Table 3 History and physical examinations of the four older children
From: Case report of 5 siblings: malnutrition? Rickets? DiGeorge syndrome? Developmental delay?
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 | |||