When Developmental Delay and Failure to Thrive Are Not Psychosocial.

C A S E A 5-month-old Caucasian male presented to the emergency department after his primary care physician referred him for workup of noted failure to thrive (FTT) and severe global developmental delay (DD) that did not respond to hypercaloric formula and physical therapy. The patient was born at 39 weeks’ gestation to a 26-year-old primigravida mother via spontaneous vaginal delivery. The mother had not received prenatal care until ∼33 weeks’ gestation and endorsed both alcohol and marijuana use throughout the pregnancy. An antenatal ultrasound was performed at that time and revealed polyhydramnios. His birth weight was 3290 g, which was appropriate for gestational age. Shortly after birth, the patient had hypotonia, nystagmus, and failed hearing screens both at birth and at 3 months of age. At 4 months of age, physical and occupational therapy were started. Additionally, he was started on a concentrated formula of Enfamil Premium 22 kcal/oz, which provided 115 calories/kg/day, considering catch-up growth requirement. Despite this, he was unable to appropriately gain weight.