The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess?

A. The child has above-normal growth for his age: Congenital hypothyroidism typically results in slowed growth and delayed skeletal maturation due to insufficient thyroid hormone. Above-normal growth is not consistent with this condition and would be unexpected. B. The child is active and playful: Hypothyroidism in infants usually causes lethargy, hypotonia, and decreased activity. A highly active and playful infant would be atypical and not indicative of untreated congenital hypothyroidism. C. The skin is pink and healthy looking: Infants with congenital hypothyroidism often have pale, dry, or mottled skin due to decreased metabolism and poor perfusion. Healthy, rosy skin is not a common finding in this condition. D. It is difficult to keep the child awake: Lethargy and excessive sleepiness are hallmark signs of congenital hypothyroidism in infants. Difficulty keeping the infant awake reflects central nervous system depression caused by thyroid hormone deficiency and is a key clinical indicator.