An 18-month-old girl presents with irritability and decreased appetite. She was born at 38 weeks' gestation with a birth weight of 2.8 kg. She was breastfed for 9 months and then c... An 18-month-old girl presents with irritability and decreased appetite. She was born at 38 weeks' gestation with a birth weight of 2.8 kg. She was breastfed for 9 months and then changed to a cow's milk-based formula. The infant is drinking about 1 liter of formula per day together with solid foods. The mother reports that the stool has been loose and smelly over the last 3 days. Physical examination confirms pallor of the skin and mucous membranes, and systolic heart murmur (see lab results). Heart rate 120/min, oxygen saturation 95% on room air, respiratory rate 30/min, temperature 37.3° C. Test Result: Hb 90 (Normal Values: 112-165 g/L), RBC 3.0 (Normal Values: 4.6-4.8 x 10^12/L). Which of the following is the most likely underlying cause? A. Gastrointestinal infection B. Cow's milk consumption C. Bone marrow defect D. Low birth weight
Understand the Problem
The question describes an 18-month-old girl presenting with symptoms like irritability, decreased appetite, pallor, and abnormal lab results (low Hb and RBC). Given the history of breastfeeding followed by cow's milk formula, and the current symptoms, we need to determine the most likely underlying cause from the options provided. The main considerations are gastrointestinal infection, cow's milk consumption, bone marrow defect, and low birth weight.
Answer
Cow's milk consumption.
The most likely underlying cause is cow's milk consumption, as it can lead to iron deficiency anemia in infants due to several factors, including poor iron content in cow's milk, inhibition of iron absorption, and gastrointestinal blood loss in some cases.
Answer for screen readers
The most likely underlying cause is cow's milk consumption, as it can lead to iron deficiency anemia in infants due to several factors, including poor iron content in cow's milk, inhibition of iron absorption, and gastrointestinal blood loss in some cases.
More Information
The infant's age (18 months), history of breastfeeding followed by cow's milk-based formula, high formula intake (1 liter per day), symptoms of irritability, decreased appetite, loose and smelly stools, and signs of anemia (pallor, heart murmur, low Hb and RBC) all point towards this diagnosis. Although other options may cause similar symptoms, cow's milk consumption is the most likely cause based on the information provided.
Tips
It is a common mistake to overlook dietary factors when assessing anemia in infants. Always consider the child's feeding history, including the type and amount of milk consumed.
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