Well-Child Part I

I. Identifying data:

A. First Name: Mia

B. Description: Blonde hair, blue eyes, healthy appearance, teeth look strong and

healthy, no evidence of stunting or wasting.

C. Economics Environment: live in a small home, mother works as a hair stylist at

home, she is babysat a few times on the weekends, father has full time job. It seems

she is well loved and well cared for.

II. Health History:

A. Sex, age: Female, four years and 1 week

B. Birth Info:

- Birth date: Feb. 28, 2007

- Birth weight and percentile: 6 lb 14 oz - 75th

percentile

- Birth length and percentile: 21 in. - above the 98th

percentile

- BMI : 17.2 – between 85th

and 90th

precentile

C. Present Info:

- Present weight and percentile: 35 lb - between 5th

and 10th

percentile

- Present height and percentile: 3 ft 1 in. - between the 50th

and 75th

percentile

D. Number of siblings, ages: 1 sister who 2 years old

E. Mother’s obstetrical history: two healthy full term births. Gained 10 pounds with

pregnancy. Mother had severe morning sickness, nausea, and vomiting.

F. Child’s history of illnesses: Healthy no chronic illnesses

G. Medications, fluoride treatments? Taking fluoride pill

H. Dental History? No history of dental caries

I. Allergies, other food intolerances: no allergies or food intolerances as of yet

III. Developmental and nutritional assessment:

A. Developmental skills: I have no concern with her development. She did have some

trouble with opposites, but that comes with learning, she was an active and very smart

little girl. Normal development.

B. Parental description of food habits: Mia is definitely a snacker, but she is not picky at

all. She will eat about everything. She does not like beef, onions, celery, and spicy

foods. She loves fish, fruits, and vegetables.

C. Child’s intake of vitamin/mineral supplements: Takes a gummy vitamin every night

D. Comparison with RDA and MyPyramid: See attached sheets for mypyramid

24-hour recall:

Meal Food Amount

Breakfast Tortilla 1 med

Egg 1 each

Cheese 2 oz

Turkey meat 2 oz

Mustard 1 tsp

Snack Gold fish ½ cup

Pringles 6 each

Tootsie pop 1 each

Dinner Taco soup: ½ cup

Beans 1/8 cup

Corn 1/8 cup

Hamburger 1/8 cup

Cheese 1 oz

Tomato juice ½ cup

Sour Cream 2 tsp

Garlic Toast 1 slice

Dessert Brownie 1 each

E. Use of supplemental foods, WIC, food stamps: No

IV. Nutritional care plan and implementation

A. Nutritional Risk Factors:

The most significant nutritional risk factors from Mia’s diet are her low milk, fruit, and

vegetable intake. Calcium is so important to build her peak bone mass. Also, incorporating milk

into her diet while she is young will create a healthy dietary practice that she will carry on into

adolescence. Her fruit and vegetable intake were also very low. These foods are essential for the

vitamin, mineral, and fiber content. Ample fiber will help prevent heart diseases, cancer,

hypertension, and adults. It also helps relieve constipation, which is a common among children.

Meeting the fruit and vegetable intake will also help Mia meet all of her nutrient

recommendations. Making an effort to have Mia consume fruit and vegetable intake will create

a dietary habit and increase her food acceptance and food preference for foods like that later on

in life. This habit will hopefully carry into adolescence and create a healthy living style that will

prevent chronic disease.

B. Recommendations

For the most part, Mia’s diet seems pretty adequate and her growth seems normal. I

would recommend the consumption of more milk, fruits, and vegetables. I would recommend

adding a cup of milk for snack time, cheese on sandwiches or with crackers, and yogurt for

breakfast or a gogurt while mom is running errands. I would stress the health effects of Calcium

and why it is so important that Mia needs Calcium for a strong and healthy skeleton. I would also

recommend increasing fruit and vegetable consumption. Instead of the typical snacks like the

goldfish or pringles she ate, I might suggest incorporating easy portable snack foods such as

grapes, dried fruit, carrots, bananas etc. I would also stress the importance in increasing fruit and

vegetable intake. They are packed with essential nutrients and fiber which has numerous

benefits.

Mia’s mom also mentioned that she snacked a lot, because of this I would educate Mia’s

parents on the division of responsibility as presented by Ellyn Satter. The parents are responsible

for when, where, and what is provided for meals while the child is responsible for whether to eat

and how much to eat. Parents should avoid allowing the child to graze all day. They should focus

on adding structured meal times and snack times for the child while offering a variety of healthy

options. By following this division, it will help to create a healthy pattern and lifestyle for Mia to

follow and maintain as she grows up.

Well Child

Part II

A. My recommendations via e-mail:

Sister Sandgrin,

First of all, I just want to thank you so much for letting me come to your home and talk with you

and Mia. You have such a cute family!

Part of the assignment I did is to do a follow up on the analysis of Mia’s diet. So I just have a

few suggestions.

Mia’s fruit and milk intake were fairly low when compared to her age group requirement. (this is

just based off of the one day I analyzed for the 24 hour recall, so it’s a little bit of an

extrapolation) A child Mia’s age needs:

2 cups of milk

2 oz of meat (3 oz is about the size and width of your palm)

1 cup vegetables

1 cup fruit

3 oz grains (1 oz = 1 slice of bread, 1 cup of cold cereal, ½ cup rice/pasta)

Her milk and fruit intake were low on the day I analyzed. I wanted to emphasize the importance

of fruits and vegetables. They are very nutrient dense and provide many of the essential nutrients

required for healthy growth and development. Calcium is extremely important for children

especially for girls. Up until the age of 30 females are building their peak bone mass and need 2

cups of milk as children and 3 cups as adolescents/adults to maintain their bone strength. This

will help prevent osteoporosis and other bone diseases.

I also, wanted to share with you the concept of the division of responsibility. This division makes

up the core of what we learn as dietetics students for child nutrition. Essentially, feeding is

divided into two responsibilities. The parent is responsible for what to eat, when to eat it, and

where. Parents should provide structured meal times and snacks. Parents should not cater to the

child’s wants and provide a healthy range of options. Always be sure to provide at least one

food item the child will eat, but continually present other options. Research has shown that it

takes 7-9 times before a child will try a new food. The child’s responsibility is determine what to

eat and how much to eat. Keeping to these roles promotes healthy growth and development and

decreases risk for eating disorders, obesity, and other abnormal eating behaviors.

I think you’re doing great! Thanks again for letting me do this!

B. Impact of the education:

Mia’s mother took my recommendations well. She really wants the best for her children

and valued what I had to say. It was interesting to hear how she catered to both her children.

She said Sammie, the youngest, really worked well with structured meals. Mia on the other

hand was more apt to snack. The division of responsibility that I explained helped her to see

that Mia too could learn and benefit from eating with structured meal and snack times. She

also commented that the day I analyzed was not a typical day, the day being a Sunday. But

she did say that she could improve on serving more fruit and vegetables and offering more. I

also think it was a real benefit for Mia’s mom to see the actual requirement for her child.

Looking back, one thing I wish I would have recommended/known is the book Ellyn Satter

wrote about the division. I would have recommended that to her.