WELL-CHILD PROJECT ABBY MILLER

PART I

I. Identifying data (1 point)

A. Kambria (Kami)

B. Healthy, pudgy, adorable 3-year-old with rosy skin, blond hair, and blue eyes. Healthy baby teeth.

C. Middle class family with a stay at home mom and a lot of friend and sibling interaction.

II. Health history (10 points)

A. (1) Female (2) 3 years, 2 months (at time of interview)

B. (1) Date of Birth: 09-29-2009 (2) 6 lbs 14 oz , between the 50th and 75

th percentile range (3) 19 in,

between the 25th and 50

th percentile range

C. (1) 35 lbs, at the 75th percentile (2) 37 in, between the 25

th and 50

th percentile range

D. 4 siblings ages: 9 years,7 years, 5 years, and 8 months

E. 35 lbs, 38 ½ weeks, parity: 4th child

F. No major illnesses, recently had strep throat and took antibiotics

G. No current medications or fluoride treatments

H. No dental carries

I. No allergies or intollerances

III. Developmental skills assessment (6 points)

Summarize your findings from the DDST (refer to PowerPoint instructions on BYU Learning Suite):

i. “No opportunity” : None Identified

ii. “Caution” items: None Identified

iii. “Delayed” items: None Identified

iv. According to this screening Kami is normal. She is fully able to perform all motor, language, and

social skills required for a 3 year old.

IV. Nutritional assessment (8 points) A. (1) Macronutrient Distributions: Carbohydrate: 52%; Fat: 34%; Protein: 15%; All of Kami’s

Macronutrient percentages were exactly on target for her age recommendations. B. (2) Grains: 5 oz; Vegetables: Less than 1/4 cup; Fruits: ½ cup; Dairy: 1 ¼ cup; Protein: 2 ½ ounces.

Kami only met her requirements in the grain group. According to Kami’s mother today’s diet was less nutritious than normal. But during her 24 hour recall her vegetables were less than 1 cup and her fruit was only ½ cup, far below her recommendation. Kami usually eats more fruits and vegetables during the day. Kami did pretty well with dairy, she had 1 ¼ cup, although there is no specific recommendation. Kami ate 2 ½ ounces of protein which is 1 ½ ounces short of her goal.

C. (3) Kami’s diet was low in fiber; she had 7 g when her target is 19. She was over in saturated fat by 1%, so there should be a slight reduction. Kami was only 45 mg under in calcium, so that should be watched for. More importantly Kami was low in potassium. She ate 1087mg, while her target was 3000 mg. Kami was also low in her fat soluble vitamins D, E.

D. Kami is a great eater. She loves most food that is put in front of her, including vegetables. She loves

tomatoes.

E. At a typical family meal they sit at the table and eat a home-cooked meal as a family.

F. No vitamins or supplements.

G. No use of assistance programs.

V. Nutritional care plan and implementation (15 points)

A. The major concern in Kami’s diet is the lack of fruits and vegetables. If Kami can increase her intake

of whole fruits and vegetables she should be able to increase her fiber intake to an ideal range. Increasing

fruits and vegetables would also increase Kami’s potassium intake. Kami has high saturated fat, and low

vitamin E. She should increase the amount of oils she consumes in place of saturated fat. Most of the

saturated fat in Kami’s diet came from crackers. Decreasing the amount of crackers in Kami’s diet would

be very helpful. Cheese, ice cream, and chicken nuggets also significantly contributed to saturated fat.

Cheese is a great source of calcium for Kami, so I would probably limit chicken nuggets first and replace

them with a less saturated protein source, such as baked or grilled chicken. Kami’s diet was also low in

the protein and dairy food groups.

B. I will make three recommendations for Kami’s caregiver. First I will recommend more fruits and

vegetables throughout the day. Kami enjoys fruits and vegetables and will gladly eat them when they are

offered. Although these foods are usually available at dinner, I will recommend them for snacks as well. I

will recommend more tomatoes because they are kami’s favorite and they are very healthy. I will also

educate her caregiver on the importance of potassium. I will recommend increased fruits, such as

bananas. The second recommendation I will give concerns the types of fat in Kami’s diet. Kami is a child

and high fat intake is recommended, however, Kami has too much saturated fat. I will explain the types

of food in Kami’s diet that are high in saturated fat (such as crackers and chicken nuggets) and suggest

that these foods be limited, although not completely taken away. I will recommend the use of oils. For

example, if Kami has vegetables as a snack she could dip them in an oil-based dressing. Finally Kami

should try to increase the amount of protein and dairy in her diet by increasing the portions of these foods

that she receives at meal times.

Kami's Nutrients Report 03/18/13 - 03/18/13Your plan is based on a 1400 Calorie allowance for a preschooler.

Nutrients Target Average Eaten Status

Total Calories 1400 Calories 1219 Calories OK

Protein (g)*** 13 g 45 g OK

Protein (% Calories)*** 5 - 20% Calories 15% Calories OK

Carbohydrate (g)*** 130 g 158 g OK

Carbohydrate (% Calories)*** 45 - 65% Calories 52% Calories OK

Dietary Fiber 19 g 7 g Under

Total Fat 30 - 40% Calories 34% Calories OK

Saturated Fat < 10% Calories 11% Calories Over

Monounsaturated Fat No Daily Target or Limit 12% Calories No Daily Target or Limit

Polyunsaturated Fat No Daily Target or Limit 7% Calories No Daily Target or Limit

Linoleic Acid (g)*** 7 g 9 g OK

Linoleic Acid (% Calories)*** 5 - 10% Calories 6% Calories OK

α-Linolenic Acid (g)*** 0.7 g 0.8 g OK

α-Linolenic Acid (% Calories)*** 0.6 - 1.2% Calories 0.6% Calories OK

Omega 3 - EPA No Daily Target or Limit 3 mg No Daily Target or Limit

Omega 3 - DHA No Daily Target or Limit 6 mg No Daily Target or Limit

Cholesterol < 300 mg 101 mg OK

Minerals Target Average Eaten Status

Calcium 700 mg 655 mg Under

Potassium 3000 mg 1087 mg Under

Sodium** < 2300 mg 1886 mg OK

Copper 340 µg 603 µg OK

Iron 7 mg 9 mg OK

Magnesium 80 mg 138 mg OK

Phosphorus 460 mg 836 mg OK

Selenium 20 µg 43 µg OK

Zinc 3 mg 5 mg OK

Vitamins Target Average Eaten Status

Vitamin A 300 µg RAE 441 µg RAE OK

Vitamin B6 0.5 mg 1.1 mg OK

Vitamin B12 0.9 µg 1.8 µg OK

Vitamin C 15 mg 69 mg OK

Vitamin D 15 µg 2 µg Under

Vitamin E 6 mg AT 3 mg AT Under

Vitamin K 30 µg 28 µg Under

Folate 150 µg DFE 316 µg DFE Over

Thiamin 0.5 mg 1.0 mg OK

Riboflavin 0.5 mg 1.2 mg OK

Niacin 6 mg 15 mg OK

Choline 200 mg 129 mg Under

Information about dietary supplements.

** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In addition, people who are age 51 and older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.

*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and α-linolenic acid) have two separate recommendations:

1) Amount eaten (in grams) compared to your minimum recommended intake. 2) Percent of Calories eaten from that nutrient compared to the recommended range.

You may see different messages in the status column for these 2 different recommendations.

Meals from 03/18/13 - 03/18/13

Kami's Meals Your plan is based on a 1400 Calorie allowance for a preschooler.

Date Breakfast Lunch Dinner Snacks

03/18/13 1 packet, prepared Oatmeal, instant, raisins and spice, cooked (with milk, no fat added)

5 nugget Chicken nuggets (McDonald's, Weaver Mini Drums, Tyson Chicken Sticks, Carl's Jr. Chicken Stars)

1 cracker-size slice Cheese, Cheddar

½ string cheese stick Cheese, Mozzarella, part skim

1 tube (2-1/4 oz) Yogurt, fruit, low fat

1 ounce(s) cooked, no bone Chicken, breast, boneless, skinless, stewed

8 Wheat Thin Cracker, wheat (Wheatables, Wheat Thins)

½ portion (10 chips) Chips, wheat and corn (pizza chips)

2 Wheat Thin Cracker, wheat (Wheatables, Wheat Thins)

½ cup Tomato vegetable soup, prepared with water

8 regular cracker (various shapes) Crackers, cheese (Cheez-its, Cheese Nips, Cheddar Goldfish)

1 pouch (0.9 oz) Fruit snacks, high vitamin C (Welch's Fruit Snacks, Brach's Hi-C Fruit Snacks)

1 tablespoon, tiny pieces Hard candy (Jolly Rancher, Life Savers, Gob Stoppers, Lollipop)

1 small scoop Ice cream, regular, chocolate

Kami's Food Groups and Calories Report 03/18/13 - 03/18/13Your plan is based on a 1400 Calorie allowance for a preschooler.

Food Groups Target Average Eaten Status

Grains 5 ounce(s) 5 ounce(s) OK

Whole Grains ≥ 2½ ounce(s) 2 ounce(s) OK

Refined Grains ≤ 2½ ounce(s) 3 ounce(s) OK

Vegetables 1½ cup(s) 0 cup(s) Under

Dark Green 1 cup(s)/week 0 cup(s) Under

Red & Orange 3 cup(s)/week 0 cup(s) Under

Beans & Peas ½ cup(s)/week 0 cup(s) Under

Starchy 3½ cup(s)/week 0 cup(s) Under

Other 2½ cup(s)/week 0 cup(s) Under

Fruits 1½ cup(s) ½ cup(s) Under

Fruit Juice No Specific Target ¼ cup(s) No Specific Target

Whole Fruit No Specific Target ¼ cup(s) No Specific Target

Dairy 2½ cup(s) 1¼ cup(s) Under

Milk & Yogurt No Specific Target ¾ cup(s) No Specific Target

Cheese No Specific Target ½ cup(s) No Specific Target

Protein Foods 4 ounce(s) 2½ ounce(s) Under

Seafood 6 ounce(s)/week 0 ounce(s) Under

Meat, Poultry & Eggs No Specific Target 2½ ounce(s) No Specific Target

Nuts, Seeds & Soy No Specific Target 0 ounce(s) No Specific Target

Oils 4 teaspoon 3 teaspoon Under

Limits Allowance Average Eaten Status

Total Calories 1400 Calories 1219 Calories OK

Empty Calories* ≤ 121 Calories 377 Calories Over

Solid Fats * 189 Calories *

Added Sugars * 188 Calories *

*Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories.

Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be included in the Nuts, Seeds & Soy subgroup.

WELL-CHILD PROJECT ABBY MILLER

PART II : Discussion and Follow-Up

I spoke with Kami’s mother about three major concepts. First we discussed Kami’s low fruit and

vegetable intake. The 24 hour recall was an unusual day for their family; however, I still emphasized eating

more fruits and vegetables during snack times, and also keeping them consistently in meals. I noticed in

Kami’s recall that most of the food groups she was short in were present in meals, so the next concept I

discussed with Kami’s mom was having more structure to their snack schedule so that her kids would be

hungrier at meal times. This way Kami would be able to cut down on some of her snack foods (which were

high in saturated fats), and increase the food she ate at mealtimes. Kami’s meals included more protein, dairy,

fruits, and vegetables, so this was one simple piece of advice that could cover many of the insufficiencies

noted in Kami’s diet. Finally we discussed increasing the amount of oils in Kami’s diet. I suggested using

more salad dressing with oils, and also oils in cooking to replace saturated fats.

Following up with Kami’s mom I found that she had mainly chosen one piece of advice to follow.

Kami’s mom had really tried to schedule snacks so that her kids were hungrier for meals. As far as increasing

the food groups, she said that it really depends on the day. For a mother of 5 kids who has some health issues

in the family right now, I was very pleased with her progress. I think implementing scheduled snacks will

really help Kami, and her siblings, to eat more of the nutritious foods offered at mealtimes. It is a lot of work

to try to think about some of the smaller details, such as increasing oils. I feel that with her busy schedule,

Kami’s mom chose what she felt was most important from my advice and decided to focus on that one thing.

In the future I feel that I would narrow my education. I tried to cover all of the things that were noted in part

one of the assignment and I feel like that was slightly overwhelming for the mother of 5 kids. I am glad that

she simplified on her own and was still able to implement changes that will help improve her family’s health.