What is a major cause of poor growth velocity in chronic illness?

• A. Excess caloric intake
• B. Inadequate caloric intake and increased energy expenditure
• C. Genetic factors
• D. Lack of exercise

Answer: (B)

In chronic illness, how fast a child grows depends on energy balance: calories coming in versus calories the body uses. Illness often raises metabolic demands through fever, inflammation, tissue repair, and reduced activity tolerance, so energy expenditure goes up. At the same time, appetite and intake commonly drop due to malaise, nausea, abdominal pain, and malabsorption. When intake does not meet these higher needs, the body may slow or pause linear growth, leading to poor growth velocity. That combination—inadequate caloric intake with increased energy expenditure—best explains why growth slows in chronic illness.

Excess calories wouldn’t typically cause poor growth velocity and, in many cases, could support growth if other factors allowed. Genetic factors influence ultimate height but aren’t the main driver of growth velocity loss during acute chronic illness. Lack of exercise is less impactful than the energy balance issue in this context.