Pediatric Medical Consult

Thank you for the referral. I had the opportunity to meet Ethan, accompanied by his father, in the office today. Ethan is a child referred for assessment of nasal symptoms and decreased appetite.

Patient and Parent Concerns:
Ethan presented for follow-up regarding previously reported 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 nighttime nasal stuffiness persisting. The primary ongoing concern is selective eating; Ethan prefers fruit and sweets and continues to avoid rice, meats, and most vegetables. His parent reports a weight gain from 27.7 kg in early January to 29.1 kg on February 8th, indicating a 1.5 kg increase over one month. Height remains above average, and weight is around the 15th percentile, consistent with his prior growth pattern. The family has been offering more variety and balanced meals, and efforts are being made to limit sugar intake.

Review of Systems:
Diet: Persistent selective eating with preference for fruit and sweets; avoidance of rice, meats, and most vegetables. Weight gain of 1.5 kg over one month.
Hearing: 
Vision: 
GI: Persistent selective eating with preference for fruit and sweets; avoidance of rice, meats, and most vegetables. Weight gain of 1.5 kg over one month.

Past Medical History
Medical History: 
Hospitalizations: 
Surgeries: 

Development History:

Family History:

Social History:

Allergies:
No known allergies.

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

Immunization History:

Investigations:

Physical Examination:

Assessment and Plan:
In summary, Ethan is a child seen today for follow-up of nasal symptoms and decreased appetite. His nasal symptoms have improved with current treatment, and his weight has increased by 1.5 kg over the past month despite ongoing selective eating.

The following issues were discussed today:
- Avoidant/restrictive food intake disorder (F50.82): Continue current dietary approach with emphasis on offering nutritious, varied options without forcing food. Maintain efforts to limit sugar intake. Monitor growth and nutritional status.
- Allergic rhinitis, unspecified (J30.9): Continue nasal spray as needed for nighttime nasal stuffiness.

Today we discussed the following plan for follow-up: Schedule follow-up in July or August to reassess growth and nutritional status. Clinic coordinator to contact family in the coming months to arrange next appointment.

Thank you for the opportunity to collaborate in the care of this patient. Please do not hesitate to contact me if you have concerns or questions.