Development/Behaviour Consult

Thank you for the referral. I had the opportunity to meet Ethan, accompanied by his father via telehealth on 2026-01-29. Behaviour consultations are conducted in two parts: an initial virtual caregiver interview followed by an in-person visit with the patient. Ethan is a child referred for assessment of follow-up for nasal symptoms and decreased appetite.

Patient and Parent Concerns:
Ethan was seen for follow-up regarding previously noted nasal symptoms and decreased appetite. Since the last visit in November, his nasal symptoms have improved with the use of a prescribed nasal spray, with only mild nighttime nasal congestion persisting. The primary ongoing concern is selective eating; Ethan continues to prefer fruit and sweets while avoiding rice, meats, and most vegetables. Despite this, his weight has increased from 27.7 kg in early January to 29.1 kg by February 11th, indicating a gain of approximately 1.5 kg over one month. His parent reports increased efforts to provide a more varied and balanced diet, which may have contributed to the weight gain. Ethan has historically tracked as tall and slim, with height above average and weight around the 15th percentile.

Review of Systems:
Diet: Persistent selective eating, preference for fruit and sweets, avoidance of rice, meats, and most vegetables. Weight gain of 1.5 kg over one month.
Sleep: Not mentioned.
Stooling: Not mentioned.
Exercise: Not mentioned.
Screen time: Not mentioned.
Hearing: Not mentioned.
Vision: Not mentioned.
Puberty: Not mentioned.
Constitutional: Not mentioned.
Cardiac: Not mentioned.
Respiratory: Not mentioned.
GI: Persistent selective eating.
Skin: Not mentioned.
MSK: Not mentioned.

Behaviour Review:

ADHD Screen:
Inattention:
- Fails to give close attention to details: 
- Difficulty sustaining attention: 
- Does not listen when spoken to directly: 
- Does not follow through with instructions: 
- Difficulty organizing tasks: 
- Avoids tasks requiring sustained mental effort: 
- Often loses things: 
- Easily distracted: 
- Forgetful in daily activities: 
Hyperactive-impulsive:
- Fidgeting or squirming: 
- Leaves seat inappropriately: 
- Runs or climbs inappropriately: 
- Unable to play quietly: 
- "On the go" or "driven by a motor": 
- Talks excessively: 
- Blurts out answers: 
- Difficulty waiting for turns: 
- Interrupts or intrudes on others: 

Autism Screen:
Communication:
- Speech delay: 
- Poor eye contact: 
- Poor understanding of body language: 
- Lack of facial expressions: 
- Uses parent as object: 
Social Skills:
- Difficulty understanding social context: 
- Difficulty sharing in imaginative play: 
- Difficulty making friends: 
- Lacks interest in peers: 
- Always plays independently: 
- Does not share joy: 
Restrictive or Repetitive Behaviours:
- Repetitive motor movements: 
- Repetitive speech: 
- Lines up toys: 
- Flips objects: 
- Strong attachment to unusual objects: 
Inflexibility:
- Strict adherence to routines: 
- Ritualized patterns of behaviour: 
- Distress over small changes: 
- Difficulties with transitions: 
- Rigid thinking patterns: 
- Unusual greeting ritual: 
- Rigid eating pattern: 
Sensory Input:
- Indifference to pain or temperature: 
- Adverse response to sounds or textures: 
- Excessive smelling or touching of objects: 
- Visual fascination with lights or movement: 

Learning Disability Screen:
- Supports in school: 
- Supports outside of school: 
- IEP: 
- Psychoeducational assessment: 
- Report cards: 

Psychiatric Screen:
Depression:
- Mood: 
- Anhedonia: 
- Sleep changes: 
- Feelings of guilt: 
- Poor energy: 
- Cognitive slowing: 
- Poor concentration: 
- Appetite changes: 
- Agitation: 
- Suicidal ideation: 
Anxiety:
- Worries: 
- Difficulty controlling worries: 
- Restlessness: 
- Easily fatigued: 
- Difficulty concentrating: 
- Irritability: 
- Muscle tension: 
- Sleep difficulties: 
- Panic attacks: 
- Phobias: 
- Social anxiety: 
Psychosis:
- Hallucinations or delusions: 

Past Medical History:
Medical History: 
Hospitalizations: 
Surgeries: 

Development History:

Family History:

Social History:

Allergies:

Medications:
1. Nasal spray as previously prescribed for nasal symptoms.

Immunization History:

Investigations:

Physical Examination:

Assessment and Plan:
In summary, Ethan is a child seen for follow-up for nasal symptoms and decreased appetite.
Ethan has shown improvement in nasal symptoms with ongoing mild nighttime congestion. The main concern remains selective eating, with a preference for fruit and sweets and avoidance of rice, meats, and most vegetables. Despite this, he has demonstrated a healthy weight gain over the past month. Family is making efforts to provide a more balanced and varied diet.

The following items and plans were discussed:
1. Avoidant/restrictive food intake disorder (F50.82): Continue current dietary approach, offering nutritious and varied foods without forcing intake. Limit sugar intake, especially sweets.
2. Allergic rhinitis, unspecified (J30.9): Continue nasal spray as needed for nighttime congestion.

Follow-up:
Schedule follow-up in July or August to reassess growth and nutritional status. Coordinator will contact family to arrange next appointment.

Thank you for the opportunity to collaborate in the care of this patient. Please contact me with any concerns or questions.