With time I would come to understand and appreciate the simple and complex factors contributing to this infant’s growth failure. I also wondered about his mother’s ability to properly care for her infant boy, which stemmed from cognitive issues that I could tell were significant.

Within seconds of entering the exam room, I had a good theory as to the causes of the boy’s poor growth: inadequate caloric intake with poverty as a subtext. Even more alarming, he had quickly moved from consistent tracking close to the 50th percentile for weight from birth to 4 months to the lowest percentile curve on the graph. At my initial visit with the boy, his weight plotted at the fifth percentile, meaning 95 percent of all infants of the same age weighed more. As I did for all routine exams, I plotted his growth (weight, height and head circumference) before making the face-to-face. One look at his file, just prior to the visit, told me that there was at least one important medical issue I’d need to address. The boy was 9 months old and had come for a routine check-up. She stammered a little before gaining control of her speech. I felt her rough palms and couldn’t help but notice her odor. “It’s nice to meet you.” Mom took my hand.

“I’m Doctor Chris,” I said as I held out my hand. When our eyes met, her head shook ever-so-slightly from left to right. She didn’t immediately notice me, and the seconds it took for her gaze to slowly turn to me made me uneasy. He played by himself, apparently content in his own infant world, while mom existed in her own parallel universe. His palms and soles were darkened with dirt. Her infant son crawled around on the floor, clothed only in a disposable diaper that seemed to hang in the crotch like it had needed changing hours before. Opening the door my eyes immediately focused on the mom - obese and disheveled, maybe 30 years old, sitting on a chair, her eyes peering at some point in her lap. I thought I might encounter something extraordinary in the exam room that summer morning, but I wasn’t prepared for what found.

Failure thrive meaning