Our world was rocked

Nicole is a beautiful 14-month wide-eyed girl who presents for routine health care maintenance in your office. Since her 9 month visit, her weight has fallen from the 25th percentile to significantly less than the 5th percentile. Her height has dropped from the 10th percentile to slightly less than the 5th percentile, while her head circumference has remained at about the 25th percentile. Her language, motor, cognitive, and social development are normal. She is 2 months late for this visit as her family has recently had significant family loss because of the earthquake in Haiti. When you take a feeding history, she seems to eat age-appropriate foods--macaroni, chicken pieces--but her mother notes that she tends to be restless and fidgety while eating and will no longer sit still in her mother's lap while she feeds her. Her stools tend to be frequent, with particles of food seen. Urine is normal. There are no symptoms of respiratory or neurological disease, and her review of systems is otherwise negative. She has been a healthy child and this is the first time they have fallen behind in routine health care maintenance visits. Her medical history is entirely unremarkable. She was born at term, weighing 3.5 kg, without any perinatal complications. The family has lived in the United States for the last 10 years. Mother recalls that there were other children in her family who were deemed small as young children but who caught up later in childhood. Mother describes a history of increased sadness and worry in the last 2 months. They receive phone calls from family in Haiti several times per week and she admits to being upset during and after these calls. When asked how the event has impacted her family, she states, "It has rocked our entire world but Nicole is just a baby who won't eat!" Parents are married, and there is no history of abuse or violence in the household. Her physical examination is essentially normal. Her anterior fontanelle is still open, roughly 2 cm. Two teeth (one just emerging) are present. She is alert and interactive and appears to relate well with her mother. You update her vaccinations and then struggle with where to head next.