Download - Poor Eating H abits
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Poor Eating Habits
Poor Weight Gain
Dental Carries
Exposure to TB
Poor Hygiene
“Ako si Jayme. Payatot at malungkot!
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Ahaa, ito pala si Jayme ang
batang payatot!
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12 kg
92 cm
BMI = 14.2
Severely Stunted
Severely Underweight
Normal BMI
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Pale Conjunctivae
Impacted Cerumen
Cervicolymphadenopathy
Dental Carries
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Medical
Family
Social/Environme
ntBehaviour
al
Economic
Interventions
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Medical AssessmentHistory of Present
IllnessTWO YEARS PTC
Diagnosed to have low weight based on ageEnrolled in the feeding program yearlyNo improvement in weightWith poor eating habitsNo associated signs and symptoms
CONSULT
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URTI; Acute gastroenteritisNo previous hospitalizationsNo maintenance medicationsNo allergies to food and medications
Past Medical History
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Birth and Maternal History
Born full term via NSD to a 21 y/o G1P1Attended by the hilot; born in the houseBW: ~ 3 kgDenies any perinatal or neonatal
complicationsOne prenatal check-up in the health
center
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Nutritional HistoryBreastfed until 2 years oldWeaned at the age of 6 (Cerelac and
lugaw)Food preferences: junkfoods, noodles,
candies and chocolates
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Nutritional History24 hour diet recall
BREAKFAST Biscuit or Bread1 glass of chocolate milk
MORNING SNACKS 1 taho
LUNCH ½ cup of riceNoodles
SNACKS Junkfoods or cookiesDINNER ½ cup of rice
Soup
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IMMUNIZATION HISTORYBCG: 1 doseDPT/OPV: 2 dosesHepa B: 3 dosesMeasles: 1 doseInfluenza virus: 1 dose
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Family History MATERNAL
Sister of grandmother: Hypertension and DiabetesCousin of mother: Hypertension and DMSecond cousin: Primary Complex (treated for 3
months; lost to follow-up)Grandmother: died of hemorrhagic shock
secondary to child bearing PATERNAL
Uncle: Hepatitis
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PERSONAL-SOCIAL HISTORY
Patient lives in a shanty house near the riverside in Ilugin. 5 household members
Father is an elementary graduatePrimary breadwinner (works as plywood delivery
assistant)Mother finished until second year high schoolUncle: works in the soap making factory
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PERSONAL-SOCIAL HISTORY
Environment Water source: boiled tap water Garbage collected everyday Has their own restroom Near the river Exposure to internal pollution
Cooks inside the home using coal Father and Uncle smokes inside the house
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Interventions
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Malnutrition
Identify other medical causes of malnutrition (including TB, parasitism, dental caries, etc.)
Changing eating behaviourEducate the child and the whole family regarding
healthy eating habitsDiscourage giving money as a rewardDiscourage buying food from outsideEncourage variation in food choices
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MalnutritionChanging eating behavior
Find cheap and healthy alternatives Teach meal planning and budgetingTeach creative cooking. Make eating time a pleasurable activity (e.g.
good food presentation, incorporate games, encourage eating together, etc.)
Awareness of importance of growth and development monitoring
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Malnutrition
Encourage involvement in government or non government programs to address malnutritionReligiously attending the feeding
program set by the community center
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Exposure to TBScreening for TB for all relatives and
possibly neighbors tooEncourage and emphasize compliance with
treatmentEducate the family regarding truths about
TB, how it’s spread, its treatment and its complications
Educate family about importance of BCG vaccine
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Dental CariesDental Caries
Referral to DentistDecrease intake of sugar-rich foodsTeach proper dental hygiene (including
proper toothbrushing)
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Poor HygieneEducate the family regarding good
hygienePromote handwashing and sanitation to
prevent spread of diseasesEducate family how to sterilized and
store of their drinking water
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Hazardous EnvironmentAdvise alternative cooking methodsUse of mosquito nets Main goal: Encourage them to transfer to
a safer and conducive place to live
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Health MisconceptionsAddressing other social Issues
Health misconceptionsEducateCreate programs teaching all families
regarding truths on health (including pulongs on health, health counseling, focus group discussions, etc.)
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Parenting IssuesFamily issues
Establish a unified parenting styleCall for a family meeting or dialogue with
the parentsEncourage good communication between
partners and children Advice good parenting styles
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Transtheoretical Model of Changeby Prochaska & DiClemente, 1983.
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Pre-Contemplation Increasing awareness
Does the family recognize the need for a change? Educate the family on the importance of a healthy
lifestyle and diet Do they understand the consequences of unhealthy
eating habits and opposing parenting styles? Teach them about the short term and long term
effects of being unhealthy Do they see the benefits of living a healthy lifestyle?
‘Quiz’ them on their learnings
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ContemplationRe-affirm the family’s decision to make
changes Praise the family’s decision to commit to
change State, once again, the benefits that they will
gain from it Assure that you support their decision
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PreparationTarget and build specific knowledge and
specific skills Make a list of objectives
Set achievable goals for the family Start with small, realistic goals that are easy to
attain
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Seed 3: CommunicateListen. Be open. Check for understanding.
To your partner To your child
Try to understand where the other person is coming from.
Explain. Respond openly and honestly.
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ActionChild
Start slowly but surelyIntroduce vegetable and fruits one at a time
Encourage but not coerceUse of coercive control tactics to counter
children’s resistance during mealtimes resulted to problematic eaters (Sanders, et. al., 1993)
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ActionChild
Set simple cognitive rules Vague instruction giving was
particularly likely to be associated with increased food refusal and decreased chewing (Sanders et. al, 1993)
“When, then” rule
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ActionParents
Establish a unified parenting styleAuthoritative parenting styleCommunicate with one another
Set an example to children
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MaintenanceAre they aware of the change they have
achieved?Are they aware of the things that they may
tempt them to revert in their old behavior?
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MaintenanceOperant conditioning: creating an
environment that will support healthy eating habits and reduce exposure to bad eating healthy habits
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MaintenanceAvailability of high fat, high sugar foods
are considered antecedent of poor eating habits (Bowmann and Pratt, 2008)o Discourage buying junkfoods,
chocolates and candieso Discourage buying noodles and other
unhealthy alternatives
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MaintenanceReinforce positive behavior by
commending good behaviorAssociate healthy eating with
happiness. Make eating time a pleasurable activity
Be involved in community programs that motivate them to continue the change.
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MaintenanceAddressing other issues that will contribute to
the problems (e.g. finances)
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Seeds to Make the Perras Family Grow
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Seeds to make the Perras family grow
Attention givingBuilding self-esteemCommunicating regularly and wellDisciplining with loveEnhance couple relationship
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Seed 1: Pay Attention!Regular fun time
Cooking time Eating together Making meal time a pleasurable experience
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Seed 2: Be happy.Accept and affirm If child refuses to eat food, be patient.
CEA: Ask why, avoid getting mad. Encourage the child.
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Seed 3: CommunicateListen. Be open. Check for understanding.
To your partner To your child
Try to understand where the other person is coming from.
Explain. Respond openly and honestly.
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Seed 4: DisciplineSet house rules, agree on consequences
Rules on the dining table Hygiene, toothbrushing Reward good behavior
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Seed 5: EmpowerBe proactive.
Finances Health-seeking behavior