CASE STUDY: Preschool Child: Ricky
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?
- Additional Assessment Information: To gain a comprehensive understanding of Ricky’s situation and address his feeding issues, you would need to collect the following additional assessment information:
a. Dietary History: Gather detailed information about Ricky’s daily dietary intake, including the types of food he consumes, portion sizes, and any food preferences or aversions.
b. Growth and Development: Obtain Ricky’s growth history, including his height, weight, and any previous growth charts. Compare his current growth to age-appropriate standards.
c. Feeding Routine: Learn about the family’s typical mealtime routine, including the location, timing, and atmosphere during meals.
d. Medical History: Inquire about any medical conditions or allergies that Ricky may have, as well as any recent illnesses or hospitalizations.
e. Family Dynamics: Explore the family’s dynamics, including interactions between Ricky, his parents, and his infant sister during mealtimes. Identify any specific behaviors or strategies they use during meals.
f. Developmental Milestones: Assess Ricky’s developmental milestones, particularly his social and emotional development. Understand his level of independence and ability to self-feed.
g. Parenting Styles: Gain insights into the parenting styles of Ricky’s parents, including their approach to discipline, communication, and routines.
- Questions for Exploration with the Mother: To further explore the issue of Ricky’s feeding problems, you can ask the following questions:
a. Can you describe Ricky’s eating habits and behaviors during meals in more detail?
b. When did these feeding issues start, and have they worsened or improved over time?
c. How do you usually handle mealtime conflicts with Ricky?
d. Are there any specific foods or textures that Ricky seems to dislike or have difficulty with?
e. Can you provide a typical daily meal plan for Ricky, including snacks and beverages?
f. Have you noticed any other changes in Ricky’s behavior or health that might be related to his feeding issues?
g. What strategies have you tried to address these feeding problems?
h. Can you share any concerns or worries you have about Ricky’s health and nutrition?
- Influence of Extended Family Distance: The distance of the extended family can influence this family’s approach to health promotion in several ways:
a. Limited Support: The lack of nearby extended family may mean that the parents have fewer resources and support networks to help with childcare and mealtime challenges. They may rely more on their immediate family.
b. Emotional Impact: The absence of extended family may lead to feelings of isolation and stress for the parents, affecting their ability to cope with Ricky’s feeding issues.
c. Lack of Cultural or Family Traditions: Extended family often plays a role in passing down cultural or family traditions related to food and mealtimes. The absence of this support system may impact the family’s mealtime customs and approaches.
- Factors to Consider Regarding Malnourishment: To determine whether malnourishment is a factor in Ricky’s case, consider the following factors:
a. Growth Parameters: Evaluate Ricky’s height, weight, and overall growth trends in relation to age-appropriate norms. Growth faltering or failure to thrive may indicate malnourishment.
b. Dietary Intake: Review Ricky’s daily dietary intake to assess if he is receiving a balanced and adequate diet for his age and developmental stage. Inadequate caloric or nutrient intake can contribute to malnourishment.
c. Behavioral and Emotional Factors: Assess Ricky’s eating behaviors, attitudes towards food, and emotional well-being during meals. Emotional distress and food refusal may lead to malnourishment.
d. Medical Assessment: Consider any underlying medical conditions or gastrointestinal issues that could affect Ricky’s appetite or digestion.
e. Parenting Strategies: Evaluate the parents’ feeding strategies and communication with Ricky during mealtimes to identify any potential barriers to proper nutrition.
f. Developmental Milestones: Compare Ricky’s developmental milestones to ensure that he is meeting age-appropriate expectations for self-feeding and independence.
g. Nutritional Counseling: Consult with a pediatric nutrition specialist or dietitian to assess Ricky’s nutritional status and provide guidance on improving his diet and resolving feeding issues.
h. Parental Stress: Consider the parents’ level of stress and frustration related to the feeding problems, as it can impact their ability to address Ricky’s nutritional needs effectively.
i. Overall Health and Well-being: Take a holistic approach to assess Ricky’s overall health, considering factors such as sleep, physical activity, and emotional well-being.
By gathering this information and addressing these reflective questions, you can develop a more comprehensive understanding of Ricky’s feeding issues and work with the family to create a plan for improving his nutrition and overall well-being.