A 13 months old girl who was born at full term via NSVD to a G2P0A1 mother. Pregnancy was complicated by recurrent UTIs and premature contractions. The perinatal and postnatal histories were unremarkable, and she was discharged on the second day. Growth parameters at birth were weight 2.9 kg and head circumference 35 cm (50th-75th percentile). The first concern was a poor growth and absent vision fixation. Developmentally, she started sitting with support, reaching and transferring objects at 11 months. On examination, her dysmorphic features include facial asymmetry, bilateral temporal narrowing, epicanthal folds, upslanting palpebral fissures, bulbous nose, and full cheeks. She has ataxic movement of the head and hypotonia. Her Hearing assessment was normal, and other examinations were within normal limits. Her growth parameters at 13 months of age were weight 7.1 kg (<3rd percentile), height 66.8 cm (<3rd percentile) and head circumference 39(<3rd percentile).