On this page
Study tools
Write your answer
Saved on this device. No marking — you are the marker.
Stem
An 11-month-old infant is brought to clinic. Weight has fallen from the 25th to below the 3rd centile over 4 months. She takes around 1 litre of cow's milk daily and eats poorly at meals. Height is on the 10th centile and head circumference on the 25th. Development is normal. [1]
Questions
a) What is the most likely diagnosis? (2 marks) [1]
Non-organic failure to thrive (inadequate caloric intake). Evidence: weight falling centiles while height (10th) and head circumference (25th) are relatively preserved — brain growth prioritised. High-volume milk intake (over 700 mL/day; >24 oz is the threshold associated with severe iron-deficiency anaemia) is filling her up and displacing nutritious foods. Normal development and social interaction support non-organic cause. [1]
b) What key history is needed? (3 marks) [1]
- Detailed feeding diary: 3-day food diary — what, when, how much, mealtime behaviour
- Social history: family income, housing, parental mental health, family dynamics
- Birth and developmental history: prematurity, neonatal complications, milestone trajectory
- Screen for organic symptoms: diarrhoea, vomiting, cough, recurrent infections
- Family growth patterns: parental heights [1]
c) What is the initial management? (3 marks) [1]
- MDT referral: dietitian (nutritional assessment), health visitor (home visit, feeding support)
- Feeding advice: reduce milk intake (excess milk reduces appetite for other foods — NICE), offer 3 meals + 2 snacks, energy-dense foods, structured mealtimes
- Oral nutritional supplements if dietary changes insufficient
- Monitor: weighing no more often than fortnightly at this age (6-12 months), plotted on the growth chart
- Consider investigations: urine testing and coeliac serology (gluten-containing diet); other tests only if clinically indicated [1]
d) What would be a safeguarding concern? (2 marks)- Parental hostility or refusal to engage
- Child appears unkempt, dirty, or has unexplained injuries
- No weight gain despite adequate support and feeding plan
- Inconsistent history between caregivers
- Signs of developmental delay or emotional neglect
- Follow local safeguarding procedures; involve social services if concerned [1]
References1ShowHide
- [1]Goodwin ET, Buel KL, Cantrell LD. Growth Faltering and Failure to Thrive in Children. Am Fam Physician, 2023.PMID 37327159