Table 3

History and physical examinations of the four older children

18-month-old girl

39-month-old boy

52-month-old boy

78-month-old boy

Past medical history

Unknown (ed note: no illnesses by the parents history) All born at home with assistance of a midwife or the husband. None were premature. All played outdoors in sunny Southern Florida more than 6 hours per week

Exclusive breast feeding period

3 months

3 months

8 months

12 months

Medications

Unknown (ed note: no medications by the parents history)

Family history

Unknown (ed note: mother 169 cm [5 feet 6 1/2 inches] and 52 1/4 kg [115 pounds], father 168 cm [5 feet 6 inches] and 70.5 kg [155 pounds]. The father weighted 104.5 kg [230 pounds] on the standard American diet about 7 years previously. The paternal grandmother was 152 cm tall [5 feet 0 inches] and the paternal grandfather was 170 cm tall [5 feet 7 inches]).

Immunizations

None

None

None

None

Diet

See Table 2

Physical exam

Relevant positive and negative findings

General

Small thin female/male, alert

Length

68-1/2 cm (27 inches: 3.68 SD below the mean height/age)

83-1/3 cm (34 inches: 2.9 SD below the mean height/age)

94 cm (37 inches: 2.82 SD below the mean height/age)

104 cm (41 inches: 2.93 SD below the mean height/age)

Weight

7.5 kg (16 pounds 8 ounces): 4.1 SD below the mean weight/age)

11 kg (24 pounds 8 ounces: 2.06 SD below the mean weight/age)

13 2/3 kg (30 pounds: 2.48 SD below the mean weight/age)

15 2/3 kg (34 1/2 pounds: 2.98 SD below the mean weight/age)

Head circumference

44 cm (17 1/3 inches)

50 cm (19-2/3 inches with two

52-1/2 cm (20-2/3 inches)

54 cm (21 1/4 inches)

Mouth

Dental caries

Dental caries

Dental caries

Dental caries

Thorax

Ribcage prominent

Ribcage prominent

Bilateral beading of the ribs (Rachitic rosary)a

Ribcage prominent

Abdomen

Soft, protruding, no masses. Girth: 42 cm. (16 1/2 inches)

Soft, protruding, no masses. Girth: 49 cm (19 1/3 inches)

Soft, protruding, no masses. Girth 49-1/2 cm (19.5 inches)

Soft, protruding, no masses. Girth: 53 cm (21 inches)

Neuro

No deficits

No deficits

No deficits

No deficits

Skin

No rashes

No rashes

No rashes

No rashes

Labs

See Table 4

Impression

Children with signs of severe malnutrition, including decreased subcutaneous fat tissue. These cases represent appropriate food deprivation, severe physical neglect, and failure to thrive.bc


aPhotograph of child's chest: Beading of ribs was not seen by the pediatrician or other observers.

bThe 18-month-old girl was also diagnosed with developmental delay.

cThe 52-month-old boy was also diagnosed with clinical rickets

Cundiff and Harris Nutrition Journal 2006 5:1   doi:10.1186/1475-2891-5-1

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