Additional assessment information to collect

• Ricky’s developmental history: This would include information about Ricky’s milestones, such as when he started sitting, crawling, walking, and talking. It would also be important to know about any developmental delays or concerns.
• Ricky’s feeding history: This would include information about how Ricky was fed as a baby, whether he had any breastfeeding or bottle-feeding difficulties, and when he started eating solid foods. It would also be important to know about any food aversions or allergies.
• Ricky’s current diet: This would include information about what foods Ricky eats and drinks on a daily basis, as well as the types of meals and snacks that his family typically eats. It would also be important to know about any food restrictions or allergies that other members of the family have.
• Ricky’s mealtime behavior: This would include information about how Ricky behaves at mealtimes, such as whether he is picky, distracted, or resistant to eating. It would also be important to know how Ricky’s parents respond to his mealtime behavior.
• Ricky’s overall health and well-being: This would include information about Ricky’s weight, height, and growth rate. It would also be important to know about any medical conditions that Ricky has, as well as any medications that he is taking.

Questions to ask the mother

• Can you tell me more about Ricky’s frustration with food? What kinds of things does he say or do?
• What are some of the specific challenges that you face at mealtimes?
• How do you and your husband typically respond to Ricky’s mealtime behavior?
• How do you feel about Ricky’s eating habits? Are you concerned about his nutrition?
• Is there anything else that you would like to tell me about Ricky’s feeding challenges?

How to further explore the issue with the mother

• Use open-ended questions and reflective listening to encourage the mother to share her story. For example, instead of asking “Are you concerned about Ricky’s nutrition?”, you could ask “How do you feel about Ricky’s eating habits?” or “What worries you the most about Ricky’s feeding?”
• Be supportive and non-judgmental. It is important to let the mother know that you are there to help her and her family, and that you are not blaming her for Ricky’s feeding challenges.
• Ask about the mother’s own experiences with food and feeding. This can help you to better understand her perspective and approach to feeding her children.
• Collaborate with the mother to develop a plan to address Ricky’s feeding challenges. This plan should be tailored to Ricky’s individual needs and preferences, and it should be realistic and achievable.

Influence of the distance of the extended family

The distance of the extended family may influence this family’s approach to health promotion in a number of ways. For example, it may be more difficult for the parents to access support and resources from other family members. Additionally, the children may have fewer opportunities to learn about healthy eating and cooking from their extended family.

Specifically, the fact that Ricky’s mother has to spoon-feed her baby sister may make it more difficult for her to give Ricky the attention and support that he needs at mealtimes. Additionally, the fact that the extended family lives far away may make it more difficult for the parents to get help with childcare and other household tasks, which can add to their stress levels.

Factors to consider to determine whether malnourishment is a factor

To determine whether malnourishment is a factor, the healthcare provider would consider the following factors:

• Ricky’s weight, height, and growth rate.
• Ricky’s overall health and well-being.
• Ricky’s dietary intake.
• Ricky’s medical history and any medications that he is taking.

The healthcare provider may also order some blood tests to check for any nutritional deficiencies.

Conclusion

It is important to take a comprehensive approach to assessing and managing Ricky’s food refusal. By collecting additional information, asking probing questions, and collaborating with the mother, the healthcare provider can develop a plan to address Ricky’s feeding challenges and promote his overall health and well-being.