Nutrition

| December 16, 2015

aha32

Order Description
Half of page per response to my peers, with references, use first person, be nice and respectful. Posts attached.
Respond in one or more of the following ways:
1))Suggest additional health risks or issues that could be relevant to the child.
2))Critique your colleagues’ questions, and suggest how the parents or caregivers might interpret these questions. Provide alternate or additional questions.
3))Suggest an additional strategy for gathering patient information or promoting proactivity.

(TONY)
Weight and Body Composition
The weight and body composition of children and adolescents can reveal important details related to their health and wellbeing. When these two components are out of balance, the individual should be assessed for any disease that could be causing this imbalance. The body mass index (BMI) is recognized and standardized for the use in children and adolescents, except the results interpreted using age and gender-specific percentiles (Ball, Dains, Flynn, Solomon, & Stewart, 2015, p 86). An underweight child is considered to have an age-specific BMI less than the fifth percentile on the growth curve (Ball et al., 2015, p 86). The purpose of this discussion post is to elaborate further on the case scenario of a severely underweight 12 year-old girl with underweight parents by describing health issues and risks the child could experience.

Health Issues & Risks

Many studies have shown that children and adolescents living in the United States consume a diet that does not meet the national dietary recommendations (Evans, Seth, Smith, Harris, Loyo, Spaulding, & Gottlieb, 2011). If these recommendations are not met, malnutrition occurs and results in the child being overweight or underweight. Malnutrition in children and adolescents place them at risk for poor growth development and impaired cognitive function (McCarthy, Dixon, Crabtree, Eaton-Evans, & McNulty, 2012). If the malnutrition continues into adulthood, it places them at risk for decreased wound healing, increased risk for infection, increased hospital stays, and increased morbidity and mortality (McCarthy et al., 2012).

Assessment of the Underweight Child

The nutritional assessment of the underweight child is conducted with four commonly used procedures that consist of a detailed history, clinical examination, anthropometric measurements, and laboratory test (Antwi, 2011). Some of the specific information that would need to be obtained to assess this patient’s weight-related health disorder is her weight, height, age, nutrient analysis, current medications, glucose level, thyroid hormone levels, metabolic panel, complete blood count, urinalysis, and electrocardiogram (Medscape, 2015; Sullivan, 2012). With the patient’s parents also being underweight, additional information from them would need to be acquired because family lifestyle plays an important part in the nutritional and behavioral choices made by the child (Lazzeri, Pammolli, Pilato, & Giacchi, 2011, p. 1). The additional economic and social information needed would be the place of residence, economic assets, family culture, and family income (Lazzeri et al., 2011, p. 1). The patient in the scenario could be suffering from a psychiatric eating disorder, such as anorexia nervosa which can result from economic factors, sociocultural factors, and genetics, most commonly seen in females of the adolescent period (Ball et al., 2015, p 111). Additional information about her psychiatric status should be obtained to exclude this possible diagnosis. The underweight child could be suffering from a number of health issues or related issues that are causing her to be malnourished, depending on the combined results of the total health assessment.
Potentially Sensitive Topics

Eating patterns and food choices of children are highly impacted by the feeding practices, food restrictions, and the kind of food presented to them by their parents (Evans et al., 2011). With the parents of this patient also being underweight, their perception of an individual’s diet would be a potentially sensitive topic to address. The parents of this patient could be providing her with a diet that restricts certain foods because of their own beliefs. Past studies conducted on maternity perception of children’s weight revealed 65.2 percent of underweight children were perceived as normal weight, and 7.6 percent of normal-weight children were perceived as underweight which resulted in unhealthy dieting and eating disorders (Lopes, Santos, Pereira, & Lopes, 2013). Other sensitive topics may include living environment, family income, and economic status. With these topics being potentially sensitive to the parents or caregiver, the interview would take place away from the child. Keeping the subtle topics in mind, below is a list of questions created to gain more information about the child.

1.Are there any cultural beliefs I should know about?
2.How often do you prepare food at home and eat as a family?
3.How many times a day does your daughter eat?
4.Does your child follow a specific diet, with or without supplements?
5.Have you noticed any signs of depression or peer-related problems with your child?
6.Does your financial status allow you to obtain enough food for everyone in your family each month?

Strategy Suggestions
The advanced practice nurse (APN) is in a unique position to offer many different strategies for this family, depending on the results of the complete health assessment. One strategy for the APN is to provide the parents with results from the health assessment that indicates their child is underweight at an unhealthy level. Bringing this to their attention might change the parent’s perception about the weight and health status of their child. Education on the acceptable height and weight of a twelve-year-old child would be provided while encouraging them to keep a record of their child’s height and weight to ensure she is not experiencing growth disorders. With the possible perception of the child’s parents thinking she is at a normal weight, regular appointments with a pediatrician are very important (Júlíusson, Roelants, Markestad, & Bjerknes, 2011). A suggestion of monitoring the child’s diet to ensure she is receiving the recommended serving amount of fruits, protein, vegetables, and dairy would also be a helpful strategy. Another suggestion would be for the parents to prepare the food at home and incorporate the child to make the experience enjoyable for the whole family. Inclusion of the entire family encourages a healthy diet because the children will follow the food habits of their parents, and allows the family an opportunity to bond and assess the child for depression or any peer-related problems (Lazzeri et al., 2011, p. 3). If a psychiatric disorder were detected, I would suggest the family see a specialist in this area, and stress the importance of their involvement with the child’s rehabilitation. If the assessment revealed financial status was an issue, requiring them to spend less money on food, information on specific programs that help families with low income obtain food would be suggested. Since this is a potentially sensitive topic, assistance would be provided to them by contacting the agency and setting up an appointment. Finally, education and expressions of importance to the whole family in regards to being underweight and the health risks it exposes to the individual. By increasing this awareness, maybe the family will change their diet together and maintain an enjoyable, healthy lifestyle.
Conclusion
As previously mentioned, the weight and body composition of children and adolescents can reveal important details related to their health and wellbeing. When or if any of their weight and body composition are out of balance, the patient should be assessed for any disease that could be causing this imbalance. The case scenario of a severely underweight 12 year-old girl with underweight parents could have malnutrition, poor growth development, impaired cognitive function, or suffering from anorexia nervosa (McCarthy et al., 2012). The child’s parents are also underweight so additional information from them would need to be acquired because family lifestyle plays an important part in the nutritional and behavioral choices made by the child. The additional economic and social information could be contributing to her health and so other information needed would be the place of residence, economic assets, family culture, and family income (Lazzeri et al., 2011, p. 1). The APN may offer many different strategies for this family, depending on the results of the complete health assessment. In order to promote change, awareness would be the first priority so by providing the parents with results from the health assessment that indicates their child is underweight at an unhealthy level and educating them would encourage lifestyle changes.

References
Antwi, A. (2011). Assessment and management of severe malnutrition in children. West African Journal Of Medicine, 30(1), 11-18.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Evans, A., Seth, J. G., Smith, S., Harris, K. K., Loyo, J., Spaulding, C., & … Gottlieb, N. (2011). Parental feeding practices and concerns related to child underweight, picky eating, and using food to calm differ according to ethnicity/race, acculturation, and income. Maternal And Child Health Journal, 15(7), 899-909. doi:10.1007/s10995-009-0526-6
Júlíusson, P. B., Roelants, M., Markestad, T., & Bjerknes, R. (2011). Parental perception of overweight and underweight in children and adolescents. Acta Paediatrica (Oslo, Norway: 1992), 100(2), 260-265. doi:10.1111/j.1651-2227.2010.02039.x
Lazzeri, G., Pammolli, A., Pilato, V., & Giacchi, M. V. (2011). Relationship between 8/9-yr-old school children BMI, parents’ BMI and educational level: A cross sectional survey. Nutrition Journal, 1076, 1-8. doi:10.1186/1475-2891-10-76
Lopes, L., Santos, R., Pereira, B., & Lopes, V. (2013). Maternal perceptions of children’s weight status. Child: Care, Health And Development, 39(5), 728-736. doi:10.1111/j.1365 2214.2012.01380.x
McCarthy, H., Dixon, M., Crabtree, I., Eaton-Evans, M. J., & McNulty, H. (2012). The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff. Journal Of Human Nutrition & Dietetics, 25(4), 311-318 8p. doi:10.1111/j.1365-277X.2012.01234.x
Medscape. (2015). Anorexia nervosa. Retrieved from http://emedicine.medscape.com/article/912187-overview
Sullivan , D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
(SAUNDRA)

Health Assessment
Obesity is a condition that is on the rise in the United States. According to The Center for Disease Control and Prevention (2013), roughly 17 percent of children and teens are obese and this condition has been rising over the past decades. The following will discuss the scenario of a 5-year old boy who is overweight.
Overweight according to Ball, Dains, Flynn, Solomon, & Stewart (2015), is having a body mass index (BMI) between 25 and 29.9 percent. A BMI is a calculation of one’s height and weight and is a standard test to indicate nutritional status and total body fat (Ball, et.al., 2015). According to the Ball, et.al.(2015), this condition could be attributed to genetics, behavioral, and environmental factors. This shows that there is an imbalance between caloric intake and energy expenditure (Ball, et.al., 2015) in this child. This condition can lead to additional comorbidities.
Risk Factors
The presence of additional weight can be harmful to one’s body. Carrying of the additional weight can cause several health problems, including increased blood pressure and an increased chance for diabetes and breathing issues (CDC, 2012). These conditions could start a cascade effect leading to more in-depth problems in all major system within the body. In addition to the physical effects of being overweight, there also can be psychological effects that result, such as, disturbed body image, anxiety, depression, and disturbed self-esteem (Russell-Mayhew, McVey, Bardick, Ireland, 2012).
Gathering Information
Additional information would be beneficial other than the BMI. Questions regarding the client’s genetics, habits, activities and nutritional intake. There is also the question of whether there are weigh issues caused by disease, such as metabolic disorders. Specific questions could be:
Eating patterns-
Does this child eat between meals? Does the family have meal times together? Is food used as a reward or punishment? What are the child’s favorite foods?
Activities-
Does the child get at least 30 to 60 minutes of physical activity every day? Is the child enrolled in any sports?
Encouraging Family
A strategy could be not to focus on the weight itself but to focus on activities and family habits including meals and snacks (Pryke, & Docherty, 2009). Focusing on promotion of vegetables and fruits instead of focusing on reduction of readily available high carbohydrate snacks. Also focusing on activities that a family can do together to increase their activity i.e. playing a game of tag instead of a card game of go fish. These small changes can increase over time and lifestyle changes are more readily to occur. Additionally, one could promote weight maintance opposed to weight loss. This strategy would stop further weight increase and would reduce progression from overweight to obesity (Pryke, & Docherty, 2009). This strategy would have to be a short term goal for the case of a five-year-old to ensure proper development and growth.

References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Centers for Disease Control and Prevention. (2012). Obesity rates among all children in the United States. Retrieved fromhttp://www.cdc.gov/obesity/data/childhood.html
Pryke, R., & Docherty, A. (2009). Obesity in primary care: evidence for advising weight constancy rather than weight loss in unsuccessful dieters. The British Journal of General Practice, 58(547), 112–117. http://doi.org/10.3399/bjgp08X277023
Russell-Mayhew S., McVey G., Bardick A., Ireland A. (2012). Mental health, wellness, and childhood overweight/obesity. Journal of Obesity, Volume 2012, Article ID 281801, doi:10.1155/2012/281801

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