A father who is a business banker, brings his 2.5 years

Discussion in 'AMC Clinical Exam' started by Joseph., Oct 13, 2007.

  1. Joseph.

    Joseph. Guest

    A father who is a business banker, brings his 2.5 years old child to see you because his daughter losses appetite. She has 2 siblings, 10 and 12 years old, both of them are eating well. He’s worried that he didn’t take care of her very well.
    Task: Relevant history
    PE
    Management the case and explain to the father.

    History: Any other concerns? Family problem?
    Has the child been well?
    Growth and development?
    PE: GA, Growth chart, percentile of height and weight

    Hello, I’m Dr.Anna, what do you want me to call you? (Mr.Smith)
    All right, I understand that you concerns about your daughter’s appetite, what’s her name? (Lucy) Has she been well? (yes)
    Does she drink a lot of juice or milk? (no, she doesn’t drink or eat as much as she did)
    Can you remember her birth weight?
    What is her growth and development? (good)
    Is she constipated? (no)
    Do you know what she eats at the childcare? (not really)
    How does your wife feel about this problem?
    Do you have any other concerns?

    I’d like to examine the child. (What do you want to know?)
    GA (normal) weight and height and I would like to see the growth chart. (60 percentile for her age)
    Any other abnormal findings on examination? (no)

    I’ll then explain to the father and show him the growth chart.
    All right Mr.Smith, I understand that you concern about Lucy’s eating habit. However, let’s see from this growth chart, her growth and development is within normal range. And you can see from the normal pattern here, the growth rate slows down in 2nd year of life so they don’t need food as much as in the 1st year of life and drop in appetite as we call them ‘fuzzy eater’. As same as what happen with Lucy, she doesn’t want as much energy as when she was 1 so she loss her appetite as well. As long as her growth as development is still in a normal range, there is no need to be worried.
    What can I do for her?
    You can do many things such as allow her to eat what she likes and serve her small proportion, try to reduce your expectation. Don’t give her so much milk and juice and avoid argument over food. You might try to serve her some finger food, would be fun for both of you and give time to enjoy meal, don’t be hurry. Remember, a healthy child will eat when they are hungry and let her choose what she likes. Showing independency is important for toddler development as well.
    Can she have cereal for lunch? She seems to eat ‘Coco Pops’ a lot.
    Yes, she can as long as she wants to eat and she likes. Variety of food is not a big concern in her age. Do you still have any other concerns?

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