Approach to a Case Of 3 Year Old Boy With Malnutrition

A 3 year old boy is brought by his mother as she feels he is not gaining weight. His height is on the 25th centile and weight is below 5th centile for age. There is also history of passing worms in stool.
Answer the following questions.
1. Enlist 6 relevant questions you would like to ask in history?
2. Enlist 2 relevant investigations you would order?
3. Enlist 3 nutritional points you would like to emphasize?
4. Enlist 4 points in your pharmacological management plan.?

(Question From MCPS Family Medicine paper October 19th 2016.)

Solution:

 1. Enlist 6 relevant questions you would like to ask in history?

Answer:

1. Ask about h/o repeated infections. ( respiratory and diarrhea) 
2. Source of drinking water (tap water, or boiled water) 
3. Physical and mental developmental history. (appropriate for age or not) 
4. Immunization status ( vaccinated or not) 
5. Number of siblings under age 5 years. 
6. Socioeconomic history of the family,

2. Enlist 2 relevant investigations you would order?

Answer: 

1. Stool DR ( for ova and parasites) 
2. CBC (will indicate infections if WBC count is high and Anemia if Hb is low) 

3. Enlist 3 nutritional points you would like to emphasize?

Answer: 

1. Avoid junk food like chips, biscuits bought from unhygienic stores. 
2. Diet should include good protein content like eggs, milk, nuts and legumes. 
3. Add some extra ghee/oil/butter and sugar when cooking for the child.

4. Enlist 4 points in your pharmacological management plan.? 

Answer:

1. Start Zinc supplement ( as zinc sulphate 20 mg/day orally), should continue at least for 2 weeks. 
2. Give Vitamin A 5000 IU and continue daily Vitamin A supplements. 
3. A single dose of Intramuscular Vitamin D 6 lac units. 
4. Albendazole 400 mg single dose orally and should be repeated after 2 weeks ( for intestinal worms)