A 7-day-old male infant presents to the pediatrician for weight loss. There is no history of excessive crying, irritability, lethargy, or feeding difficulty. The parents deny any history of fast breathing, bluish discoloration of lips/nails, fever, vomiting, diarrhea, or seizures. He was born at full term by vaginal delivery without any perinatal complications and his birth weight was 3.6 kg (8 lb). Since birth he has been exclusively breastfed and passes urine six to eight times a day. His physical examination, including vital signs, is completely normal. His weight is 3.3 kg (7.3 lb); length and head circumference are normal for his age and sex. Which of the following is the next best step in the management of the infant?
AReassurance of parents
BEvaluation of the mother for malnutrition
CAdmission of the infant in the NICU to treat with empiric intravenous antibiotics
DEmphasize the need to clothe the infant warmly to prevent hypothermia
ESupplementation of breastfeeding with an appropriate infant formula
A 2-month-old girl is brought to the physician for a well-child examination. She was born at 32 weeks' gestation and weighed 1616 g (3 lb 9 oz); she currently weighs 2466 g (5 lb 7 oz). She is exclusively breastfed and receives vitamin D supplementation. Physical examination shows no abnormalities apart from low height and weight. This patient is at increased risk for which of the following complications?
AIron deficiency anemia
BHemorrhage
CScurvy
DSubacute combined degeneration
EIntussusception
A 20-week-old infant is brought to an urgent care clinic by her mother because she has not been eating well for the past 2 days. The mother said her daughter has also been "floppy" since yesterday morning and has been unable to move or open her eyes since the afternoon of the same day. The child has recently started solid foods, like cereals sweetened with honey. There is no history of loose, watery stools. On examination, the child is lethargic with lax muscle tone. She does not have a fever or apparent respiratory distress. What is the most likely mode of transmission of the pathogen responsible for this patient’s condition?
AVertical transmission
BVector-borne disease
CDirect contact
DContaminated food
EAirborne transmission
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