Nutrition

A breast-fed infant is expected to have a lower incidence of which of the following common childhood conditions:
A. Conjunctivitis
B. Impetigo
C. Diarrhea
D. Urinary tract infections
E. Asthma

C. Breast-feeding is associated with a lower incidence of diar¬rhea.

A 14-month-old child is noted to have lower extremity bowing, a waddling gait, genu varum, and to be at the 5th percentile for height. Laboratory data include low-normal serum calcium, mod-erately low serum phosphate, elevated serum alkaline phos-phatase, hyperphosphaturia, and normal parathyroid levels. The most likely diagnosis in this child is:
A. Genetic primary hypophosphatemia
B. Renal osteodystrophy
C. Malabsorption of vitamin D
D. Phosphate malabsorption
E. Fanconi syndrome

A. Lower extremity bowing, low to normal calcium and phos¬phate levels, and normal parathyroid hormone levels point to fa¬milial primary hypophosphatemia.

A 2-year-old child had previously been slightly less than the 50th percentile for weight, height and head circumference, but in the last 6 months has fallen to slightly less than the 25th percentile for weight. The pregnancy was normal, the child’s development is as expected and the family reports no psychosocial problems. The mother reports that the child has become a finicky “picky” eater (wants only macaroni and cheese for each meal) but the mother insists that the child eat a variety of foods at each meal. The meals are marked by much frustration for all family members. Physical examination of the child is normal. The next step in the care of this child should be:
A. Sweat chloride testing
B. Examination of the eyes for retinal hemorrhages
C. Reassurance and counseling for family about normal developmental stage of child
D. Testing of stool for parasites
E. MRI of the brain

C. It is not unusual for a child between about 18 months and 30 months of age to become “picky eaters.” They sometimes slow their rate of growth, and the period can be distressing for parents (and grandparents). Calm counseling of the family to provide nutrition, avoid “force-feeding,” and avoid snacks is usually effec¬tive. Close follow-up is required.