WELL-CHILD PROJECT (55 POINTS)

Transcription

1 WELL-CHILD PROJECT (55 POINTS) The purpose of this project is to provide you with a real-life experience to enhance your skills in assessing the nutritional and developmental status of a young child and in providing appropriate recommendations for dietary improvement based on nutrient requirements during young childhood (Course Learning Outcomes #1 and # 3). Overall, this will provide a learning experience in which you can apply the didactic information learned in the textbook and from class lectures to a real situation. Assignment Overview PART I: Your subject should be a child - not your own - between the ages of 2 and 6. You must submit the name of the child selected, along with the first name(s) of his/her caregiver(s) and their mailing (or ) address to the instructor on or before January 22 using this form (5 points). You should visit (inperson) with the child and his/her caregiver(s) to interview the caregiver(s) regarding the child s usual food intake, to perform the Denver Developmental Screening Test (DDST) on the child, and determine any recommendations you plan to give the child s caregiver(s) (Part I). Please used the outlined format in Part I on pp Part I is due March 17 (hard copy) at 4 pm, in class. NOTE: Make sure you save your graded version of Part I because you will need to turn it (the graded version) back with your Part II. PART I & II: After you have received the instructor s comments on your assessment and follow-up plan, you will be required to provide the advice to the child s caregiver(s) (Part II). Please use the outlined format in Part II on p. 5 for completing your assignment. Graded Part I with Part II is due April 14 at 4 pm, in class. NOTE: Failure to review the instructor s comments and include the graded Part I (the version with the instructor s comments on it) with Part II will result in a 5 point penalty from your total assignment score. 1

2 PART I (Complete Sections I V): I. Identifying data (1 point) A. Duncan B. Dark hair, blue eyes, good skeletal development and proportion, good muscle growth, C. Mom stays at home, lives in a good neighbor in a house, has one younger brother who is 11 months old. They play together throughout the day. II. Health history (10 points) A. Male B. 2 years, 6 months (30 months) C. Birth anthropometrics (of child): (1) Birth weight (lbs or kg) and percentile range (i.e. between 10 th and 25 th percentile) 6lbs 13oz Weight for length below the 2 nd percentile, Weight for age between the 10 th and 25 th percentile. (2) Birth length (in or cm) and percentile range (i.e. between 25 th and 50 th percentile) 20.5 inches Length for age between the 75 th and 85 th percentile, weight for length below the 2 nd percentile. (3) ATTACH PLOTTED GROWTH CHARTS D. Current anthropometrics (of child): 30 lbs 32.5 inches (1) Current weight (lbs or kg) and percentile range (i.e. between 50 th and 75 th percentile) 30lbs Weight for age between the 50 th and 75 th percentile, Weight for stature above the 97 th percentile, BMI for age above the 95 th percentile. (2) Current length or height (in or cm) and percentile range (i.e. above the 98 th percentile) 32.5 inches Stature for age below the 5 th percentile, Weight for stature above the 97 th percentile. (3) ATTACH PLOTTED GROWTH CHARTS E. Edwin 10 months F. Mother s obstetrical history - weight gain, term, parity (with your subject) 45 lbs weight gain, 40 weeks, No previous children G. Child s history of illnesses (including any chronic diseases): Flu, mild ear infections H. Child s current use of medications, fluoride treatments? Multivitamin I. Child s dental history: all his teeth, no cavities, been to the dentist twice J. Child s allergies, other food intolerances: 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 - ATTACH THE COMPLETED SCREENING FORM B. Summarize your findings from the DDST using the following format (refer to PowerPoint instructions on BYU Learning Suite): 2

3 (1) No opportunity items (if none, list none identified ) (2) Caution items (if none, list none identified ) (3) Delayed items (if none, list none identified ) (4) Discuss your interpretation of the test, including if the child s development would be categorized as normal, suspect, or untestable and any concerns you have with the child s development. IV. Nutritional assessment (8 points) A. Obtain a 24-hour recall from your subject. Most likely you will need to obtain this from the child s caregiver(s). Enter his/her diet using USDA s ChooseMyPlate s Super Tracker. For this section, ATTACH 3 PRINTOUTS FROM SuperTracker TO PROJECT: (1) Food Group and Calories Report (2) Nutrients Report (3) Meal Summary Report. Breakfast: Oatmeal waffle, water Snack: 2 string cheese Lunch: 1 string cheese, 1 ½ c macaroni, water Dinner: 1 string cheese, ½ slice bacon, 1 cup Cottage cheese, water Snack: 2 pieces of cheddar cheese, mini pack of M&M s Please print your reports as PDF documents and attach to your completed project (see the printing instructions on p. 5). B. SUMMARIZE: (1) Your subject s macronutrient distributions (%) and whether the percentages are appropriate for his/her age based on macronutrient recommendations. (2) The number of MyPlate food group equivalents your subject consumed based on his/her actual intake and how he/she is meeting (or not meeting) his/her personalized MyPlate food group recommended levels (3) Your subject s actual vitamin and mineral intake and how it compares to vitamin and mineral DRIs for his/her age (i.e. is his/her diet high or low in any vitamins and minerals). 1) Duncan s macronutrient distribution for fat is 38% of calories and is okay. He is over with 28% of calories from protein and under with 33% calories from carbohydrates. 2) Duncan is not consuming enough fruits and vegetables. From the 24hr recall, he consumed zero fruits or vegetables. He does not consume enough protein or oils. He is slightly consuming too many grains and is over consuming dairy. 3) Duncan is consuming too much sodium, selenium, zinc, vitamin A, and folate. He is not consuming enough potassium, vitamin C, vitamin D, vitamin E, or choline. All other vitamins and minerals are okay. C. Parental description of food habits Goes through stages of things he loves. Last week he loved grapes. Likes simple foods, won t eat meals that mom cooks. Loves to snack throughout the day. D. Parental description of typical family meal times (do they sit at a table or in front of the TV or does everyone eats at different times, etc). Duncan eats at the same time as the family and they eat at the dinner table but sometimes he eats at the breakfast bar with his brother or dad. E. Child s intake of vitamin/mineral supplements? Multivitamin daily F. Use of food assistance programs like WIC, SNAP, food bank, church resources, etc. None 3

4 V. Nutritional care plan and implementation (15 points) A. Summarize (1-2 paragraphs) what you think are the most significant nutritional risk factors to this child and how the child s diet can be altered to reduce this risk. The most significant nutrition risk factor for Duncan would be minimal intake of fruits and vegetables. Although he goes through stages of likes and dislikes, trying to add variety to his diet would help meet his specialized MyPlate plan. Eating more fruits and vegetables will help him meet the DRIs for many vitamins and minerals. Also, eating more fruits and vegetables will raise his carbohydrate intake level. He is not consuming enough carbohydrates and adding fruits and vegetables will help him reach his goal of 45-65% of calories from carbohydrates. B. Explain (1-2 paragraphs) any recommendations, suggestions, or education you plan to give the child s caregiver(s) and the rationale. I would recommend brining different fruits and vegetables into the house so the child can try a variety of foods. If new foods are brought into the home, this may help the child get excited about trying new things. Try to find fruits and vegetables that are visually appealing that the child will be interested in. Also, invite Duncan to help prepare some of the foods. Also, I noticed that Duncan likes to eat throughout the day. Establishing more scheduled meal and snack times might help him eat more foods and make mealtime more enjoyable. 4

5 PART II (Complete Section I II): I. Education (5 points): Provide the child s caregiver(s) with the recommendations/advice you suggested in Part I (after you review the instructor s comments). Ideally, this should be done in-person. Summarize (1-2 paragraphs) what you discussed with the child s caregiver(s). The first topic we discussed was Duncan s excessive intake of diary and lack of fruits and vegetables. I gave some suggestions on how to increase fruit and vegetable intake. For example, I recommended bringing different fruits and vegetables into the house and letting the child pick out a food at the store. Also, we discussed letting the child take part in meal preparation. Additionally, I explained Ellen Satter s principles. I explained the division of responsibilities and how the child is the one to decide how much to eat. Also, we discussed how the parent is the one who provides the food. We talked about how the parent decides what foods to keep in the house and what foods to prepare. II. Reflection: Write 1-2 paragraphs about your overall impression of how the child s caregiver(s) received your advice (i.e. do you think the caregiver[s] will follow your advice? Why or why not?). Also describe how you could have improved the education you gave. The child s caregiver did not take my advice as well as I expected. She was polite and listened to the advice I provided but in the end, I did not feel she was willing to make any changes. I think she didn t want to make any changes because the child is temperamental and their current routine keeps him happy. The way I provided the education could have been improved. In the future, when giving advice, I think it would be best if I spoke to the child s caregiver alone or only with the child being discussed. When I spoke with the child s caregiver, she seemed very distracted by her other children and sometimes I felt she wasn t listening. In a calmer environment, I believe she would have gotten more out of our conversation. Also, I wish I had involved the child more. I should have brought a different fruit or vegetable for the child to see. This would been a good way to get him involved and show the mom that he would be interested in other exciting foods. 5

6 Meals from 01/15/14-01/15/14 Duncan's Meals Your plan is based on a 1000 Calorie allowance for a preschooler. Date Breakfast Lunch Dinner Snacks 01/15/14 1 round (4" across) Waffles, plain (Belgian waffles) 1½ cup Macaroni and cheese, made from dry mix, with margarine 2 string cheese stick String cheese, fat free ½ medium slice Bacon, pork, cooked 1 cup Cottage cheese, low fat (1-2% fat) 1 string cheese stick String cheese, fat free 2 slice (1 oz) Cheese, Cheddar 1 fun size package M&M Milk Chocolate Candies (Plain M&M's)

7 Duncan's Food Groups and Calories Report 01/15/14-01/15/14 Your plan is based on a 1000 Calorie allowance for a preschooler. Food Groups Target Average Eaten Status Grains 3 ounce(s) 4 ounce(s) Over Whole Grains 1½ ounce(s) 0 ounce(s) Under Refined Grains 1½ ounce(s) 4 ounce(s) Over Vegetables 1 cup(s) 0 cup(s) Under Dark Green ½ cup(s)/week 0 cup(s) Under Red & Orange 2½ cup(s)/week 0 cup(s) Under Beans & Peas ½ cup(s)/week 0 cup(s) Under Starchy 2 cup(s)/week 0 cup(s) Under Other 1½ cup(s)/week 0 cup(s) Under Fruits 1 cup(s) 0 cup(s) Under Fruit Juice No Specific Target 0 cup(s) No Specific Target Whole Fruit No Specific Target 0 cup(s) No Specific Target Dairy 2 cup(s) 5½ cup(s) Over Milk & Yogurt No Specific Target ¼ cup(s) No Specific Target Cheese No Specific Target 5 cup(s) No Specific Target Protein Foods 2 ounce(s) ½ ounce(s) Under Seafood 3 ounce(s)/week 0 ounce(s) Under Meat, Poultry & Eggs No Specific Target 0 ounce(s) No Specific Target Nuts, Seeds & Soy No Specific Target 0 ounce(s) No Specific Target Oils 3 teaspoon 0 teaspoon Under Limits Allowance Average Eaten Status Total Calories 1000 Calories 1230 Calories Over Empty Calories* 137 Calories 463 Calories Over Solid Fats * 427 Calories * Added Sugars * 36 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.

8 Duncan's Nutrients Report 01/15/14-01/15/14 Your plan is based on a 1000 Calorie allowance for a preschooler. Nutrients Target Average Eaten Status Total Calories 1000 Calories 1230 Calories Over Protein (g)*** 13 g 88 g OK Protein (% Calories)*** 5-20% Calories 28% Calories Over Carbohydrate (g)*** 130 g 101 g Under Carbohydrate (% Calories)*** 45-65% Calories 33% Calories Under Dietary Fiber 19 g 6 g Under Total Fat 30-40% Calories 38% Calories OK Saturated Fat < 10% Calories 16% Calories Over Monounsaturated Fat No Daily Target or Limit 14% Calories No Daily Target or Limit Polyunsaturated Fat No Daily Target or Limit 6% Calories No Daily Target or Limit Linoleic Acid (g)*** 7 g 7 g OK Linoleic Acid (% Calories)*** 5-10% Calories 5% Calories OK α-linolenic Acid (g)*** 0.7 g 0.8 g OK α-linolenic Acid (% Calories)*** % Calories 0.6% Calories OK Omega 3 - EPA No Daily Target or Limit 4 mg No Daily Target or Limit Omega 3 - DHA No Daily Target or Limit 2 mg No Daily Target or Limit Cholesterol < 300 mg 104 mg OK Minerals Target Average Eaten Status Calcium 700 mg 1623 mg OK Potassium 3000 mg 840 mg Under Sodium** < 2300 mg 3179 mg Over Copper 340 µg 931 µg OK Iron 7 mg 7 mg OK Magnesium 80 mg 129 mg OK Phosphorus 460 mg 1650 mg OK Selenium 20 µg 94 µg Over Zinc 3 mg 8 mg Over Vitamins Target Average Eaten Status Vitamin A 300 µg RAE 680 µg RAE Over Vitamin B6 0.5 mg 0.8 mg OK Vitamin B µg 4.5 µg OK

9 Vitamin C 15 mg 1 mg Under Vitamin D 15 µg 1 µg Under Vitamin E 6 mg AT 3 mg AT Under Vitamin K 30 µg 30 µg OK Folate 150 µg DFE 383 µg DFE Over Thiamin 0.5 mg 1.2 mg OK Riboflavin 0.5 mg 1.7 mg OK Niacin 6 mg 8 mg OK Choline 200 mg 119 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.