Failure to Thrive in a Child—What’s the Cause?

A three-year-old African American boy is brought to his new pediatrician over concerns of poor growth, fatigue, and irritability. On examination, he has a large head and generalized muscular hypotonia. His left wrist demonstrates the findings seen here. What next step is most appropriate?

A. Bone biopsy
B. Genetics referral
C. Nutrition counseling
D. Physiotherapy

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Discussion