ARJ
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A 9-month-old infant is seen in the pediatrician's office because of failure to gain weight. Her length and weight are both below the 5th percentile at her age. The patient's chart indicates that at the age of age of 6 months, her length and weight were at the 50th percentile. A careful history reveals that the mother returned to work when the infant was 6 months old, and the grandmother assumed the care of the infant most of the time since then. She is receiving 6-8 oz of iron-fortified, cow protein-based formula every 4 hours. Which of the following is the best initial step in the management of this infant?
a)Ask how the formula is mixed
b)Obtain a detailed family history for lactose intolerance
c)Obtain a stool specimen
d)Obtain a sweat chloride test
e)Obtain a urinalysis
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| drkpp
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b
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| nisha
lil monkey
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a/b??
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| mani
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b)Obtain a detailed family history for lactose intolerance
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| catmd
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A - I think the MCC is inadeq formula.
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| ARJ
Forum Guru
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The correct answer is
A. This 9-month-old infant presents with failure to thrive, which is determined by the decline in her length and weight to below the 5th percentile. Failure to thrive can be either organic or inorganic (i.e., social). Although it is important to identify the causes of organic failure to thrive, most cases are inorganic. In this clinical vignette, since the reduction of weight happens after the mother returned to work, an inorganic cause is likely. One of the most common causes of failure to thrive is improper preparation of the formula, resulting either from an incorrect water-to-formula ratio or from poor mixing techniques. In addition to obtaining a detailed history of how the formula is mixed, it might be very useful to have the caretaker actually demonstrate how he or she prepares the formula. In this case, the most likely reason that the infant has failure to thrive is that the grandmother has improperly mixed the formula. Lactose intolerance (choice B) is an uncommon cause of failure to thrive. It usually presents with abdominal pain, bloating, and diarrhea. Obtaining a stool specimen (choice C), sweat chloride test (choice D), or urinalysis (choice E) might be helpful if no identifiable inorganic causes of failure to thrive are identified. Urinalysis is helpful in screening for renal disease. A sweat chloride test is used to detect cystic fibrosis. Stool specimens can be useful in a great variety of gastrointestinal disorders, such as gastroenteritis, parasitic infection, and fat malabsorption.
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