A 3-year-old girl presents to the emergency department after being referred from a pediatric gastroenterologist for failure to thrive. The girl’s foster mother reports that she has been noticing the child losing weight since she received her custody 7 months earlier. The girl has no significant medical history and, per her biological mother’s report, had been developing normally until the previous year. The biological mother supplies photographs and videos to support this claim; however, recent growth charts cannot be obtained. The only growth charts in the record show her at the 50th percentile for length and the 25th percentile for weight at 6 months of age. The foster mother reports frequent choking while eating but denies fever, headache, cough, abdominal pain, gross motor abnormalities, or changes in appetite.

The girl’s weight is 9,000 g (<3rd percentile for age) and height is 33.5 in (85 cm) (1.53rd percentile for age). Her...

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