WELL-CHILD PROJECT

The purpose of this project is to provide you with a “real-life” experience to enhance your skills in assessing the nutritional and developmental status of a young child and in providing appropriate recommendations for dietary improvement based on nutrient requirements during young childhood (Course Learning Outcomes #1 and # 3). Overall, this will provide a learning experience in which you can apply the didactic information learned in the textbook and from class lectures to a real situation.

Assignment Overview PART I: Your subject should be a child - not your own - between the ages of 1 and 5. You should visit (or phone) the child and his/her caregiver(s) to interview the caregiver(s) regarding the child’s usual food intake, to assist the parent in filling out the Centers for Disease Control and Prevention’s Learn the Signs. Act Early. developmental screening tool, and determine any recommendations you plan to give the child’s caregiver(s) (Part I). Please used the outlined format in Part I on pp. 2-4 NOTE: You need to include the completed assignment questions, Choose MyPlate reports, and scanned copy or photo of plotted growth charts and completed developmental screening tool. These can be put into one document or submitted as separate documents. PART II (10 points): After you have received the instructor’s comments on your assessment and follow-up plan, you will be required to provide the advice to the child’s caregiver(s) (Part II). Please use the outlined format in Part II on p. 5 for completing your assignment.

PART I (Complete Sections I – V): I. Identifying data (1 point)

A. Description of the child - Fair skin, skeletal development seems good, eyes are normal and healthy, muscles

seem strong, teeth are growing in well

B. Economics environment, interaction with siblings and parents, time with babysitters or in day care: Interacts

well with parents, no siblings, normally only with a babysitter once a week for a few hours

II. Health history (10 points)

A. Sex of child: Female

B. Age of child (years, months): 2 years 4 months

C. Birth anthropometrics (of child): (1a) Birth weight (lbs or kg) and (1b) percentile range: 6 lbs 1 oz, between 10 and 25 percentile (2a) Birth length (in or cm) and (2b) percentile range: 18 in, between 5 and 10 percentile (3) INCLUDE PLOTTED GROWTH CHARTS :

Birth to 24 months: Girls Length-for-age and Weight-for-age percentiles

98

95 90 75

50 25

10 5 2

98

95

90

75

50

25

10

5 2

Published by the Centers for Disease Control and Prevention, November 1, 2009 SOURCE: WHO Child Growth Standards (http://www.who.int/childgrowth/en)

x

x

x

x

Kyrie Albright

D. Current anthropometrics (of child):

(1a) Current weight (lbs or kg) and (1b) percentile range: 27 lbs, between 50 and 75 percentile (2a) Current length or height (in or cm) and (2b) percentile range: 33 in, between 25 and 50 percentile

(3) INCLUDE PLOTTED GROWTH CHARTS. You can either insert the reports into your assignment Word document (use copy and paste function) or upload as separate files to Learning Suite.

E. Number of siblings and their ages: none

F. Mother’s obstetrical history - weight gain, term, parity (with your subject): full term, mothers weight gain during

pregnancy was normal

G. Child’s history of illnesses (including any chronic diseases): colds, hand/foot/mouth, 2 ear infections

H. Child’s current use of medications, fluoride treatments: multivitamin

I. Child’s dental history: all teeth grew in well, she had one accident where a molar got chipped

J. Child’s allergies, other food intolerances: none

III. Developmental skills assessment (6 points)

(1) Assist the child’s caregiver in filling out the Centers for Disease Control and Prevention’s Learn the Signs. Act Early. developmental screening tool. You can use Milestones in Action – a resource that provides photos and videos about the items on the screening tool - to aid parents in completing the screening tool: http://www.cdc.gov/ncbddd/actearly/milestones/milestones-in-action.html

Your Child at 2 Years

Kyrie Albright 2 years 3/20/2017 Child’s Name Child’s Age Today’s Date

How your child plays, learns, speaks, and acts offers important clues about your child’s development.

Developmental milestones are things most children can do by a certain age. Check the milestones your child has reached by his or her 2nd birthday. Take this with you and talk with your

child’s doctor at every visit about the milestones your child has reached and what to expect next.

*Her abilities highlighted

What most children do at this age:

Social/Emotional Copies others, especially adults and older children

Gets excited when with other children

Shows more and more independence

Shows defiant behavior

(doing what he has been told not to)

Plays mainly beside other children, but is beginning

to include other children, such as in chase games

Language/Communication Points to things or pictures when they are named

Knows names of familiar people and body parts

Says sentences with 2 to 4 words

Follows simple instructions

Repeats words overheard in conversation

Points to things in a book

Cognitive (learning, thinking, problem-solving) Finds things even when hidden under two or three covers

Begins to sort shapes and colors

Completes sentences and rhymes in familiar books

Plays simple make-believe games

Builds towers of 4 or more blocks

Might use one hand more than the other

Follows two-step instructions such as “Pick up

your shoes and put them in the closet.”

Names items in a picture book such as a cat, bird, or dog

Movement/Physical Development Stands on tiptoe

Kicks a ball

Begins to run

Climbs onto and down from furniture without help

Walks up and down stairs holding on

Throws ball overhand

Makes or copies straight lines and circles Act early by talking to your child’s

doctor if your child:

Doesn’t use 2-word phrases (for example, “drink milk”)

Doesn’t know what to do with common things,

like a brush, phone, fork, spoon

Doesn’t copy actions and words

Doesn’t follow simple instructions

Doesn’t walk steadily

Loses skills she once had Tell your child’s doctor or nurse if you notice any of these

signs of possible developmental delay for this age, and

talk with someone in your community who is familiar with

services for young children in your area, such as your state’s

public early intervention program. For more information, go to

www.cdc.gov/concerned or call 1-800-CDC-INFO. The American Academy of Pediatrics recommends

that children be screened for general development

and autism at the 24-month visit. Ask your child’s

doctor about your child’s developmental screening. Adapted from CARING FOR YOUR BABY AND YOUNG CHILD: BIRTH TO AGE 5, Fifth Edition, edited by

Steven Shelov and Tanya Remer Altmann © 1991, 1993, 1998, 2004, 2009 by the American Academy of

Pediatrics and BRIGHT FUTURES: GUIDELINES FOR HEALTH SUPERVISION OF INFANTS, CHILDREN,

AND ADOLESCENTS, Third Edition, edited by Joseph Hagan, Jr., Judith S. Shaw, and Paula M. Duncan,

2008, Elk Grove Village, IL: American Academy of Pediatrics.

www.cdc.gov/actearly | 1-800-CDC-INFO

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(2) Include completed developmental screening tool.

(3) What signs of possible developmental delay, if any, did the child’s caregiver report? If any were identified, be sure to provide the caregiver with the “How to Talk with the Doctor” handout (on Learning Suite). There were just three boxes not checked, and the mother said she was beginning to do those things sometimes (ex: will lift one cover, tries to sort shapes and colors but doesn’t get them right). They did not seem worrisome enough that she should talk to the doctor.

IV. Nutritional assessment (8 points)

A. Obtain a 24-hour recall from your subject. Most likely you will need to obtain this from the child’s

caregiver(s). Enter his/her diet using USDA’s ChooseMyPlate’s Super Tracker. For this section, INCLUDE 3 PRINTOUTS FROM SuperTracker WITH PART I: Breakfast: scrambled egg w/ sausage and cheese Lunch: 2 nuggets Snacks: veggie straws, candy, chocolate chip cookie, ¼ apple, peanut butter granola bar Dinner: nothing (1) “Food Group and Calories” Report (2)

Lil K's Food Groups and Calories Report 03/19/17 - 03/21/17

Your plan is based on a 1000 Calorie allowance for a preschooler.

Food Groups Target Average Eaten Status

Grains 3 ounce(s) 1 ounce(s) Under

Whole Grains ≥ 1½ ounce(s) ½ ounce(s) Under

Refined Grains ≤ 1½ ounce(s) ½ ounce(s) OK

Vegetables 1 cup(s) ¼ cup(s) Under

Dark Green ½ cup(s)/week 0 cup(s) Under

Red & Orange 2½ cup(s)/week 0 cup(s) Under

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

Starchy 2 cup(s)/week ¼ cup(s) Under

Other 1½ cup(s)/week 0 cup(s) Under

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Fruits 1 cup(s) 1¾ cup(s) Over

Whole Fruit No Specific Target ¾ cup(s) No Specific Target

Fruit Juice No Specific Target 1 cup(s) No Specific Target

Dairy 2 cup(s) 1¼ cup(s) Under

Milk & Yogurt No Specific Target 1 cup(s) No Specific Target

Cheese No Specific Target ¼ cup(s) No Specific Target

Protein Foods 2 ounce(s) 2½ ounce(s) OK

Seafood 3 ounce(s)/week 0 ounce(s) Under

Meat, Poultry & Eggs No Specific Target 2 ounce(s) No Specific Target

Nuts, Seeds & Soy No Specific Target ½ ounce(s) No Specific Target

Oils 3 teaspoon 2 teaspoon Under

Limits Limit Average Eaten Status

Total Calories 1000 Calories 983 Calories OK

Added Sugars < 100 Calories 101 Calories Over

Saturated Fat < 100 Calories 152 Calories Over

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

(3) “Nutrients” Report (4)

Lil K's Nutrients Report 03/19/17 - 03/21/17

Your plan is based on a 1000 Calorie allowance for a preschooler.

Nutrients Target Average Eaten Status

Total Calories 1000 Calories 983 Calories OK

Protein (g)*** 13 g 29 g OK

Protein (% Calories)*** 5 - 20% Calories 12% Calories OK

Carbohydrate (g)*** 130 g 115 g Under

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Carbohydrate (% Calories)*** 45 - 65% Calories 47% Calories OK

Dietary Fiber 19 g 6 g Under

Total Sugars No Daily Target or Limit

77 g No Daily Target or Limit

Added Sugars < 25 g 25 g OK

Total Fat 30 - 40% Calories 43% Calories Over

Saturated Fat < 10% Calories 15% Calories Over

Polyunsaturated Fat No Daily Target or Limit

10% Calories No Daily Target or Limit

Monounsaturated Fat No Daily Target or Limit

13% Calories No Daily Target or Limit

Linoleic Acid (g)*** 7 g 10 g OK

Linoleic Acid (% Calories)*** 5 - 10% Calories 9% Calories OK

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

α-Linolenic Acid (g)*** 0.7 g 0.6 g Under

Omega 3 - EPA No Daily Target or Limit

1 mg No Daily Target or Limit

Omega 3 - DHA No Daily Target or Limit

27 mg No Daily Target or Limit

Cholesterol < 300 mg 233 mg OK

Minerals Target Average Eaten Status

Calcium 700 mg 484 mg Under

Potassium 3000 mg 1147 mg Under

Sodium** < 1500 mg 935 mg OK

Copper 340 µg 409 µg OK

Iron 7 mg 3 mg Under

Magnesium 80 mg 131 mg OK

Phosphorus 460 mg 673 mg OK

Selenium 20 µg 40 µg OK

Zinc 3 mg 4 mg OK

Vitamins Target Average Eaten Status

Vitamin A 300 µg RAE 264 µg RAE Under

Vitamin B6 0.5 mg 0.5 mg OK

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Vitamin B12 0.9 µg 1.8 µg OK

Vitamin C 15 mg 74 mg OK

Vitamin D 15 µg 5 µg Under

Vitamin E 6 mg AT 4 mg AT Under

Vitamin K 30 µg 11 µg Under

Folate 150 µg DFE 57 µg DFE Under

Thiamin 0.5 mg 0.4 mg Under

Riboflavin 0.5 mg 0.8 mg OK

Niacin 6 mg 5 mg Under

Choline 200 mg 200 mg OK

Information about dietary supplements. *** 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.

(3) “Meal Summary” Report.

Meals from 03/20/17 - 03/20/17

Lil K's Meals

Your plan is based on a 1000 Calorie allowance for a preschooler.

Date Breakfast Lunch Dinner Snacks

03/20/17

1 link Sausage, pork, brown and serve, cooked

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

EMPTY

½ medium (2-3/4" across) Apple, raw

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1 medium egg(s) Scrambled eggs, with cheese, cooked in butter

1 medium (2" across) Cookies, chocolate chip, homemade or bakery

4 Cadbury Mini Egg Easter eggs, candy coated chocolate (Cadbury's Mini Eggs)

1 cup Fruit juice blend, 100% juice

1 bar (1.5 oz) Granola bar, peanuts, oats, wheat germ

1 cup Milk, whole

½ single serving bag (1.1 oz) Potato chips, restructured, baked (Baked Lay's)

You can either insert the reports into your assignment Word document (use copy and paste function) or upload as separate files to Learning Suite.

B. SUMMARIZE: (1a) Your subject’s macronutrient distributions (%): Carbohydrate 47% of calories, Protein 12% of calories, and fat 43% of calories. 1b) whether the percentages are appropriate for his/her age based on macronutrient recommendations: Protein and carbohydrate distributions are appropriate, but the amount of fat is a little high.

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(2a) The number of MyPlate food group equivalents your subject consumed based on his/her actual intake: 1 ounce of grains, ¼ cup of veggies, 1 ¾ cups of fruit, 1 ¼ cup of milk, 2 ½ ounces of protein, and 2 teaspoons of fat. (2b) how he/she is meeting (or not meeting) his/her personalized MyPlate food group recommended levels: she is not meeting her food group recommendations for grains, vegetables, dairy, and fat. She is a little over the recommendations for protein and fruit. However, the mother said she often has mac ‘n cheese instead of chicken nuggets, which would put the levels for protein, dairy, and grains at a more desired level (3a) Your subject’s actual vitamin and mineral intake (all are noted on the nutrients report… main ones listed here): 4 mg zinc, 484 mg calcium, 1167 mg potassium, 935 mg sodium, 264 microg RAE vitamin A, 74 mg vitamin C, 5 microg vitamin D, 11 microg vitamin K (3b) how it compares to vitamin and mineral DRIs for his/her age (i.e. is his/her diet high or low in any vitamins and minerals). Her intake is low for calcium, potassium, and iron in minerals and Vitamins A, D, E, K, folate, thiamin, and niacin. She is not over the recommended amounts for any vitamins or minerals.

C. Parental description of food habits - likes, dislikes, snacks, food jags, pica: She is usually grumpy during dinnertime so she doesn’t eat a lot then. That’s probably because she is tired, and is having a hard time with mom’s bedrest (mom is pregnant, due very soon). She doesn’t seem to understand hunger, and will ignore hunger to play more. She loves chocolate, cheese, snacking, doesn’t like vegetables but is trying celery, snap peas, and carrots more now.

D. Parental description of typical family meal times (do they sit at a table or in front of the

TV or does everyone eats at different times, etc). Emily used to start dinner before Adam got home, so they could eat dinner together. Before bedrest, Emily and Kyrie would eat all the other meals at the same time. Now that the mother, Emily, is on bedrest, there are no family meals.

E. Child’s intake of vitamin/mineral supplements? She occasionally takes a multivitamin.

F. Use of food assistance programs like WIC, SNAP, food bank, church resources, etc. none

V. Nutritional status evaluation and recommendations (15 points)

A. Summarize (1-2 paragraphs) what you think are the most significant nutritional risk factors to this child and how the child’s diet can be altered to reduce this risk. I think the most significant nutritional risk factors are from her overall caloric intake. When I asked the family to provide a 24-hour recall, there was only one meal and no snacks that Kyrie had eaten. So we used the day before, where she had eaten more like she normally does. It is concerning that she doesn’t seem to ever eat dinner. This could be from the amount of snacks she is allowed to eat or it could be from eating too late at night when she is overtired. Eating more vegetables would also be good but overall caloric intake I think should be focused on first.

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B. Explain (1-2 paragraphs) any recommendations, suggestions, or education you plan to give the

child’s caregiver(s) and the rationale. Counseling the caregivers will be a little difficult; since the mom is on bedrest and the husband works all day, they do not seem very open to suggestions on what more they can do. I will definitely mention trying to time her snacks and offer some better snack options. Maybe when the husband goes shopping he can specifically pick out healthy snacks like fruits, whole grain goldfish, whole grain crackers, and hand-held vegetables that she does like such as snap peas, carrots, and celery. Counseling the mom to offer these healthy snack options for when the child is hungry could also be beneficial. Offering these healthy snack options will help her raise her intake of important vitamins and minerals that she is currently low in. Timing her snack time should help her recognize hunger cues, and be able to eat more calories throughout the day. Timing her snacks could also help her eat more at dinner time, when more nutritious food is generally offered to her.

PART II (Complete Section I – II): I. Education (5 points): Provide the child’s caregiver(s) with the recommendations/advice you

suggested in Part I (after you review the instructor’s comments). Ideally, this should be done in-person (but phone is acceptable too). Summarize (1-2 paragraphs) what you discussed with the child’s caregiver(s).

As I was analyzing Kyrie’s diet and behavior more, I realized that I had not focused on what she was drinking, or more specifically, how much she was drinking. I talked to the mom again and she told me that Kyrie does drink milk out of a bottle pretty much all day long. She had told me some of the milk that she drank, but when I specifically asked about the milk and not what she was eating, I found that it was more than what was originally reported. After this, I knew the milk, combined with the lack of family meals, was contributing the most to Kyrie’s poor diet. I talked to both the mom and the dad about Kyrie’s eating habits and how to help her eat more and healthier. I though that talking to both of them would be beneficial since they just had a baby, so the dad would probably be taking care of Kyrie more than usual as the mom will be with the new baby. I talked about limiting milk to two cups for Kyrie, and juice to only less than one cup. They were both very surprised to hear that she should not be drinking a lot of milk. We discussed how this will help her be hungrier throughout the day and during mealtimes. I also gave some ideas of healthy snacks that were quick and easy that they could get for her.

II. Reflection (5 points): Write 1-2 paragraphs about your overall impression of how the child’s

caregiver(s) received your advice (i.e. do you think the caregiver[s] will follow your advice? Why or why not?). Also describe how you could have improved the education you gave. I thought that they took the advice really well. When I mentioned limiting milk, the father thought of a great idea to help them do that. He suggested that since Kyrie would still be asking for milk and might be upset if they told her no, they could start giving her smaller bottles with a snack when she asks for it. In this way, she is still getting her bottle but not drinking as much as she used to. Then they could work on not giving her bottles as frequently and giving her more food. When I followed up with them, however, they said that with the new baby it was too hard to try to make changes in Kyrie’s diet and they would do more later. I told them I understand and also reminded them of the importance of her eating enough to grow well. I mentioned the father’s idea again of just giving her

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less milk when she asks for it and mentioned how that would be an easy change they could start making and then really focus on the family meals later when they are more adjusted to life again.