Boston University School of Medicine, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Boston, MA, USA.
J Dev Behav Pediatr. 2010 Jun;31(5):449-51. doi: 10.1097/DBP.0b013e3181e12207.
Nicole is a beautiful 14-month wide-eyed girl who presents for routine health care maintenance in your office. Since her 9 month visit, her weight has fallen from the 25th percentile to significantly less than the 5th percentile. Her height has dropped from the 10th percentile to slightly less than the 5th percentile, while her head circumference has remained at about the 25th percentile. Her language, motor, cognitive, and social development are normal. She is 2 months late for this visit as her family has recently had significant family loss because of the earthquake in Haiti. When you take a feeding history, she seems to eat age-appropriate foods--macaroni, chicken pieces--but her mother notes that she tends to be restless and fidgety while eating and will no longer sit still in her mother's lap while she feeds her. Her stools tend to be frequent, with particles of food seen. Urine is normal. There are no symptoms of respiratory or neurological disease, and her review of systems is otherwise negative. She has been a healthy child and this is the first time they have fallen behind in routine health care maintenance visits. Her medical history is entirely unremarkable. She was born at term, weighing 3.5 kg, without any perinatal complications. The family has lived in the United States for the last 10 years. Mother recalls that there were other children in her family who were deemed small as young children but who caught up later in childhood. Mother describes a history of increased sadness and worry in the last 2 months. They receive phone calls from family in Haiti several times per week and she admits to being upset during and after these calls. When asked how the event has impacted her family, she states, "It has rocked our entire world but Nicole is just a baby who won't eat!" Parents are married, and there is no history of abuse or violence in the household. Her physical examination is essentially normal. Her anterior fontanelle is still open, roughly 2 cm. Two teeth (one just emerging) are present. She is alert and interactive and appears to relate well with her mother. You update her vaccinations and then struggle with where to head next.
妮可（Nicole）是一个美丽的 14 个月大的女孩，她因常规健康保健需求来到你的办公室就诊。自她 9 个月大的那次就诊以来，她的体重从第 25 百分位降至明显低于第 5 百分位，身高从第 10 百分位降至略低于第 5 百分位，而头围则保持在第 25 百分位左右。她的语言、运动、认知和社会发育均正常。她这次的就诊时间比预期晚了 2 个月，因为她的家庭最近因海地地震而遭受了重大的家庭损失。在你询问喂养史时，她似乎吃的是适龄食物——通心粉、鸡肉块——但她的母亲注意到，她在进食时往往坐立不安，而且不再愿意坐在母亲腿上让母亲喂食。她的粪便往往比较频繁，能看到食物颗粒。尿液正常。没有呼吸道或神经系统疾病的症状，其他系统回顾也无异常。她一直是个健康的孩子，这是他们第一次在常规健康保健就诊中落后。她的病史完全无异常。她足月出生，体重 3.5 公斤，无任何围产期并发症。这个家庭已经在美国生活了 10 年。母亲回忆说，她家里以前有其他孩子，他们小时候被认为身材矮小，但后来在童年时期赶上了。母亲描述了过去 2 个月里她情绪增加和担忧的情况。他们每周都会接到几次来自海地的家人的电话，她承认在这些电话期间和之后感到难过。当被问及该事件如何影响她的家庭时，她说：“这让我们整个世界都崩溃了，但妮可只是一个不肯吃饭的婴儿！”父母已婚，家中没有虐待或暴力的历史。她的体格检查基本正常。前囟门仍未关闭，大约 2 厘米宽。有两颗牙（一颗刚刚萌出）。她机敏且互动良好，与母亲关系融洽。你更新了她的疫苗接种情况，然后开始纠结下一步该做什么。
