Each speaker/author will need to provide a case based scenario question in test format. The correct answer should not include “All of the above.” If multiple answers are correct then ask for which item is “NOT” and make it the correct answer. Please add 4 answer choices for each question.


Presentation Title:

Presentation title here

Case Based Scenario: 

An 18 month old girl presents to the office and the parents state that she is looking skinnier to them. Upon questioning,  she still drinks from a bottle as she does not like sippy cups and she is on 2% milk like her older sister.  She also likes to run around and do ‘drive-by’ snacking.  They deny any diarrhea or constipation.  No emesis.  Her vital signs show that she is at the 25th percentile for weight for age and her weight is at the 3rd percentile for weight for age based on the WHO growth chart. Her weight for length z-score is at -2.1.  What is the appopriate next step in her management?

Four answer choices:

a. Reassure the family that this is normal toddler behavior and she will outgrow it.

b. Hospitalize her immediately for a nasogastric tube

c. Instruct the family to increase calories, avoid grazing and provide structures meals and snacks

d. Obtain labs to include CBC, CMP, TSH, Free T4, celiac

Correct Answer Choice:


Rationale for Correct Answer:

90% of FTT is non-organic and there are no red flags to suggest an organic cause.  Labs are abnormal in FTT less than 7% of the time.  With her z-score at -2.1, she is has moderate malnutrition and does not need immediate nasogastric tube feeds. The most common instructions are to increase calories to whole mik or Pediasure, stop grazing and have structured meals and snacks. 

Citation for Rationale:

J Pediatr Gastroenterol Nutr. 2016 Jun;62(6):907-13. doi: 10.1097/MPG.0000000000001099. Failure to Thrive: A Prospective Study in a Pediatric Gastroenterology Clinic. Larson-Nath CM1, Goday PS