A case we saw in San Andrés

N.S., a 30-month-old boy, is seen during a follow-up house visit for failure to thrive. At this visit, he weighs 18 lbs, 12 oz. He was first seen 6 weeks previously, when he was just recovering from a 1-week bout of diarrhea, and his weight at that time was 16 lbs, 8 oz. His mother relates that N.S. began standing up and taking a few steps about 3 months ago; now, he is able to walk unassisted but cannot yet run. He says "mama," but no other words. The heart, lung, thyroid and abdominal exams are unremarkable. The boy's 8-month-old sister weighs 16 lbs. These are the household's only children. Both N.S.'s mother and father are present during the visit. When asked why she thinks N.S. is not growing well, his mother replies, "Last month he had diarrhea. Now he does not have diarrhea, but I give him food and he does not like to eat. He only eats one or two tortillas with salt. He likes Incaparina, but I only give it to him sometimes." The family lives in a resettlement community--families were moved from a plantation to this new location following landslides that destroyed all of their houses; the new land was purchased by the Catholic parish in San Lucas Tolimán. The community recently had unpurified, running water installed in all of the houses. In this community, there is a government-sponsored daycare for children 5+ years that provides two meals daily; there are mixed reports from community members and daycare caretakers regarding rate of attendance and family's usage of these free meals. There are biannual deworming treatments in the community.

-What are the possible ("social" or "environmental") etiologies of failure to thrive in N.S.? How do we figure out how likely these etiologies are, and how big an impact they are having on the growth of N.S.?

-What would be some strategies to tackling the possible etiologies of failure to thrive in this case?

-What should we be doing with respect to N.S.'s sister and protecting her growth and development?