G.R. is a 7-year-old boy with spastic quadriplegia evident since birth and a seizure disorder for which he currently is being treated with phenobarbitol and phenytoin (diphenylhydantoin). His medical history includes a pathologic fracture of his right femur. At the time of his fracture, a radiograph of his femur was described as "markedly osteoporotic." He is currently being treated with 1200 IU of vitamin D.
His diet as presented is balanced with respect to nutrients. Although spillage is not substantial, eating requires great effort, and each meal lasts approximately 1 hour. He is fed breakfast and supper at home by his mother and lunch in school. There is no history of pain with food intake, no vomiting, and no diarrhea.
He weighs 14 kg (far below the 5th percentile), and his length is 112 (at the 5th percentile). His weight for height is far less than the 5th percentile. His mother is 157.5 cm (5 ft 2 in) tall and his father is 167.5 cm (5 ft 6 in) tall. His midarm circumference is 154 mm (less than the 5th percentile), his triceps skinfold is 5 mm (5th percentile), and his midarm muscle circumference is 138 mm (less than the 5th percentile).