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Pediatric Problem Solving – Case 9
A 7-week old baby is referred with a 2-week history of vomiting. He is being formula fed (160 ml)every 2-3 hrs. On examination he is well. thriving, on the 90"' percentile and has a normal examination. What is the most likely diagnosis:
A -Pyloric stenosis
A 7-week old baby is referred with a 2-week history of vomiting. He is being formula fed (160 ml)every 2-3 hrs. On examination he is well. thriving, on the 90"' percentile and has a normal examination. What is the most likely diagnosis:
A -Pyloric stenosis
B -Gastro-oesophageal reflex
C -Over-feeding
D –Acute gastroenteritis
Explanation of the case:
Choice (A):points against: The baby is thriving, on the 90th percentile = growing well, in the high normal. If it was pyloric stenosis, there should be vomiting and malnutrition
Choice (B):points against: occurs on the second week, the child would not be on the 90th percentile, would not be able to eat every 2 to 3 hours.
Choice ( C ): [the right choice] : points with: high dose formula, high amount(every 2-3 hours).
Choice (D):points against: there is no inflammatory symptoms or signs, no diarrhea.
Explanation of the case:
Choice (A):points against: The baby is thriving, on the 90th percentile = growing well, in the high normal. If it was pyloric stenosis, there should be vomiting and malnutrition
Choice (B):points against: occurs on the second week, the child would not be on the 90th percentile, would not be able to eat every 2 to 3 hours.
Choice ( C ): [the right choice] : points with: high dose formula, high amount(every 2-3 hours).
Choice (D):points against: there is no inflammatory symptoms or signs, no diarrhea.
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