Case Scenario 1

Ahmad is a 7-month-old boy who presents with recurrent blood-stained vomiting and poor weight gain for the past 3 months.

• He has recurrent vomiting since the age of 4 months.
• He vomits 20-30 minutes after feeding, 2-3 times per day.
• His vomitus consists of large amounts of undigested milk mixed with a small amount of blood streak.
• He drinks 3 ounces (90mls) of formula milk every 3 hourly. If offered larger volumes, he would vomit.
• Complementary feeding has yet to be started.

Feeding history

• Breastfeeding was discontinued shortly after birth due to inadequate breast milk.
• Formula milk was first introduced since day 2 of life.
• Bottle feeding usually is completed in 15 minutes. There is no excessive sweating or prolonged feeding time.

Feeding history

Birth history

• He was born at term via spontaneous vaginal delivery (SVD) with a birth weight of 3.0kg.
• His antenatal period was uneventful.

Birth history

Past medical history

• 3-month-old: Treated as blood culture-negative sepsis
• 3.5-month-old: Rotavirus acute gastroenteritis, hospitalisation for 3 days
• 6-month-old: Salmonella sp acute gastroenteritis

Past medical history

Developmental history

• Chronological age: 7 months
• Demonstrates good head control, fixes and follows at horizontal and vertical planes
• Yet to roll over
• Reaches out for objects and transfers between hands
• Has started monosyllabic babbling

Developmental history