When a child has poor weight gain at home but shows improvement in the hospital, what should be suspected?

When a child exhibits poor weight gain at home but shows improvement once hospital care is initiated, it often indicates underlying psychosocial issues affecting feeding rather than non-accidental injury. Typically, when hospitalization occurs, a structured feeding environment is created that may not exist at home, leading to the improvement in weight gain.

This scenario points towards potential psychosocial factors such as feeding difficulties, inadequate supervision, or other stressors in the home environment that may negatively impact the child's nutrition. It reflects how changes in the child's surroundings, care, or support can influence their ability to feed properly and gain weight.

In contrast, non-accidental injury generally involves more severe physical signs or symptoms that would be recognizable during examinations, rather than solely manifesting as poor weight gain. Additionally, situations like malnutrition due to dietary issues and infections typically do not show abrupt improvement simply due to a change in environment unless there is direct medical intervention for those specific issues. Therefore, the suspicion of psychosocial barriers is the most pertinent conclusion when observing this pattern of weight gain.