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I'd be willing to bet, the mom sees this change in her hands and anywhere else on her body and contributes it to loosing weight from not "being fed".
After listening to Dr. Byrne he would also most likely say that's the cause.
Her hand looks much older.
Could it be due to ATN?
I hadn't thought of that ... that wrinkled hands on a 13 year old might be perceived as weight loss. With grandmother being a vocational nurse, wouldn't she have told her daughter that people don't loose weight on their fingers ... bone thin fingers in Hansel and Gretal with sagging skin? That doesn't sound right. Isn't that muscle tissue disintegration?
Is anyone being straight with the mother?