Nutrition: Foundations for Life

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Becka’s  growth curve is the one shown in Example A. 

On history you find that this baby was a healthy term baby in the 75% for weight, length, and head circumference at birth. She has not had any major illnesses in her life and has not had to be hospitalized. Her appetite is “OK” according to Mrs. Pequena.  Becka weaned herself from the breast at about 10 months of age. She never really took to infant formula,  so Mrs. Pequena started whole milk. The whole milk made Becka very constipated, so her mother started to give her some juice to help with the constipation. At presentation, Becka drinks about 24 oz of whole milk and 24 oz of juice a day and does not take vitamins or other medications.

 A typical day consists of  ¼ cup of Cheerios with an 8 oz bottle of milk. Becka may snack on some of mom’s eggs in the morning. She usually has a snack of fruit or 4-8 oz juice with some peanut butter or graham crackers before her morning nap.  For lunch Becka may have a half a cheese sandwich or a jar of stage 3 baby food and 4 oz of milk. She generally drinks an 8 oz. bottle of apple juice during the afternoon, and may snack on some crackers or banana slices. For dinner, Mrs. Pequena gives her cut up table food (generally ½ cup meat and potatoes or rice) with another 8 oz. of milk. She has a bottle of juice or milk before bed time.  Mrs. Pequena does not want to force her to eat but, she is concerned that she is not eating enough.

 Becka lives with both parents. Becka’s mother is 5’4 and her father is 5’7. Mrs. Pequena is unsure of the age of her home, but she describes it as “older.” The house did have some pealing paint and was recently re-painted. Mrs. Pequena reports no severe stresses in the home.  She does not believe her children have been abused.

 What should be the first step to intervening for this child’s failure to thrive?

a.  increase milk intake, since it is a good source of protein.

b.  add vitamins

c.  decrease juice

d.  contact Children’s Protective Services (CPS)

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