Case 96 – the beginning

Welcome to our new #TeamHaem case.

You are an SHO in a general paediatric outpatient clinic. Your next patient is a new GP referral – a 13 month old boy who has not been putting on weight for the past 3 months. Mum has had trouble with weaning and he has been having intermittent vomiting and loose stools, and Mum feels his abdomen has been more distended. The GP thought it might have been lactose intolerance but despite changing his diet, he is still not putting on weight.

On first impression he does not look unwell, though slightly pale. You plot his growth chart, and his weight, length and head circumference are all < 0.4th centile, whilst previously he had always trended around the 9th centile. Mum also said he has a lump/rash on his arm which has been coming and going. He’s also been coughing for the past few weeks & always seems to have a cold.

Questions:

1. What further history would you like to obtain?

2. What clinical examination findings might be useful to take this forward?

3. What investigations would you like to carry out?

Join us on Twitter @TeamHaem and let us know what your thoughts are, what questions you have and what you want to do as we see this case evolve over the next week.

Remember to use #teamhaem on all your posts to help us follow the case! Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality. TeamHaem are not a position of authority. It is an educational platform to allow discussion and learning.

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