Growth Failure and Abnormal Radiographs in a 3-year-old Girl

摘要

A 3-year-old African American girl is being evaluated for a history of failure to thrive and concern for neglect. She was born at term and was small for gestational age. Her growth records are unavailable, but growth velocity was reportedly normal until age 2 years. Four months ago, her pediatrician referred her to a gastroenterologist for ongoing poor weight and height gain, but she was not seen due to social barriers. The patient typically eats 3 regular meals and drinks 24 oz of chocolate milk per day. Her mother reports that her daughter has unusual dietary preferences, such as craving coffee and soda. She states that the girl has constipation, but she has no vomiting, diarrhea, abdominal pain, bone pain or fractures, hematuria, or edema. She denies recurrent infections or hospitaliza-tions. Motor and cognitive development are normal. Her tuberculin skin test result was negative 1 year ago. The mother has been previously incarcerated, and in the emergency department, the mother is agitated and her speech is slurred, with some incoherent speech.