Poor Eating Habits

Poor Weight Gain

Dental Carries

Exposure to TB

Poor Hygiene

“Ako si Jayme. Payatot at malungkot!

Ahaa, ito pala si Jayme ang

batang payatot!

12 kg

92 cm

BMI = 14.2

Severely Stunted

Severely Underweight

Normal BMI

Pale Conjunctivae

Impacted Cerumen

Cervicolymphadenopathy

Dental Carries

Medical

Family

Social/Environme

ntBehaviour

al

Economic

Interventions

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

URTI; Acute gastroenteritisNo previous hospitalizationsNo maintenance medicationsNo allergies to food and medications

Past Medical History

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

Nutritional HistoryBreastfed until 2 years oldWeaned at the age of 6 (Cerelac and

lugaw)Food preferences: junkfoods, noodles,

candies and chocolates

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

IMMUNIZATION HISTORYBCG: 1 doseDPT/OPV: 2 dosesHepa B: 3 dosesMeasles: 1 doseInfluenza virus: 1 dose

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

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

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

Interventions

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

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

Malnutrition

Encourage involvement in government or non government programs to address malnutritionReligiously attending the feeding

program set by the community center

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

Dental CariesDental Caries

Referral to DentistDecrease intake of sugar-rich foodsTeach proper dental hygiene (including

proper toothbrushing)

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

Hazardous EnvironmentAdvise alternative cooking methodsUse of mosquito nets Main goal: Encourage them to transfer to

a safer and conducive place to live

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.)

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

Transtheoretical Model of Changeby Prochaska & DiClemente, 1983.

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

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

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

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.

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)

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

ActionParents

Establish a unified parenting styleAuthoritative parenting styleCommunicate with one another

Set an example to children

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?

MaintenanceOperant conditioning: creating an

environment that will support healthy eating habits and reduce exposure to bad eating healthy habits

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

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.

MaintenanceAddressing other issues that will contribute to

the problems (e.g. finances)

Seeds to Make the Perras Family Grow

Seeds to make the Perras family grow

Attention givingBuilding self-esteemCommunicating regularly and wellDisciplining with loveEnhance couple relationship

Seed 1: Pay Attention!Regular fun time

Cooking time Eating together Making meal time a pleasurable experience

Seed 2: Be happy.Accept and affirm If child refuses to eat food, be patient.

CEA: Ask why, avoid getting mad. Encourage the child.

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.

Seed 4: DisciplineSet house rules, agree on consequences

Rules on the dining table Hygiene, toothbrushing Reward good behavior

Seed 5: EmpowerBe proactive.

Finances Health-seeking behavior