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A 9-month-old boy was referred with a 6-month history of intermittent bilious vomiting, exacerbated after weaning onto solid food, and faltering growth. He had a diagnosis of trisomy 21, hypothyroidism and repaired congenital heart disease (atrioventricular septal defect and coarctation of the aorta). On examination, as well as typical features consistent with Down syndrome, his weight of 4910 g was below the third centile on an appropriate growth …
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