Reference no: EM133444550

Question:Today at your clinic, you have Daniel a 8.5month old boy who is brought in by his mother and grandmother for a wellness-checkup. Daniel's mother is Hispanic speaks English and Spanish fluently.. When you meet him, you play briefly with him and hide your medical equipment. As you approach him, he runs to his mother and climbs into her hand. You sit next to them and after a few minutes of talking to his mother, she hands him over to you. He resists initially.
He was born at 36 weeks gestation and weighed 7lbs. He was vacuum assisted vaginal delivery and his mother is concerned about concave shape of his head. His mother is 27 years old, had anemia, and during the final weeks of her pregnancy suffered from hypertension with bp at 180/90 even on antihypertensive medication. At this visit, he currently weighs 5.7kg (at birth he weighed 7.1lbs...do the conversion math) . He has a depressed anterior fontanel, and closed posterior fontanel. On exam, you note that Daniel is unable to hold the bottle that has been given to him and unable to stand or bear weight on both feet. He is unable to sit up without support. His mother tells you that lately, he is able to move his rattle from one hand to the next. You do not elicit the grasp reflex when you examined him but also he is unable to roll from his back to his front and has not started crawling.

She tells you that she wants to stop breast-feeding because her nipples are sore, tender, and draining. She is concerned that he might be thirsty and wants to give him half a cup of water three times a day. She is also unsure if she should continue breast feeding or giving him food. You examine Daniel's mouth and note white coating that is not easily scraped. She has started giving him 2% whole milk because does not want him to be obese (since she is obese). She also tells you that his last vaccine was at his 4-month checkup and has not being vaccinated since. Due to covid-19, she is not sure if she should proceed with the remainder vaccines. Finally she tells that he sleeps (in her bed) whenever he wants and does not really wake up in the middle of the night to feed and she is ok with that because it allows her to sleep. She is curious about when his first set of tooth will come in.
When you asked about the occupants in the house, she tells you that there are four adults, 2 dogs and a cat that are in the house. She tells you she is concerned that he will have delayed speech because her and both her husband did when they were infants. She does admit that in the house Spanish is the main language for communication.

Another detail mother shares with you is that they have a loaded weapon in their room that is by the bedside in case of unauthorized entry to the house. She did tell you that she never leaves him alone in the bath. In fact, she takes showers with him and she likes hot showers. Finally, mother asks when his car seat can be turned to front facing ?

1. What are three potential safety concerns that arise with Daniel?

2. What do you find concerning (if any) about his exams? What will