A 12-month-old infant with poor weight gain and no vomiting or diarrhea should have which history taken to evaluate for failure to thrive?

A 12-month-old infant with poor weight gain and no vomiting or diarrhea should have which history taken to evaluate for failure to thrive?

• A. Stool cultures for ova and parasites
• B. Swallow study with videofluoroscopy
• C. Feeding and stooling history and 3-day diet history
• D. Complete blood count and electrolytes

Answer: (C)

The key idea is that failure to thrive often reflects inadequate caloric intake or poor nutritional balance, so the most informative first step is to understand exactly how the child is eating. A thorough feeding and stooling history, together with a 3-day diet history, allows you to quantify intake, assess feeding patterns, appetite, and potential difficulties during feeding, and see how these translate into calories consumed. It also reveals stooling patterns that might point to malabsorption or excessive losses, but without focusing on invasive testing first. A swallow study would be reserved for suspected dysphagia or aspiration during feeding, not as an initial evaluation when there are no signs of swallowing problems. Stool cultures for parasites are indicated if there are chronic diarrhea or GI symptoms or specific risk factors, not simply with poor weight gain in the absence of vomiting or diarrhea. CBC and electrolytes can help identify dehydration or anemia but do not directly explain the intake issue and are not the primary starting point in evaluating suspected FTT.

The key idea is that failure to thrive often reflects inadequate caloric intake or poor nutritional balance, so the most informative first step is to understand exactly how the child is eating. A thorough feeding and stooling history, together with a 3-day diet history, allows you to quantify intake, assess feeding patterns, appetite, and potential difficulties during feeding, and see how these translate into calories consumed. It also reveals stooling patterns that might point to malabsorption or excessive losses, but without focusing on invasive testing first.

A swallow study would be reserved for suspected dysphagia or aspiration during feeding, not as an initial evaluation when there are no signs of swallowing problems. Stool cultures for parasites are indicated if there are chronic diarrhea or GI symptoms or specific risk factors, not simply with poor weight gain in the absence of vomiting or diarrhea. CBC and electrolytes can help identify dehydration or anemia but do not directly explain the intake issue and are not the primary starting point in evaluating suspected FTT.