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* picky eater case--Q,D/D&Investigations
 #293540  
  dr_qasir - 04/17/08 06:28
 
  Recently, many people talked about the telephone case regarding the "picky eater " case. I read many posts and some references about this case. Here is the sample of this case. Please make any comments and suggestions on it. There are also many of typos and grammer errors. Please feel free to correct it. Thanks.



+++++++++++++++++++++++

Picky eater telephone case

History taking:

1. Good Morning, Mrs. Smith. This is Dr. XYZ. I am an attending physician here at the medical center. How can I help you today? (My son is a picky eater; I am wonder if you could give me some advice on what I should do about it?).
2. Ok, Mrs.Smith, I’d like to get a few details from you about your son. How old is your son? ( He is 4 years old)
3. How long has he been a picky eater? ( since six months ago)
4. Could you please tell me what is the reason that you think you son is a picky eater? (OK, for example, he only eats some potato chips, candies and drinks fruit He doesn’t like to eat regular meal . )
5. Is his picky eating habit getting worse or getter better ( getter worse)
6. Has he ever eaten well when he got really hungry? ( Yes, he ate a lot when he came back from playground)
7. Does he watch TV before dinner? ( yes, he watches TV sometimes)
8. Does he have any pain in his belly? ( No, he didn’t mention it)
9. Does he have any problems with his bowel movement? ( He has constipation )
10. How many times a week does he have bowel movements? ( 3-4 times a week)
( Now ask about associated symptom)
11. Does he have any headaches? a fever? Cough? Short of breath? Diarrhea?(No)
( Now ask about PAM HUGS FOSS question)
12. Did he ever have similar episodes in the past? (No)
13. Was he ever diagnosed with any medical illness before? ( No)
14. Does he have any allergies? ( No)
15. Is he taking any medications ?(No)
16. Has he ever been hospitalized? ( No)
17. Does he have any problems with his urination? (No)
18. Does he have any problem with sleeping?
19. Does anyone in your family also have the same problem? (Yes, I was a pick eater when I was a child)
20. How many children do you have? ( he is the only one)
21. How much time do parents spend time with him? ( a few hours a day, because both of us work)
22. Who takes care of your child when you are working? ( he goes to day care center)
23. What kind of house do you live? ( very old one)
Then ask Milestones questions ( I use IDIOT mnemonic)
24. Are his immunizations up to date? (yes)
25. When was his last well-child check-up? ( six months ago, everything is fine at that time?)
26. Did he have any infections before? (No)
27. Did you have any problems with your delivery? ( No, everything was fine)
28. Has your family moved recently? ( Yes, we just moved here six months ago)

Well, Mrs. Smith, thank you very much for answering my question. Do you have anything that you would like to tell me about? (No)

Ok, I would like to give you my impression right now. First let me summarize what you have just told me. You said your 4-year-old son has been a picky eater that started 6 months ago. He likes to eat some potato chips and drinks fruit juice but not regular meal. He also likes to watch TV before dinner. He also has constipation for past six months. Is that right? (Yes)

Mrs. Smith, based on the information you told me, I think your son may be experiencing a habitual eating disorder, however, we also need to exclude some other possibilities , such as lead-poisoning or iron-deficiency anemia. For that reason, I would like to examine him personally and order some tests on him before I make any diagnosis or give any advices. Is it convenient for you to bring him to here? (I am sorry; I cannot bring him to the hospital. Would you please just give me some advices over the telephones?)

Mrs. Smith, is there a reason why you cannot bring your son to here? (Actually, my husband is out of town and I have no means of transportation.)

OK, Mrs. Smith, in that case, we have social worker here who can help you with your transportation. After we are done on the phone, I will transfer your call to him; he will help you with this issue. Does this sound good to you? (Absolutely)

Alright then, I will see you once you get to the hospital. Take care.



D/D:

1. Habitual eating disorder
2. Lead poisoning
3. Iron-deficiency anemia
4. Fiber-lack diet
5. Parasitic Infections

Work-ups

1. CBC and electrolytes
2. Serum lead level
3. Stool for OVA and parasites
4. USG Abdomen
 
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* Re:picky eater case--Q,D/D&Investigations
#1274402
  elbamaritza - 04/17/08 08:06
 
  I beleieve it is complete and very good

maybe just add about his social development, going to a day care not necesarily mean that the kid has friends....ask about playdates always in a kid
 
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* Re:picky eater case--Q,D/D&Investigations
#1274487
  high99 - 04/17/08 09:43
 
  i have a q..y r u concerned about watching tv before dinner..  
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* Re:picky eater case--Q,D/D&Investigations
#1274502
  joannitam - 04/17/08 09:55
 
  very good case. thanks.

I would add in workup: ferritin. (iron deficiency anemia)

 
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* Re:picky eater case--Q,D/D&Investigations
#1274604
  doc_mrv - 04/17/08 11:17
 
  if the mother asks abt what food to be given to child
 
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* Re:picky eater case--Q,D/D&Investigations
#1275630
  pinworm - 04/17/08 21:34
 
  yes..what should you say....when mom wants advise regarding the type of food to be offered to the child...

dr qasir....you have come up with a wonderful list of questions....
thanks for sharing...
 
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* Re:picky eater case--Q,D/D&Investigations
#1275666
  cancer123 - 04/17/08 22:13
 
  dr_qasir!!

thanks for posting such a nice and complete case!!!

good luck and Godbless!!





 
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* Re:picky eater case--Q,D/D&Investigations
#1275959
  dr_qasir - 04/18/08 06:17
 
  regarding Question from ur side---- high 99 -- habitual eating disorder ll be explained in the qustion f his eating watching tv before dinner or during that. & joannitam ---u r right but adding only ferritin is not wise bec in CBC u r cheking his HB whic will explain his anemia.then various anemia u ll chek by their respective levels. dr mrv-----food that should be soft,plenty of fluid bec pt has constipation and milk products that ll relive his constipation problm and at proper timing. pinworm and cancer 123 --- thanks alt for all ur prayers and best wishes. i have passed recently in feb 2008.so going to enter in 2009 match.hope for the best and best of luck to u all.any help or guidance u want.u r most welcome. thanks again  
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* Re:picky eater case--Q,D/D&Investigations
#1275977
  kalmdoc - 04/18/08 07:44
 
  Malik .. please give me some advices as well ..  
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* Re:picky eater case--Q,D/D&Investigations
#1276607
  dr_qasir - 04/18/08 15:17
 
  kalmdoc---help is with u.malik always help you.ask wht u like to ask.  
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* Re:picky eater case--Q,D/D&Investigations
#1276758
  homie - 04/18/08 17:16
 
  Dr_qasir, thank you for wonderful article. Can you let me know what is the IDIOT mnemonics? thanks!  
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