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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
  1. aPhotograph of child's chest: Beading of ribs was not seen by the pediatrician or other observers.
  2. bThe 18-month-old girl was also diagnosed with developmental delay.
  3. cThe 52-month-old boy was also diagnosed with clinical rickets