WELL-CHILD PROJECT. Brianne Squires NDFS 424. PART I (Complete Sections I V):

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1 WELL-CHILD PROJECT Brianne Squires NDFS 424 PART I (Complete Sections I V): I. Identifying data (1 point) A. Kaila B. Kaila has brown eyes, reddish-brown hair and normal development of her body as far as the eye can see. Baby teeth are all in and her muscle and skin turgor are good. C. Kaila does not spend time with babysitters or at day care, mom stays at home with Kaila every day. She is a very energetic, playful child who interacts with her younger sister and parents often. She always wants to play with them and her cat. II. Health history (10 points) A. female B. 4 years, 9 months C. Birth anthropometrics (of child): (1) 6 lbs 1 oz is between the 5-10 th percentile for her weight (2) 19 in. and is between the 25-5 th percentile for her height D. Current anthropometrics (of child): (1) 48 lbs and is between the th percentile for her weight (2) 46 in. and over the 95 th percentile for her height E. Kaila has one sibling, Hailey, who is 16 months old. F. Mother had normal weight gain with Kaila (about 25 lbs) and delivered about 3.5 weeks early. This was her first child. G. No history of illness or disease H. Her first fluoride treatment was a month or two ago, no medications. I. None J. None III. Developmental skills assessment (6 points) A. Developmental skills perform the Denver Developmental Screening Test (DDST) using the screening form handed out in class B. Summarize your findings from the DDST using the following format (refer to PowerPoint instructions on BYU Learning Suite): (1) None identified (2) None identified (3) balance on one foot 6 seconds balance on foot 5 seconds (4) Kaila is a normal child based on the screening test. She was able to perform all tasks adequately, except for the standing on one foot for 5 or 6 seconds. She was able to do it for 4 seconds, but longer than that was difficult for her. I believe that she is still considered normal because the amount of

2 children who should be able to balance that long on one foot for her age is few. Her test behavior was normal with full compliance, interest, and good attention span. IV. Nutritional assessment (8 points) A. SUMMARIZE: (1) Kaila s macronutrient intake percentages statuses were all OK. The only item of possible concern is that although her fat intakes were fine, her saturated fat consumption was higher than recommended by 2%. (2) Kaila was adequately consuming everything but vegetables and whole grains. Her vegetable intake was only ¼ cup instead of the recommended 1 ½ cup. Her whole grain intake was ½ oz of the 2 required, although total grain intakes were 5 oz of the 4 recommended. The fruit intake was 2 cups when 1 cup is needed for Kaila. For dairy, 2 ½ cups is required and Kaila consumed 1 ¾ cups. Finally, her protein intake should have been 3 oz and she consumed 1 oz on this particular day. (3) Kaila was not over on any vitamins and minerals. The only minerals that were low are calcium and potassium. The vitamins that were low are vitamin A, vitamin D, vitamin E, vitamin K, and choline. B. Kaila is a pretty picky eater, but will eat when it is meal or snack times. She is provided foods and can choose to eat it if she wants, but she also picks a lot at her food and doesn t eat much. She is not much of a morning eater, and some days are harder than others. She loves to eat grains, especially pasta, pancakes and pizza. She also loves apples and fruit, as well as homemade food items, like soup. C. Kaila is asked to sit at the table during meal times (she tries to leave and play in the living room) and wait until dinner is over to leave the table. The family always sits at the table and eats dinner together, although Dad is at work for lunch. D. Kaila eats a gummy multivitamin a day E. No use of food assistance programs, food banks, etc. V. Nutritional care plan and implementation (15 points) A. The most significant nutrition risks I think Kaila has are her low vegetable intake, her higher saturated fat consumption, and low amounts of the vitamins and minerals listed. Although this may have been an off day in Kaila s normal habits, I am still concerned with the amount of cookies and juice she consumed. Her mom reported that she did not at much of her lunch so when it was snack time she gladly let Kaila have a few cookies. The cookies and juice alone provide a significant amount of added sugars into the diet. Her saturated fat intake is also concerning because of the negative effects this can have on the body over time. I am also concerned with her vegetable intake. Again, she may consume more vegetables over a given amount of time, but vegetables will provide a lot of the vitamins and minerals that she is low on, most specifically vitamins A, K, D and E. Although she is getting a lot of dairy in her diet, I am also cautious of her lower calcium intake because she is at such a critical period for growth right now. Kaila s diet can be altered by limiting, not cutting out completely, sugars in the diet. Fats are good for children, but a focus on essential fatty acids and other healthy fats are more beneficial than saturated fats. Increased consumption of whole fruits and vegetables will help with vitamin and mineral levels.

3 B. The first recommendation I have is to limit the added sugars in Kaila s diet. Cutting out sugars completely may just make her want more, but setting a goal to allow 1 cookie and some carrots instead of 4 cookies in one day is better for her health. Along with this, Kaila s saturated fats were a little high. These can be lower by providing Kaila with lean meats and fewer snacks with fats. I recommend including a vegetable and/or fruit at every meal for Kaila. Although she takes a multivitamin daily, it would be more beneficial for her to eat her vitamins and minerals through food instead of relying on supplements. An increase in green leafy and bright, colorful vegetables will help increase her vitamin intake. For example, it is concerning to have vitamin A low because it plays an important role in vision, or for low vitamins D and K that are crucial for good bone health. I plan to educate Kaila s mother on the importance of these changes to health and growth of her daughter. Although she is eating enough calories and is consuming good foods, it may be beneficial for her mom to understand the importance of good nutrition in development of young children. If willing, I will give her meal ideas that provide kid-friendly tastes, as well as balanced foods.

4 Well-Child Project Part II Kaila s mother is very aware of the ChooseMyPlate diagram and is very knowledgeable about the food groups it contains. Although she does not know the recommended intakes of vitamins and minerals for Kaila, she does know the importance they have on a growing and developing body. This all being said, Kaila s mom was much more hesitant to listen to me than I had anticipated. I felt that I had to tread lightly so as not to offend her with my suggestions. We discussed her diet however, and she was able to take away some helpful ideas. The first thing discussed was Kaila s high intake of added sugars from the four cookies and apple juice from the day. Kaila s mom insists that her intake for that day was not reflective of a regular day, so I am not sure if I got through to her on the issue or not. I did politely discuss with her some great snack time options and even a little bit about Ellyn Satar s division of responsibility. I was able to share with her the knowledge that parents have the responsibility to provide the food options at snack/meal times and that the child can choose to eat it or not. In her case, Kaila s mom can provide a healthy snack of apples or carrots, even though Kaila insists on cookies, and she can decide whether or not she wants to eat it. Another concern addressed was Kaila s intake of saturated fat in her diet. Kaila s mom did not realize how much saturated fat is being consumed through cheese and was happy to know. We discussed ways to reduced this, such as switching to lower fat milk, cheese or even cutting back on cheese and replacing it with low-fat yogurt or leaner meats than pepperoni. Finally, we discussed fun kid-friendly ways to increase vegetable consumption such as arranging vegetables on a plate to make a face, including Kaila in vegetable growing and preparing (because Mom is an avid gardener), and adding peanut butter or hummus to vegetables to increase flavors. Finally, Kaila s mom and I discussed the importance of having a balanced ChooseMyPlate meal to ensure that Kaila is getting the needed vitamins and minerals in her food. At first I was unsure if Kaila s mom would even listen to the advice I had for her. I believe she was hesitant at first, but as we continued to discuss, I think she realized that I am just telling her what I know and offering suggestions. I am not sure if she will comply and make change in her home to many things, but I do think the saturated fat intake will be addressed. I think Kaila s mom was genuinely concerned by the amount she was consuming because she knows Kaila eats a lot of cheese daily and not many other sources of calcium. She is aware now of the importance of specific vitamins and mineral but I do not think she is overly concerned because of the irregularity of the 24 hour recall information provided to me and because of the multivitamin she receives daily. I could have improved the education by coming prepared with more snack ideas for Kaila. Aside from incorporating vegetables in her diet more, I was not as prepared as I would have liked to be to answer more questions about snack ideas or kid-friendly school lunch ideas. Luckily, this was easy to Google and research together.

5 Kaila's Food Groups and Calories Report 03/14/14-03/14/14 Your plan is based on a 1200 Calorie allowance for a preschooler. Food Groups Target Average Eaten Status Grains 4 ounce(s) 5 ounce(s) Over Whole Grains 2 ounce(s) ½ ounce(s) Under Refined Grains 2 ounce(s) 4½ ounce(s) Over Vegetables 1½ cup(s) ¼ cup(s) Under Dark Green 1 cup(s)/week 0 cup(s) Under Red & Orange 3 cup(s)/week 0 cup(s) Under Beans & Peas ½ cup(s)/week 0 cup(s) Under Starchy 3½ cup(s)/week ¼ cup(s) Under Other 2½ cup(s)/week 0 cup(s) Under Fruits 1 cup(s) 2 cup(s) Over Fruit Juice No Specific Target 1 cup(s) No Specific Target Whole Fruit No Specific Target 1 cup(s) No Specific Target Dairy 2½ cup(s) 1¾ cup(s) Under Milk & Yogurt No Specific Target 1 cup(s) No Specific Target Cheese No Specific Target ¾ cup(s) No Specific Target Protein Foods 3 ounce(s) 1 ounce(s) Under Seafood 5 ounce(s)/week 0 ounce(s) Under Meat, Poultry & Eggs No Specific Target 1 ounce(s) No Specific Target Nuts, Seeds & Soy No Specific Target 0 ounce(s) No Specific Target Oils 4 teaspoon 1 teaspoon Under Limits Allowance Average Eaten Status Total Calories 1200 Calories 1212 Calories Over Empty Calories* 121 Calories 341 Calories Over Solid Fats * 271 Calories * Added Sugars * 70 Calories * *Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories. Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be included in the Nuts, Seeds & Soy subgroup.

6 Meals from 03/14/14-03/14/14 Kaila's Meals Your plan is based on a 1200 Calorie allowance for a preschooler. Date Breakfast Lunch Dinner Snacks 03/14/14 ½ medium (2-3/4" across) Apple, raw 1 slice (1 oz) Cheese, Cheddar ½ cup Corn flakes cereal 3 slice (1-3/8" across x 1/8" thick) Pepperoni 1 cup Milk, low fat (1%) ½ single serving bag (1 oz) Tortilla chips (Tostitos, Doritos) ½ small box (1.5 oz) Raisins ½ tortilla (8" across) Tortilla, flour (wheat) ½ cup Macaroni, (or rotini, ziti, shells, lasagna noodles, other pasta), cooked (no salt or fat added) 2 small meatball Meatballs, beef ¼ cup Mixed vegetables (corn, lima beans, peas, green beans, carrots), frozen, cooked (no salt or fat added) 1 tablespoon Parmesan cheese, dry grated 1 cup Apple juice 4 medium (2-5/8" across) Cookie, oatmeal 3 round Cracker, snack (Ritz, Club, Sociables, Town House, Toasteds)

7 Kaila's Nutrients Report 03/14/14-03/14/14 Your plan is based on a 1200 Calorie allowance for a preschooler. Nutrients Target Average Eaten Status Total Calories 1200 Calories 1212 Calories Over Protein (g)*** 19 g 39 g OK Protein (% Calories)*** 10-30% Calories 13% Calories OK Carbohydrate (g)*** 130 g 172 g OK Carbohydrate (% Calories)*** 45-65% Calories 57% Calories OK Dietary Fiber 25 g 10 g Under Total Fat 25-35% Calories 31% Calories OK Saturated Fat < 10% Calories 12% Calories Over Monounsaturated Fat No Daily Target or Limit 12% Calories No Daily Target or Limit Polyunsaturated Fat No Daily Target or Limit 4% Calories No Daily Target or Limit Linoleic Acid (g)*** 10 g 5 g Under Linoleic Acid (% Calories)*** 5-10% Calories 4% Calories Under α-linolenic Acid (g)*** 0.9 g 0.4 g Under α-linolenic Acid (% Calories)*** % Calories 0.3% Calories Under Omega 3 - EPA No Daily Target or Limit 1 mg No Daily Target or Limit Omega 3 - DHA No Daily Target or Limit 1 mg No Daily Target or Limit Cholesterol < 300 mg 86 mg OK Minerals Target Average Eaten Status Calcium 1000 mg 727 mg Under Potassium 3800 mg 1261 mg Under Sodium** < 2300 mg 1296 mg OK Copper 440 µg 477 µg OK Iron 10 mg 10 mg OK Magnesium 130 mg 131 mg OK Phosphorus 500 mg 769 mg OK Selenium 30 µg 54 µg OK Zinc 5 mg 5 mg OK Vitamins Target Average Eaten Status Vitamin A 400 µg RAE 394 µg RAE Under Vitamin B6 0.6 mg 0.9 mg OK Vitamin B µg 3.6 µg OK

8 Vitamin C 25 mg 34 mg OK Vitamin D 15 µg 4 µg Under Vitamin E 7 mg AT 2 mg AT Under Vitamin K 55 µg 26 µg Under Folate 200 µg DFE 326 µg DFE OK Thiamin 0.6 mg 1.1 mg OK Riboflavin 0.6 mg 1.5 mg OK Niacin 8 mg 10 mg OK Choline 250 mg 113 mg Under Information about dietary supplements. ** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In addition, people who are age 51 and older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day. *** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and α-linolenic acid) have two separate recommendations: 1) Amount eaten (in grams) compared to your minimum recommended intake. 2) Percent of Calories eaten from that nutrient compared to the recommended range. You may see different messages in the status column for these 2 different recommendations.