How much milk is too much? A case study of an obese toddler.

148 Volume 27 Number 2 CASE PRESENTATION A 2.5-year-old Hispanic boy who was obviously overweight came to the medically underserved primary care clinic for a well-child exam. When the pediatric nurse practitioner (PNP) questioned the mother about the child’s dietary history, she reported that he drinks one gallon ofmilk per day, in addition to his daily intake of typical Mexican foods, such as tortillas, rice, potatoes, and beans. The child, born at a large health care facility in the southwestern U.S., was a product of a full-term pregnancy and vaginal delivery. His mother did not smoke, drink alcohol, or use illicit drugs during the pregnancy. His birth weight was 7 lbs and 8 ounces (3.4 kg); length was 19 inches (48.26 cm). He has been healthy with no hospitalizations, major illnesses, or injuries. He has no allergies and his immunizations are current. This was the first visit for the toddler to this clinic and previous health care records were not available. The child had Medicaid health insurance until recently when it had expired due to non-renewal by the parents. The parents paid for this health care visit in cash.