyond the scope of this microchapter.
• Some examples are :

• Rickets
  1. Diffuse osteopenia in the diaphyses of the long bones.
  2. Widening and lengthening of the growth plates in the distal femur and proximal tibia.
  3. Irregular and indistinct (“fraying”) metaphyseal margins of the distal femur and proximal tibia.
  4. Bowing of the femur and tibia.

• Atrial Septum defect
  1. Chest x-ray of a child with an ostium secundum atrial septal defect showing right atrial enlargement, right ventricular enlargement and increased pulmonary vascular markings.

• Pneumatosis Intisinalis
  1. X-ray showing areas of pneumatosis in the stomach wall and dilated loops of bowel in the right lower quadrant. This should prompt a differential of necrotizing enterocolitis, gastric outlet obstruction, duodenal atresia, malrotation with volvulus or emphysematous gastroenteritis.

• Idiopathic pulmonary fibrosis
  1. Posterior-anterior x-ray film of a 6 year old child showing diffuse interstitial infiltrates secondary to idiopathic pulmonary fibrosis.

• Non Accidental Trauma
  1. An antero-posterior radiograph of the abdomen shows two pins in the duodenum and distal jejunum.
  2. An antero-posterior radiograph of the parapharyngeal and pharyngeal region shows multiple smaller pins.
  3. Such a radiograph should arouse suspicion for non-accidental trauma.

• Left femur, multiple metaphyseal lucencies show the characteristic “corner fracture”–thicker peripheral rim more readily visible and appearing as a triangular fragment, characteristic for non accidental trauma.