Table 3 |
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History and physical examinations of the four older children |
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18-month-old girl |
39-month-old boy |
52-month-old boy |
78-month-old boy |
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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 |
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Exclusive breast feeding period |
3 months |
3 months |
8 months |
12 months |
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Medications |
Unknown (ed note: no medications by the parents history) |
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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]). |
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Immunizations |
None |
None |
None |
None |
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Diet |
See Table 2 |
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Physical exam |
Relevant positive and negative findings |
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General |
Small thin female/male, alert |
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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) |
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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) |
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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) |
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Mouth |
Dental caries |
Dental caries |
Dental caries |
Dental caries |
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Thorax |
Ribcage prominent |
Ribcage prominent |
Bilateral beading of the ribs (Rachitic rosary)a |
Ribcage prominent |
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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) |
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Neuro |
No deficits |
No deficits |
No deficits |
No deficits |
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Skin |
No rashes |
No rashes |
No rashes |
No rashes |
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Labs |
See Table 4 |
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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 |
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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 |
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Cundiff and Harris Nutrition Journal 2006 5:1 doi:10.1186/1475-2891-5-1 |
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