A 7-month-old boy with failure to thrive.

This 7-month-old boy was evaluated for failure to gain weight. He was the 7-lb., 7-oz. product of a full-term pregnancy to a 31-year-old gravida 2 para 2 woman. It was a precipitous vaginal delivery, but there were no perinatal problems. His mother initially nursed him every 3 hours for 20 minutes on each breast. Recently, he had been feeding once during the night. He had three normal bowel movements each day without diarrhea or vomiting. If his mother pumped, she expressed a total of 4 oz. from the combination of the two breasts. Although his parents have tried to give him solid foods, he will not eat from a spoon. He drinks pumped breast milk from a bottle, although he prefers nursing. When he drinks from a bottle, he can take 3 oz. in about 30 minutes. There is no history of choking, sputtering, or tachypnea with feeds. His past history is remarkable for a skin rash that started at 4 months. The rash was described as pruritic, red, and scaly over his entire body. He was treated with Eucerin without effect and was switched to EpiCeram. He has had no signifi cant infections, other than one episode of otitis media. Development is normal. The family history is unremarkable. On physical exam, he was a thin, uncomfortable boy who was con-