CASE STUDY: Preschool Child

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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?

Sample Solution

Reflective Questions

  1. What additional assessment information would you collect?

Here is some additional assessment information that I would collect:

  • Ricky’s height and weight: This would help to assess his growth and development.
  • Ricky’s diet: I would ask the mother to keep a food diary for Ricky for a few days to track what he is eating and drinking.
  • Ricky’s activity level: I would ask the mother about Ricky’s physical activity level and how much time he spends in screen time.
  • Ricky’s social and emotional development: I would ask the mother about Ricky’s social and emotional development. Is he able to communicate his needs and wants? Is he able to tolerate frustration?
  • Family history: I would ask the mother about any family history of eating disorders or feeding challenges.
  1. What questions would you ask, and how would you further explore this issue with the mother?

Here are some questions I would ask the mother to further explore this issue:

  • Can you tell me more about Ricky’s frustration with food? What foods does he seem to dislike the most?
  • Can you tell me more about the battles you have at mealtime? What happens typically?
  • How does Ricky react when you try to feed him?
  • How does Ricky react when you try to get him to try new foods?
  • How does Ricky react when he is hungry?
  • How does Ricky react when he is full?
  • What are your thoughts on why Ricky is so resistant to eating?
  • What have you tried in the past to help Ricky eat better?

I would also ask the mother about her own thoughts and feelings about Ricky’s eating habits. Is she worried about him? Is she feeling frustrated or overwhelmed? It is important to support the mother and to help her to feel like she is not alone.

  1. In what ways does the distance of the extended family influence this family’s approach to health promotion?

The distance of the extended family may make it more difficult for the mother to get support with Ricky’s eating habits. She may not have access to family members who can help her with meal planning or cooking. She may also not be able to get advice from other mothers who have faced similar challenges.

The distance of the extended family may also make it more difficult for Ricky to learn about healthy eating habits. He may not have the opportunity to see other children eating a variety of healthy foods. He may also not have the opportunity to learn about different food cultures.

  1. What factors would you consider to determine whether malnourishment is a factor in this family?

I would consider the following factors to determine whether malnourishment is a factor in this family:

  • Ricky’s height and weight: Is he below the 5th percentile for his age and sex?
  • Ricky’s diet: Is he eating a variety of foods from all food groups? Is he getting enough calories?
  • Ricky’s activity level: Is he physically active?
  • Ricky’s social and emotional development: Is he able to communicate his needs and wants? Is he able to tolerate frustration?

I would also consider the mother’s concerns about Ricky’s eating habits. Is she worried that he is not eating enough? Is she worried that he is not getting enough nutrients?

Conclusion

It is important to take a holistic approach to assessing Ricky’s eating habits. This includes considering his physical health, social and emotional development, and family environment. By understanding all of these factors, I can develop a plan to help Ricky and his mother.

Here are some specific recommendations I would make to the mother:

  • Create a relaxed and positive mealtime environment. Avoid pressuring Ricky to eat. Instead, focus on creating a relaxed and enjoyable mealtime experience.
  • Offer Ricky a variety of healthy foods. Let him choose what he wants to eat and how much he wants to eat.
  • Be a role model. Let Ricky see you eating healthy foods.
  • Don’t give up. It may take time for Ricky to develop healthy eating habits. Be patient and consistent.

I would also encourage the mother to reach out to her pediatrician for support. The pediatrician can help her to develop a plan to help Ricky eat better and to monitor his growth and development.

 

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