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PE2.1-3 | Growth Problems — Assignment

CLINICAL SCENARIO

You will evaluate a real or simulated paediatric patient with growth faltering and produce a structured clinical case write-up that demonstrates your ability to assess failure to thrive or short stature, formulate a differential diagnosis with organic vs non-organic reasoning, plan appropriate investigations, initiate management, and counsel the family. This task develops the integrative clinical reasoning expected of an intern managing growth problems independently.

Instructions

Select a child (from your clinical posting, a simulated vignette provided by your tutor, or a structured case sheet) who presents with one of: failure to thrive (weight-for-height <−2 SD or crossing two centile lines), short stature (height <−2 SD), or severe acute malnutrition.
Obtain a detailed history: feeding history (type, frequency, quantity, texture), birth history, gestational age, birth weight, growth chart review from birth, developmental history, recurrent illness, family history of short stature or consanguinity, psychosocial and socioeconomic assessment.
Plot the child's weight, height, and head circumference on WHO/IAP growth charts; calculate weight-for-height Z-score and MUAC.
Perform and document a structured physical examination including nutritional status grading, signs of organic disease, dysmorphic features, pubertal stage (if applicable), and any features pointing to an aetiology.
Classify the growth problem (FTT vs short stature; organic vs non-organic; SAM vs MAM if applicable) and construct a differential diagnosis with reasoning.
Propose a targeted investigation plan with justification (minimum: TFT, IGF-1 if short stature; dietary recall and MUAC reassessment if FTT; bone age X-ray if short stature suspected constitutional delay or GH deficiency).
Outline a management plan: nutritional rehabilitation protocol or specific treatment, family counselling approach, and a follow-up schedule.
Write a structured counselling summary in plain language that you would deliver to the parents — include what the diagnosis means, what they should do at home, red flag signs to return urgently, and next follow-up date.
Compile the above into a single write-up following the scaffolding sections below. Word limit: 800–1200 words (excluding growth chart and tables).

Length: 800–1200 words (excluding growth chart plots and laboratory tables)

What to Submit

Patient Background and Growth History

Guidance: Age, sex, birth weight, gestational age, current measurements plotted on growth chart, growth trajectory from birth, MUAC. State which chart (WHO/IAP) you used and why.

History — Feeding, Development, and Psychosocial Assessment

Guidance: Detailed dietary history (type/frequency/quantity/texture for age); developmental milestones (compare to norms); family income, caregiver situation, and psychosocial stressors; recurrent illness or hospitalisation; family history of short stature, chronic disease, or consanguinity.

Physical Examination Findings

Guidance: Nutritional status (SAM/MAM/normal), dysmorphic features, signs of organic disease (hepatosplenomegaly, oedema, pallor, thyroid enlargement), pubertal staging (if ≥8 years), and bone age correlation (if X-ray available).

Classification and Differential Diagnosis

Guidance: Classify as FTT or short stature; organic vs non-organic. List at least three differential diagnoses in order of likelihood with a one-sentence rationale for each. State clearly which aetiology you favour and why.

Investigation Plan

Guidance: List investigations in order of priority with specific justification: e.g., 'TFT to exclude hypothyroidism as a reversible organic cause of short stature'; 'bone age to estimate remaining growth potential and guide rhGH decision'; 'anti-tTG IgA if malabsorption suspected with adequate intake'. Avoid blanket panels — justify each test.

Management Plan

Guidance: Nutritional rehabilitation (F-75/F-100/RUTF with 10-step protocol if SAM; energy-enriched diet with target calories if non-organic FTT; levothyroxine if hypothyroid; rhGH referral if GH deficiency confirmed). Include dosing approach (weight-based), monitoring parameters, and criteria for reassessment or escalation.

Family Counselling Summary

Guidance: Write in plain, accessible language (avoid jargon) as if speaking directly to the parents: explain the diagnosis in lay terms, specific dietary changes at home (quantities and meal frequency), positive feeding practices to adopt, red flag symptoms requiring immediate return (e.g., child unconscious, unable to feed, rapid breathing, bilateral swelling), and next scheduled follow-up date.

Grading Rubric — Growth Faltering Case Write-up Rubric

Criterion	Points	Full-marks descriptor
Growth Chart Interpretation and Anthropometric Accuracy	15 pts	Correct plot on WHO/IAP chart; accurate Z-scores and/or percentiles stated; MUAC documented; growth trajectory from birth described; chart choice justified.
History Taking — Dietary, Developmental, and Psychosocial	15 pts	Comprehensive dietary history with type/frequency/quantity/texture; developmental milestones compared to norms; psychosocial and family history; recurrent illness explored systematically.
Classification and Differential Diagnosis	20 pts	Correct classification (FTT/short stature; organic/non-organic; SAM/MAM if applicable); ≥3 ranked differentials with a reasoned rationale; favoured diagnosis clearly justified with clinical evidence.
Investigation Plan — Targeted and Justified	15 pts	Investigations listed in priority order with specific one-sentence justification for each; no blanket panels; tests appropriate for the suspected aetiology (TFT/IGF-1/bone age/anti-tTG as indicated).
Management Plan — Clinically Appropriate and Weight-based	20 pts	Management plan is aetiology-specific; weight-based dosing/targets stated (e.g., 150 kcal/kg/day target; mg/kg drug dosing); monitoring parameters and escalation criteria defined; follow-up schedule specified.
Family Counselling Quality — Clarity, Empathy, and Completeness	15 pts	Written in lay language free of unexplained jargon; diagnosis explained simply; specific dietary actions stated; red flag symptoms clearly listed; responsive feeding principles reflected; follow-up date given; empathetic tone.

PEER REVIEW

Review your peer's case write-up using the rubric above. For each criterion, assign a score and write 1–2 sentences of specific, constructive feedback — what was done well and one concrete suggestion for improvement. Pay particular attention to: (1) whether the organic vs non-organic distinction is supported by evidence from the history; (2) whether the management plan includes weight-based targets; and (3) whether the counselling summary is genuinely accessible to a lay parent. Your review should be respectful, specific, and grounded in the case data.