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Pediatric — Failure to thrive

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Case 1 of 5PediatricFailure to thrive

A 20-month-old boy is brought to a family medicine clinic by his parents because of poor appetite and pallor. His weight has fallen from the 50th to the 10th percentile over the past 6 months. He is a picky eater who refuses most solid foods, and he drinks about 1.2 L of homogenized (3.25%) cow's milk daily from a bottle, including at bedtime. He was born at term, has no chronic illness, takes no medications, and his immunizations are up to date. On examination he is pale with a soft systolic flow murmur and no hepatosplenomegaly. Investigations show hemoglobin 85 g/L (105-135), MCV 62 fL (70-86), and ferritin 6 µg/L (greater than 12).

Heart rate128/min
Respiratory rate28/min
Temperature36.8 °C
O2 saturation99%, room air

Question 1 of 15

Which of the following are the most appropriate initial management steps?

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