Case history
Case history #1
A 17-month-old boy presents with a weight-for-age decline from the 25th to 5th percentile over 5 months, a weight-for-length decline from 20th to 5th percentile, and a length-for-age tracking on the 30th percentile. He was born at term with a birth weight of 3.2 kg and a length of 49 cm, and was partially breastfed for 3 months. He had mild reflux that was treated with medication and has since resolved. He attends day care. His mother is 24 years of age, has completed high school, and is employed full time. She is currently single and has 2 older children. The child's father is employed full time and sees the child weekly. The grandmother assists with child care. The family is food secure and reports no serious psychosocial problems. Mealtimes are described as regular and pleasant. The mother's concerns are weight, height, and feeding behaviour of the child. His appetite is fair to poor; he eats slowly and spits out food but there are no problems of choking or vomiting. The mother is anxious at mealtimes and frequently coaxes her child, makes alternative foods, and occasionally feeds him on her lap. The child prefers snacks and juice throughout the day. He has frequent tantrums. His development is normal. Initial evaluation reveals no history or examination findings suggestive of an allergic, endocrinological, or gastrointestinal disorder.
Case history #2
A 7-month-old boy presents with a weight-for-length markedly below the 5th percentile. The child appears listless, with poor hygiene and marked buttock folds of skin from a loss of muscle mass and subcutaneous tissue. His single, teenage mother has been living with a friend. The family had been lost to follow-up since the 2-month checkup when concerns about parenting were noted. Efforts by a home nursing agency had failed to contact the mother. She brought her baby to the clinic because her grandmother kept nagging that he 'didn't look right'.
Other presentations
Faltering growth may present in many other ways.[7][8][9] Frequently, the poor growth is not obvious to the parent or healthcare professional but only when plotted. Parents may report problems with feeding or eating and concerns with growth. There may be symptoms or signs such as persistent diarrhoea, frequent spitting/vomiting, recurrent or unusual infections, shortness of breath, and lethargy; these may reflect underlying conditions that impair growth. Behavioural or developmental problems, as well as parental and family problems such as parental depression or lack of regular routines, may be the presenting problem. Problems related to poverty such as homelessness, unemployment, and lack of access to health care may draw attention to possible food insecurity as a contributing factor to faltering growth.
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