Failure to thrive
A 13-month-old girl is anemic and not gaining enough weight. How would you proceed with her care?
Parent education is the key
The child’s father expressed gratitude several times for the instruction on healthy food choices for the daughter, while the mother smiled in shy agreement. He said they did not know what to feed her, and when she refused most things they offered, they fed her the noodles and juice she seemed to prefer. He was grateful to the nutritionist, social worker, nursing staff, and physicians for taking care of his daughter. He was eager to go to the grocery store and to start feeding her the “right foods.”
Ready to go home
By discharge, the child had received the full dose of vitamin D and was eating a variety of foods, including 1 to 4 ounces of milk daily, supplemented with Poly-Vi-Sol, 1 mL orally twice daily, and calcium carbonate (OsCal) with vitamin D, 1 crushed tablet orally twice daily. Home health nursing provided follow-up twice a week, and weekly appointments in the clinic with the physician were also scheduled. Compliance with the discharge plan was impeccable. Both laboratory and clinical signs of rickets resolved over the subsequent weeks.
