A child presents with failure to thrive to pediatrics OPD. The doctor counseled the parents about improving nutrition of child , to which mother strongly asseed that they have ensured everything is perfect from their side especially nutrition, but to no avail. Then doctor requested for few investigations. What is the diagnosis?

**Core Concept**
The case presented involves a child with failure to thrive, which is a common pediatric problem characterized by inadequate weight gain or growth in children. This condition can be caused by various factors, including inadequate nutrition, gastrointestinal disorders, or underlying systemic diseases.

**Why the Correct Answer is Right**
The doctor's request for investigations suggests that the child's failure to thrive may not be solely due to inadequate nutrition. The mother's assertion that everything is perfect from their side, including nutrition, may not be entirely accurate. A closer look at the child's overall health, including laboratory tests and imaging studies, may reveal an underlying condition such as celiac disease. Celiac disease is an autoimmune disorder that causes the immune system to react to gluten, leading to malabsorption of nutrients and failure to thrive. The diagnosis of celiac disease is typically made through serological tests (e.g., tissue transglutaminase antibody) and intestinal biopsy.

**Why Each Wrong Option is Incorrect**
**Option A:** This option may be a consideration if the child's failure to thrive is due to a rare genetic disorder, but it is not the most likely diagnosis in this case.

**Option B:** While gastrointestinal disorders can cause failure to thrive, this option is too broad and does not provide a specific diagnosis.

**Option C:** This option may be a consideration if the child's failure to thrive is due to a chronic illness, but it is not the most likely diagnosis in this case.

**Clinical Pearl / High-Yield Fact**
Celiac disease is a common cause of failure to thrive in children, and it is often associated with other symptoms such as abdominal pain, diarrhea, and fatigue. Early diagnosis and treatment with a gluten-free diet can lead to significant improvement in growth and development.

**Correct Answer: C. Celiac disease is a common cause of failure to thrive in children, and it is often associated with other symptoms such as abdominal pain, diarrhea, and fatigue.**

✓ Correct Answer: B. Ostium secundum, type of ASD