Breanna Keller NDFS 424

Well Child Project Part 1

I. Identifying data Amelia is a 3-year-old girl with a lot of energy and spunk. She has brown hair, pale white skin, normal skeletal development/muscle turgor, and healthy baby teeth. Amelia is mother’s first child, no siblings. This family of three lives in the suburbs of Lehi, UT. Amelia spends time with babysitters occasionally to allow parents to go out, but does not attend daycare. Mother is stay-at-home mom and raises Amelia, while the father works for Coca Cola Co.

II. Health history

Female. DOB 3/29/2010. 2 years 11 months. Birth weight: 8 # 6 oz (between 75th and 90th percentile range). Birth height 20” (between 75th and 90th percentile range). CW: 34 # Ht: 38”Adequate growth. See growth charts No siblings. Mother’s weight gain during pregnancy was normal. Amelia was a week overdue. Amelia had an acute respiratory infection post natal with no complications. No hx of chronic illness. Amelia is given fluoride drops qd and has not been to see a dentist. No known allergies or other food intolerances.

III. Developmental skills assessment See Denver Developmental Screening Test (DDST) “No opportunity” to play board/card games. “Caution” failed to know two adjectives. “Delayed” none identified Normal AEB no delays & maximum of 1 caution. Follow-up at next clinical visit.

IV. Nutritional assessment See Food Group and Calories Report, Nutrients Report, and the Meal Summary Report SUMMARIZE based on 24 hr recall Macronutrient distributions (%)

Protein (5-20% calories) OK 13% calories, carbohydrate (45-65% calories) OK 63% calories, total fat (30-40% calories) under 28% calories

MyPlate food group equivalents Grains total intake under (2 ! oz < 4 oz). Whole grain vs refined grain intake good.

Vegetable intake OK (1 ! cup = 1 ! cup). Dark green, red & orange vegetables under. Fruit intake OK (1 " cup > 1 cup) Dairy intake OK (2 # cup >2 ! cup) Protein food intake under (0 oz < 3 oz) Total calorie intake OK (1012 kcal < 1200 kcal). Empty caloric intake over (274 kcal > 121 kcal). Vitamin/mineral intake All OK with exception of potassium, vitamin D, and choline intake under, zinc and folate intake over. Amelia doesn’t like meat, but likes milk and cheese. Parents describe Amelia as kind of a picky eater i.e. won’t eat pasta if meatballs are on it and will spit the pasta out. Amelia will eat any kind of fruit, likes cucumbers, peas, green beans, and will eat broccoli

sometimes, eat steamed not raw carrots, but will not eat corn or potatoes. Amelia will eat whole-wheat tortillas, bread, pasta/noodles, and rice sometimes, but won’t eat mashed potatoes, soup, and yogurt because of the funky texture. The family typically eats at the table for dinner. Amelia can be fussy during dinner, but is usually calm and says the prayer. Amelia usually gets up before parents are done eating. Amelia is given a gummy MV BID. No reported use of food assistance programs like WIC, SNAP, food bank, church resources, etc.

V. Nutritional care plan and implementation

Amelia has an adequate intake of protein, but refuses to eat meat. Recommend continue to offer a variety of foods that contain meat e.g. chicken nuggets, as well as offer cheerios or other cereals that are Iron fortified. When preparing meals include all the food groups: meat or other protein e.g. yogurt, nuts, or beans; a couple of starchy foods, fruit or vegetable or both; oil-based salad dressing or use canola or olive oil with cooking; and milk. Remember, when you introduce new foods, also offer something familiar that everyone likes and can fill up on. Include high- and low-fat food in meals and snacks. Make mealtimes pleasant. Make conversation. Don't scold or fight. Amelia will get hungry, eat, get filled up, and stop eating. Amelia instinctively eats as much as she needs and will automatically eat the right amount of food to grow and be as active as is right for her. Eat with her, and let her eat with other adults who are friendly and supportive and who enjoy a variety of food. Give her experience with a variety of food. Don't limit the menu to foods she readily accepts. It takes some kids 10-20 exposures before they will try a food. Understand that her watching, looking, smearing and in-and-outing are her ways of getting used to new food and getting ready to eat it. Show her how to behave at the table as well as how not to behave.

Amelia's Food Groups and Calories Report 03/18/13 - 03/18/13Your plan is based on a 1200 Calorie allowance for a preschooler.

Food Groups Target Average Eaten StatusGrains 4 ounce(s) 2½ ounce(s) Under

Whole Grains 2 ounce(s) OK

Refined Grains 1 ounce(s) OK

Vegetables 1½ cup(s) 1½ cup(s) OK

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 1 cup(s) Under

Other 2½ cup(s)/week ½ cup(s) Under

Fruits 1 cup(s) 1¼ cup(s) OK

Whole Fruit No Specific Target 1¼ cup(s) No Specific Target

Fruit Juice No Specific Target 0 cup(s) No Specific Target

Dairy 2½ cup(s) 2¾ cup(s) OK

Milk & Yogurt No Specific Target 2 cup(s) No Specific Target

Cheese No Specific Target ¾ cup(s) No Specific Target

Protein Foods 3 ounce(s) 0 ounce(s) Under

Seafood 5 ounce(s)/week 0 ounce(s) Under

Meat, Poultry & Eggs No Specific Target 0 ounce(s) No Specific Target

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

Oils 4 teaspoon 0 teaspoon Under

Limits Allowance Average Eaten StatusTotal Calories 1200 Calories 1012 Calories OK

Empty Calories* 274 Calories Over

Solid Fats * 231 Calories *

Added Sugars * 43 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.

Amelia's Nutrients Report 03/18/13 - 03/18/13Your plan is based on a 1200 Calorie allowance for a preschooler.

Nutrients Target Average Eaten StatusTotal Calories 1200 Calories 1012 Calories OK

Protein (g)*** 13 g 34 g OK

Protein (% Calories)*** 5 - 20% Calories 13% Calories OK

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

Carbohydrate (% Calories)*** 45 - 65% Calories 63% Calories OK

Dietary Fiber 19 g 13 g Under

Total Fat 30 - 40% Calories 28% Calories Under

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 2% Calories No Daily Target or Limit

Linoleic Acid (g)*** 7 g 2 g Under

Linoleic Acid (% Calories)*** 5 - 10% Calories 2% Calories Under

Linolenic Acid (g)*** 0.7 g 0.2 g Under

Linolenic Acid (% Calories)*** 0.6 - 1.2% Calories 0.2% Calories Under

Omega 3 - EPA No Daily Target or Limit 0 mg No Daily Target or Limit

Omega 3 - DHA No Daily Target or Limit 0 mg No Daily Target or Limit

Cholesterol < 300 mg 61 mg OK

Minerals Target Average Eaten StatusCalcium 700 mg 959 mg OK

Potassium 3000 mg 1642 mg Under

Sodium** < 2300 mg 1664 mg OK

Copper 340 µg 366 µg OK

Iron 7 mg 13 mg OK

Magnesium 80 mg 154 mg OK

Phosphorus 460 mg 998 mg OK

Selenium 20 µg 41 µg OK

Zinc 3 mg 13 mg Over

Vitamins Target Average Eaten StatusVitamin A 300 µg RAE 432 µg RAE OK

Vitamin B6 0.5 mg 1.7 mg OK

Vitamin B12 0.9 µg 6.4 µg OK

Vitamin C 15 mg 24 mg OK

Vitamin D 15 µg 6 µg Under

Vitamin E 6 mg AT 8 mg AT OK

Vitamin K 30 µg 38 µg OK

Folate 150 µg DFE 478 µg DFE Over

Thiamin 0.5 mg 1.5 mg OK

Riboflavin 0.5 mg 2.3 mg OK

Niacin 6 mg 16 mg OK

Choline 200 mg 160 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 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.

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

Amelia's Meals Your plan is based on a 1200 Calorie allowance for a preschooler.

Date Breakfast Lunch Dinner Snacks

03/18/13 4 slice Banana, raw 1 cup, sauce Applesauce, unsweetened ½ cup Green beans, canned, cooked, no fat added

½ cup MultiGrain Cheerios Cereal

4 fluid ounce(s) Milk, reduced fat (2%) 6 fluid ounce(s) Milk, reduced fat (2%) 6 fluid ounce(s) Milk, reduced fat (2%) 1 medium (5" across) Pancakes, plain 1 string cheese stick String cheese, part skim 1 cup Potato puffs (Tater Tots) 1 tablespoon Syrup, pancake (Karo pancake

syrup, Aunt Jemimah, Hungry Jack)

1 medium roll (2-1/2" across) Roll, 100% whole wheat

Breanna Keller NDFS 424

Well Child Project Part 2

A. Amelia has an adequate intake of protein, but refuses to eat meat. It was recommended to continue to offer a variety of foods that contain meat e.g. chicken nuggets, and include cheerios or other cereals that are iron fortified. When preparing meals include all the food groups: meat or other protein sources like fish, eggs, and nuts; a couple of starchy foods, fruit or vegetable or both; milk; oil-based salad dressing and the use canola or olive oil in cooking. Include high- and low-fat food in meals and snacks. Amelia will get hungry, eat, get filled up, and stop eating. I explained that Amelia instinctively eats as much as she needs and will automatically eat the right amount of food to grow and be as active as is right for her. It was recommended to give her experience with a variety of food and to not limit the menu to foods she readily accepts. I explained that her watching, looking, and smearing foods are ways of getting used to new food and getting ready to eat it. Show her how to behave at the table as well as how not to behave. Make mealtimes pleasant. Make conversation. Don't scold or fight. B. During the 1-week follow up, we discussed Ellyn Satter’s division of responsibility in feeding. The parent is responsible for what foods are offered, and the child is responsible for how much (and everything else) food to eat. Amelia has a great appetite – she loves to eat fruit and cheese sticks. She refuses to eat meat. Amelia didn’t express why she did not like to eat meat. I explained to the mother that it takes some kids 10-20 exposures before they will try a food. Also, when you introduce new foods, offer something familiar that everyone likes and can fill up on. As a result, one family meal consisted of roast beef and rolls – Amelia can see that everyone was eating both the rolls and roast beef. The mother had also been providing cheerios to help with iron consumption. At family dinners the parents ate with Amelia, asked about her day, enjoyed conversation, and showed Amelia and how to behave at the table and how not to behave. If I were to change what I did on the Well Child Project Part 2, I would try to find a time to talk with Amelia more about her likes and dislikes, and interact with her a little more. A lot of the information I got was from her parents.