Case one: Failure to thrive, and poor attention for book reading at 12month old
05/31/06
09/27/2005 My 6 months old well check up
The 1 st time I came to the clinic I saw my new doctor.
No concerns from my parents
Growing normal
Developmental screen
- Personal and social-normal: feed self by bottle, work for toys
- Fine motor-normal: Take 2 cubes in both hands, pass cube from hand to hand
- Speech in high normal: Jabbers, combine sounds, call dada non-specific
- Gross motor-normal: Sit without support
Feeding:
- Breast feeding 4 times a day
- Bottle feeding with breast milk 8oz for each feeding, and two bottle feedings per day
- Baby jar food and home made food.
- I have a great appetite.
My physical exam is all normal except for the left side of the back of my head is slightly flat.
My doctor’s order
- Shots for 6 months old baby
- Position my head more on the right side.
- I need to start multivitamins with iron 0.5 ml daily because
- All the milk I drink is breast milk
- The winter is coming, there is less sunshine in that season. I’m an African American baby and my skin is a little darker, which will absorb less sunshine than other babies.
- The pick of calcium deficiency and poor weight gain starts in the coming month, esp. for the babies in breast feeding. Sometimes, mothers’ production of breast milk decreases, but they may not recognize it. Then babies get less nutrition, less iron, less vitamin D, and calcium than they need.
4. My parents should read 2-3 different books to me daily, and to not let me be exposed to TV. |
9 months well check up
No concerns from my parents
Growing: head and length are growing normal, weight gain is slowing down
Development
- Personal and social-normal: wave bye-bye, indicate the wants, and play pat-A cake.
- Fine motor- normal: Bang 2 cubes head in hands, and uses the thumb and fingers to grasp.
- Speech progress is slowing down. I can’t call dada or mama specifically.
- Gross motor- normal: get to sitting, pull to stand.
Feeding
- Breast feeding 3-4 times a day
- Bottle feeding with pumped breast milk 10 oz daily
- One #3 baby jar food per day
My physical exam is all normal. My doctor didn’t worry about the shape of my head.
My doctor’s orders
My parents need to increase learning stimulations for me.
- Read 2-3 different books daily.
- Go to library to check out age appropriate books for me.
- Talk more, and talk clearly to me.
- Cut TV exposure
- More music time
Increase solid food and give vitamins with iron 1.0ml daily
Blood test:
- Anemia screen: normal
- Lead screen: normal
- Iron screen: low normal
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12 months old well check-up
Parents concern: Mother’s breast milk supplies significantly decreases and baby refuses to drink formula and regular milk. The baby has a temper.
Growing
- Head and length are growing normally.
- Very poor weight gain (13oz) for three months.
Development
- Personal and social-normal: drinks from sipping cup, imitates activities, and plays with toys with parents.
- Fine motor- ? For progress: I think I can, but my parents haven’t let me try to scribble, or put small objects into a bigger container.
- Speech progress normal: I can call dada, baba, and mama specifically. I also can say “Hi” (In average 12mo babies can say one word except for dada, or mama specifically). Thanks my dad and mom, who read more books to me daily.
- Gross motor- normal: I can walk well and I can find and recover the things my parents hide in front of me (Stoop and recover).
Feeding
- Breast feeding once a day
- Bottle feeding: none
- Eat solid food good, three meals a day with snacks between.
- Vitamin with iron 1.0ml daily
Physical exam is all normal.
My doctor’s concerns and orders
No weight gain for three months and baby’s weight fell below the 3rd percentile of the normal weight range, which definitely fits the diagnosis of failure to thrive (FTT). The baby does not have a fever, vomiting, diarrhea, and fussiness. I will not do any blood tests today. But we have to work very hard with the feeding (parents)/eating (baby) behavior and let your baby gain weight.
- Try different foods and find which one your littler girl accepts.
- Increase dairy products such as milk, cheese, ice cream, or yogurt.
- Continually increase solid food
- Start food diary. My doctor discussed with my parents how to do food diary for me.
- I may need an extra 200-300kcal daily to catch up on my weight gain.
- Continually give multivitamins with iron 1.0ml daily.
- Come back in 1 month to follow up my weight gain and feeding status.
My attention for book reading drops from 10minutes at 9months old to 1 minute at 12 months old. My TV exposure increases from 2 hours at 9 months old to 8 hours now. My doctor told my mother TV exposure is same as watching TV, because the baby’s eyes can track the sparkling light that TV produces for 180 degrees since 4 months old. There are more and more research reports talking about more TV watch with a high risk of ADHD, and behavior problems of children in the school years. My doctor suggested my parents
- To not let me be exposed to TV
- Continue to read 2-3 different books daily to me
- Try to increase my attention span to book reading by a few minutes.
- Let me play with wooden blocks, and scribble 5-7 times per week, which can help my fine motor development.
- Structural play and do one thing each time.
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14 months old on May 31, 2006
I came for following up for my weight gain. I weigh 18 lbs today!!!
Dr. Shi: Your baby gained weight. What did you change in your baby’s diet?
My mother: She still refuses to drink milk or formula. I tried different foods and found that she is willing to take 2 string cheeses (50kcal per string) and 2-3 cans of 2.25 yogurt bags (80 kcal/bag) daily. She likes home made foods and I don’t know how to count calories for them.
Dr. Shi: let us review the food diary handout again
Vegetable: 6 kcal/oz
Fruits: one 2 inch diameter apple, or 2 inches long banana, or… 40 kcal per serving Carbohydrate: 11 kcal per one oz of cereal, and …
Fat: 73 kcal per each oz of meat, one egg, and …
1gm carbohydrate = 4 kcal
1gm protein = 4 kcal
1gm of fat = 9 kcal
My TV exposure decreased from 8 hours at my 12 months old to 2 hours daily now. My doctor said it still is too much exposure time. I should not be exposed to TV at all.
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