Additional Assessment Information to Collect

Ricky, age 4 years, arrives in the clinic with his mother. Ricky lives with his mother and father,
who both work full-time, and his infant sister. Their extended family lives in a different state
more than 100 miles away. Both parents are of average height and in good health. Ricky’s
mother mentions that Ricky often expresses frustration, particularly in regard to food. Conflict
over food occurs every day. Mealtime is a battle to get him to eat, unless his mother feeds him.
Ricky’s baby sister seems to tolerate all baby foods but requires her mother to spoon-feed.
Ricky’s mother is quite frustrated and concerned that he will become malnourished.
Reflective Questions
1. What additional assessment information would you collect?
2. What questions would you ask, and how would you further explore this issue with the
mother?
3. In what ways does the distance of the extended family influence this family’s approach
to health promotion?
4. What factors would you consider to determine whether malnourishment is a factor in
this family

Read the case study and answer the reflective questions.  Please provide evidence-based rationales for your answers.  APA, 7th ed. must be followed

1. Additional assessment information to collect:

• Ricky’s growth and development history, including his weight, height, and head circumference measurements over time. This will help determine if there are any growth concerns or patterns.
• Detailed dietary intake information, including the types of food Ricky eats, his portion sizes, and his eating habits. This will provide insight into his overall nutritional status and identify any specific nutrient deficiencies.
• Any signs of oral motor difficulties or sensory issues related to food, such as aversions to certain textures or flavors, difficulty swallowing, or gagging.
• Family dynamics and the parents’ feeding practices, including their attitudes towards food, the presence of any power struggles during mealtimes, and their overall feeding approach.

2. Questions to ask and further exploration:

• How long has Ricky been displaying these food-related frustrations?
• Does Ricky show similar behaviors or frustrations in other aspects of his life?
• Has Ricky had any significant changes in his routine or environment recently?
• What does a typical mealtime look like for the family? Are there any specific triggers or conflicts that arise during meals?
• How does Ricky’s father participate in mealtimes? Does he have any strategies or techniques that work well with Ricky?
• How does Ricky’s mother feel about feeding him directly? Does she think it’s necessary for his nutrition, or is she concerned about enabling his dependency?
• Are there any underlying health conditions or medications that may affect Ricky’s appetite or ability to eat?

By asking these questions and exploring the issue further, a more comprehensive understanding of Ricky’s feeding difficulties can be obtained. This will help identify potential causes and inform the development of an appropriate intervention plan.

3. Influence of extended family distance on health promotion: The extended family living more than 100 miles away can impact the family’s approach to health promotion in several ways:

• Limited support network: The physical distance may limit the availability of practical and emotional support from extended family members, making it more challenging for the parents to seek guidance or respite when dealing with Ricky’s feeding issues.
• Cultural or familial influence: Depending on the cultural background and family traditions, extended family members may have different beliefs and practices related to feeding and child-rearing. The physical distance may limit the direct transmission of these cultural practices, leading to a reduced influence on the family’s approach to health promotion.
• Increased self-reliance: The parents may need to rely more on themselves, healthcare professionals, and local resources for advice and assistance in managing Ricky’s feeding difficulties. This may lead to a greater emphasis on seeking professional guidance and implementing evidence-based strategies for promoting healthy eating habits.

4. Factors to consider regarding malnourishment: To determine if malnourishment is a factor in this family, the following factors should be considered:

• Growth parameters: Assess Ricky’s growth parameters, including weight, height, and head circumference, and compare them to age-appropriate standards or growth curves. Persistent or significant deviations from expected growth patterns may indicate malnourishment or nutritional deficiencies.
• Nutritional intake: Evaluate Ricky’s dietary intake to determine if he is consuming a variety of foods from different food groups and meeting his nutritional requirements. Assessing portion sizes, the presence of balanced meals, and potential nutrient deficiencies will help identify any gaps in his nutrition.
• Signs of malnutrition: Look for physical signs of malnourishment, such as poor muscle tone, pale skin, dry or brittle hair, and general weakness or fatigue. These signs may indicate inadequate nutrition or nutrient deficiencies.
• Feeding relationship: Assess the dynamics between Ricky and his parents during mealtimes, particularly their feeding practices and approach. The presence of power struggles, food coercion, or a lack of responsive feeding can contribute to poor eating habits and potential malnourishment.
• Underlying health conditions: Consider any underlying medical conditions or medications that could affect Ricky’s appetite, eating abilities, or nutrient absorption. These factors may impact his overall nutritional status and contribute to the feeding difficulties.

By considering these factors, healthcare professionals can better determine if malnourishment is a concern and develop appropriate interventions to address Ricky’s nutritional needs. Regular monitoring of growth parameters and ongoing assessment of dietary intake will also be essential to track his progress and ensure adequate nutrition.