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1) A 2-month-old male infant is brought for a

routine health supervision visit. His mother

reports that he cries a lot. He feeds vigorously

then regurgitates. The regurgitation is

nonbilious and nonprojectile. Findings on

physical examination are normal except for the

fact that the infant’s weight has fallen from the

60th to the 25th percentile for age.

Of the following, the MOST likely diagnosis is:

A. adrenal insufficiency

B. cystic fibrosis

C. gastroesophageal reflux

D. poor feeding technique

E. pyloric stenosis

2) A 15-month-old girl who was placed in foster

care recently has had poor growth over the past

6 months. Her weight is markedly below the 5th

percentile for her age and has plateaued since

the age of 9 months. Length and head

circumference are at the 25th and 50th

percentile, respectively. Development is

normal, although she still uses a bottle rather

than a cup.

The findings in this patient are MOST likely due


A. a chromosomal abnormality

B. an endocrine disorder

C. an intrauterine insult

D. constitutional growth failure

E. inadequate intake of calories

3) You are examining a girl at her 1-year health

supervision visit. Her weight, length, and head

circumference all were at the 10th percentile at

birth. There were no pregnancy, labor, delivery

or nursery complications. Physical examination

reveals her weight, length, and head

circumference are at the 5th percentile.

Of the following, this child’s growth parameters

MOST likely represent:

A. a chromosomal abnormality

B. a malabsorptive disorder

C. an endocrine disorder

D. inadequate caloric intake

E. normal growth

4) You are evaluating a 6-month-old boy whose

Length is at the 20th percentile and weight is at

the 5th percentile. Review of his growth chart

documents the following:

His head circumference has been consistently at

the 50th percentile. He was born at term to an

18-year-old single mother. The grandmother is

the caregiver while the mother works. He was

breastfed for 2 weeks, and his formula was

changed twice in the first 4 months. Although

he is offered one cereal feeding a day, he does

not seem to like it. His mother denies any

history of fever, diarrhea, or vomiting.

Physical examination reveals an active, thin

infant who has otherwise normal findings. Of

the following, the factor MOST likely to explain

this infant’s failure to thrive is the:

A. family’s low socioeconomic status

B. infant’s difficult temperament

C. infant’s inadequate caloric intake

D. mother’s age of younger than 19 years

E. participation of multiple caregivers

5) You are evaluating a 2-year-old child for a

Failure to thrive. The dietary history suggests the

boy’s caloric intake is 100 kcal/kg per day, which is

the recommended dietary allowance (RDA) for his

age. He has not been vomiting, and he is passing

one to two normal bowel movements per day. On

physical examination, he appears to be an active,

happy, thin toddler. His weight is 10.5 kg (5th

percentile), height is 85 cm (25th percentile), and

weight for height ratio is at the 5th percentile. There

is mild eczema on the cheeks and antecubital fossae.

The abdomen is not distended, and other findings

are normal.

Of the following, the BEST explanation for this

child not gaining weight is that he has:

A. a food allergy

B. caloric requirements that exceed the RDA

C. celiac disease

D. cystic fibrosis

E. reflux esophagitis

6) Both the weight and height parameters of a 6-

Month-old girl have dropped too substantially

below the 5th percentile for age. Until 2 months

of age, she had maintained growth at the 50th

percentile. At that time, her mother returned to

work and the grandmother assumed her care.

She has received iron-fortified formula since

birth and currently ingests 6 oz every 4 hours.

Of the following, the best INITIAL step in

management of this child is to:

A. determine how the formula is mixed

B. obtain a creatinine level

C. obtain a sweat test

D. obtain thyroid function studies

E. reassure the mother that this is a normal

growth pattern



Q1: What factors influence / control


Q2: How to know that a child is not

growing normally?

Q3: What causes failure to thrive? How to

classify it?

Q4: What specific points in history you

need to know?

Q5: How you approach examination of a

child who has growth failure?

Q6: What investigations you need to do on

a child with failure to thrive?

Q7: How to treat children with failure to


Q8: Take home messages.

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