Case 1: Constipation, Irritability, and Poor Feeding in 2-month-old Boy

Nidhi A. Shah; Henry C. Lee

doi:10.1542/pir.2014-0114

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Nidhi A. Shah, MD*
Henry C. Lee, MD*

^*Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA.

AUTHOR DISCLOSURE
Drs Shah and Lee have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 2-month-old boy, who had been born at term, presents to the emergency department with irritability and poor feeding. The infant had been healthy with no temperature instability until approximately 2 weeks ago, when he became fussier than usual. Yesterday he refused to breastfeed and had a decreased number of wet diapers. His last stool was 5 days ago. His parents report that the infant is drooling more and appeared to choke on his secretions today.

The pregnancy was unremarkable and was completed with a normal vaginal delivery. The infant is exclusively breastfed, with good weight gain and normal development. Family members were ill with a stomach virus 10 days ago, but the infant appeared unaffected. His only medications are probiotics, chamomile, and an herbal supplement. Recent travel includes camping along the coastline. The infant has not received any vaccines.

Vital signs are as follows: temperature of 36.7°C (98.1°F), heart rate of 166 beats per minute, respiratory rate of 75 breaths per minute, blood pressure of 85/43 mm Hg, and oxygen saturation of 95%. …