import json

data = {
 "topic": "Growth Failure",
 "slug": "growth-failure",
 "category_id": 15129,
 "summary": "Growth failure (formerly \"failure to thrive\") is a descriptive sign of inadequate weight gain relative to growth-chart norms, almost always driven by undernutrition from organic, nonorganic, or mixed causes.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "Pediatric Nutrition Handbook", "author": "Kleinman, Ronald E.", "pages": [652]},
  {"title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)", "author": "CamScanner", "pages": [47]},
  {"title": "Berkowitz's Pediatrics", "author": "Berkowitz, Carol D.;", "pages": [1122]},
  {"title": "The Clinician's Guide to Pediatric Nutrition", "author": "Natalie D. Muth;Mary Tanaka;", "pages": [96]},
  {"title": "Pediatrics for Practitioner (Sharad Thora)", "author": None, "pages": [179]},
  {"title": "Pediatric Decision-Making Strategies", "author": "Pomeranz, Albert J.", "pages": [326]},
  {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [276]},
  {"title": "Cover", "author": "Vitalsource Download", "pages": [406]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Growth failure (old term \"failure to thrive\") is a descriptive sign, not a diagnosis - the underlying cause is malnutrition in nearly all cases\n"
   "- Common anthropometric criteria: weight-for-age below the 3rd-5th percentile, weight-for-length below the 5th percentile, or downward crossing of 2 or more major percentile lines\n"
   "- Also defined as no growth for 2 consecutive months if under age 6 months, or no growth for 3 consecutive months if over age 6 months\n"
   "- Affects mainly infants and toddlers, most sources scope it to children under 3-5 years of age\n"
   "- Prevalence is about 5-10% in Western primary care populations, roughly 8% by one estimate, with 1% of tertiary-center hospital admissions attributable to it\n"
   "- Traditionally split into organic (identifiable medical illness) and nonorganic/psychosocial causes; nonorganic causes account for up to 80% of cases and the two often coexist\n"
   "- Weight is affected earlier and more severely than length; head circumference is relatively spared until undernutrition is prolonged\n"
   "- Use WHO growth charts (not CDC) for children under 2 years - they flag fewer children as underweight\n"
   "- When correcting for prematurity, adjust weight until 24 months, head circumference until 18 months, and length/height until 40 months of age\n"
   "- Distinguish from constitutional growth delay, where weight and height dip in infancy, track along a lower percentile through childhood, then show a growth spurt in late adolescence reaching a normal adult height"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Growth failure - long labeled \"failure to thrive\" (FTT) - is a descriptive sign rather than a diagnosis. It refers to a child whose growth in weight (and sometimes length and head circumference) is significantly below expected norms for age and sex. The term \"failure to thrive\" is now considered imprecise and even stigmatizing to families, so texts increasingly prefer \"growth faltering,\" \"growth deficiency,\" or simply \"malnutrition/undernutrition,\" though FTT remains in common clinical use. There is no single agreed anthropometric definition. Commonly used criteria include: weight-for-age below the 3rd or 5th percentile; weight-for-length below the 5th percentile; downward crossing of two or more major percentile lines on a growth chart over time (for example, 75th to 50th); a decline in the weight-for-age or weight-for-length z-score of more than 1; or no measurable growth for 2 consecutive months in an infant under 6 months, or 3 consecutive months in a child older than 6 months. The term is generally applied to infants and toddlers, most commonly under 3 years of age, though some texts extend the scope to children up to 5 years."
  )},
  {"title": "Epidemiology", "content": (
   "Growth failure is common in general pediatric practice. Estimates put its prevalence at roughly 5-10% of children in Western primary-care settings, with one source citing approximately 8% overall. It is a frequent reason for referral, accounting for an estimated 5-10% of pediatric referrals, and for about 1% of admissions in tertiary hospital centers."
  )},
  {"title": "Etiology", "content": (
   "Growth failure has traditionally been divided into \"organic\" causes, where an identifiable underlying medical illness impairs growth, and \"nonorganic\" (psychosocial) causes, where inadequate caloric intake and/or emotional deprivation are responsible. This dichotomy is now viewed as an oversimplification, since organic and nonorganic contributors frequently coexist - for example, in children with cerebral palsy or multiple congenital anomalies who also face feeding and psychosocial challenges. Nonorganic causes account for up to 80% of cases. Regardless of the label, the proximate mechanism in essentially all cases - organic or nonorganic - is malnutrition, whether primary (inadequate intake) or secondary to another process. Causes can be grouped functionally as: inadequate caloric intake, excessive caloric losses (malabsorption/maldigestion), ineffective use of calories once absorbed, or increased metabolic/caloric demand."
  )},
  {"title": "Pathophysiology", "content": (
   "At its core, growth failure represents a state of caloric insufficiency relative to the child's needs. Malnutrition does not only blunt growth; it also impairs immune competence and contributes to concurrent and long-term deficits in cognitive and socioaffective development. The pattern of growth deceleration follows a recognizable sequence: weight-for-height typically falls first and most severely, followed by a decline in height/length-for-age, with head circumference relatively preserved unless the undernourished state is prolonged, at which point head circumference growth also falters. This staged pattern (weight, then height, then head circumference) is a useful marker of chronicity and severity when reviewing a growth chart."
  )},
  {"title": "Diagnostics", "content": (
   "Accurate, serial anthropometry is the foundation of evaluation: weight, length/height, and head circumference should be measured carefully and plotted over time. WHO growth charts are preferred over CDC charts for children younger than 2 years, since they identify a lower proportion of children as underweight. Measurement technique matters - standing height should never be recorded as if it were recumbent length, since a child's standing height reads shorter than supine length. For infants born preterm, correct for gestational age when plotting: continue adjusting weight until 24 months, head circumference until 18 months, and length/height until 40 months of age. Beyond the growth chart itself, evaluation requires a detailed feeding/dietary history, birth and past medical history, developmental assessment, and a thorough psychosocial evaluation of the family, since undernutrition reflects a complex interaction of medical, nutritional, emotional, and social factors rather than a single cause."
  )},
  {"title": "Differential diagnosis", "content": (
   "Constitutional growth delay (constitutional delay of growth and puberty) can mimic growth failure but follows a distinct trajectory: weight and height decelerate in infancy, then the child tracks along a lower percentile through middle childhood, followed by an accelerated growth spurt in late adolescence that brings the child to an expected adult height. In contrast, true growth failure predominantly affects weight, while conditions causing short stature predominantly affect height; head circumference is comparatively spared in most growth problems, so a significant change in head circumference should prompt separate investigation rather than being attributed to simple growth failure."
  )},
  {"title": "Complications", "content": (
   "Because the underlying process is malnutrition, growth failure carries risks beyond poor weight gain: impaired immunocompetence increases susceptibility to infection, and inadequate nutrition during periods of rapid brain development is linked to long-term deficits in cognition and socioaffective functioning. These risks underline why growth faltering warrants prompt recognition and evaluation rather than being dismissed as a benign variant of normal growth."
  )}
 ],
 "clinical": [
  {"title": "Evaluation and management at the bedside", "content": (
   "Start with careful, accurate anthropometry at every visit: weigh and measure length/height and head circumference with consistent technique, and plot on the appropriate growth chart (WHO for children under 2 years). Look specifically for the defining patterns - weight-for-age below the 3rd-5th percentile, weight-for-length below the 5th percentile, or crossing of two or more major percentile lines - and correct for prematurity where relevant (weight to 24 months, head circumference to 18 months, length/height to 40 months). \n\nBecause the underlying problem is almost always undernutrition, structure the history and exam to sort the child into one (or more) of four functional categories: inadequate intake (feeding technique, access to food, formula preparation errors, oral-motor or behavioral feeding problems), excessive losses (vomiting, diarrhea, malabsorption), ineffective use of calories (metabolic disease), or increased requirement (chronic illness, congenital heart disease, chronic infection). A thorough psychosocial assessment of the family is a required part of the work-up in every case, not only when a nonorganic cause is suspected, since organic and nonorganic contributors commonly overlap. Reserve escalation to subspecialty or hospital-based evaluation for children with severe or rapidly progressive growth deceleration, suspected serious organic disease, or when outpatient nutritional intervention and follow-up have failed - re-measurement and re-plotting of growth parameters over time is the key tool for judging whether an intervention is working."
  )}
 ]
}

with open("/tmp/growth-failure.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")