CWHC1334888

 a

• 15-month-old boy with faltering growth and feeding difficulties

• Food refusal and intermittent non-bilious vomiting

• Requires nasogastric feeding with high-calorie formula

• Ongoing dietetic input; growth remains a concern

Medical background:

• Recurrent viral infections (adenovirus, coronavirus, rhinovirus, RSV, previous COVID)

• Neutropenia

• Iron deficiency anaemia with thrombocytosis

• Recent hand, foot and mouth disease

• History of frequent illness episodes reported by family

Investigations:

• Normal immunology (immunoglobulins and lymphocyte subsets)

• Normal barium swallow and abdominal ultrasound

• Normal calprotectin

• Low iron, normal B12

• Stable blood counts with improving neutrophils

• Other routine bloods unremarkable

Current management:

• NG feeding with concentrated formula

• Proton pump inhibitor

• Iron and zinc supplementation

• Twice-weekly weights

• Regular blood monitoring

• Clinically stable (PEWS 0)

• Ongoing admission for nutritional management and monitoring

• Input from dietetics, speech and language therapy, and paediatrics

• Discharge planning ongoing;