1

Brynna Bangerter NDFS 424

Well-Child Project

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

A. First name: Landon

B. Description of the child - general appearance, hair, skin, skeletal development, eyes, muscle

turgor, teeth: Looks very healthy and fit. Running around and playing. Strong looking muscles

and bones.

C. Economics environment, interaction with siblings and parents, time with babysitters or in day

care: Mostly at home with mom.

II. Health history (10 points)

A. Sex of child: Male

B. Age of child (years, months): 2 years 6.5 months

C. Birth anthropometrics (of child):

(1) Birth weight (lbs or kg) and percentile range: 6 lbs 10 oz; between 25th and 50

th percentile

(2) Birth length (in or cm) and percentile range: 20 inches; between the 50th and 75

th percentile

(3) INCLUDE PLOTTED GROWTH CHARTS

2

D. Current anthropometrics (of child):

(1) Current weight (lbs or kg) and percentile range: 29lbs; between 25th and 50th

(2) Current length or height (in or cm) and percentile range: 36in; between 25th and 50

th percentile

(3) BMI-for-Age percentile range, if appropriate for your Well-Child subject: BMI = 16; between

25th and 50

th percentile

3

(4) INCLUDE PLOTTED GROWTH CHARTS.

4

E. Number of siblings and their ages – none (mother currently pregnant)

5

F. Mother’s obstetrical history - weight gain, term, parity (with your subject): gained 15-20lbs and

was full term

G. Child’s history of illnesses (including any chronic diseases): none

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

I. Child’s dental history: none

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

III. Developmental skills assessment (6 points)

A. Developmental skills – perform the Denver Developmental Screening Test (DDST) using the

screening form handed out in class - INCLUDE THE COMPLETED SCREENING FORM

WITH PART I

6

B. Summarize your findings from the DDST using the following format (refer to PowerPoint

instructions on BYU Learning Suite):

(1) “No opportunity” items (if none, list “none identified”): 1

(2) “Caution” items (if none, list “none identified”): None

7

(3) “Delayed” items (if none, list “none identified”): None

(4) Discuss your interpretation of the test, including if the child’s development would be

categorized as “normal”, “suspect”, or “untestable” and any concerns you have with the

child’s development.

I would categorize Landon’s development as “normal”. He had no delays or cautions and he

passed the majority of the tests. I don’t have any concerns with his development as he seems to

be developing just fine. It was hard to administer a perfect test due to lack of exact materials. It

was however apparent that his development was normal since he passed most of the tests easily

and overall had a general sense of development.

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: (1) “Food Group and Calories” Report (2) “Nutrients” Report (3) “Meal Summary” Report.

Landon's Food Groups and Calories Report 03/01/16 - 03/01/16

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

Food Groups Target Average Eaten Status

Grains 3 ounce(s) 4½ ounce(s) Over

Whole Grains ≥ 1½ ounce(s) 0 ounce(s) Under

Refined Grains ≤ 1½ ounce(s) 4½ ounce(s) Over

Vegetables 1 cup(s) ½ 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 ½ cup(s) Under

Other 1½ cup(s)/week 0 cup(s) Under

Fruits 1 cup(s) 1 cup(s) OK

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

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

Dairy 2 cup(s) 1¾ cup(s) OK

8

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

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

Protein Foods 2 ounce(s) 1½ ounce(s) OK

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

Meat, Poultry & Eggs No Specific Target 1½ ounce(s) No Specific Target

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

Oils 3 teaspoon 5 teaspoon Over

Limits Limit Average Eaten Status

Total Calories 1000 Calories 1142 Calories Over

Added Sugars < 100 Calories 64 Calories OK

Saturated Fat < 100 Calories 150 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.

Landon's Nutrients Report 03/01/16 - 03/01/16

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

Nutrients Target Average Eaten Status

Total Calories 1000 Calories 1142 Calories Over

Protein (g)*** 13 g 41 g OK

Protein (% Calories)*** 5 - 20% Calories 14% Calories OK

Carbohydrate (g)*** 130 g 137 g OK

Carbohydrate (% Calories)*** 45 - 65% Calories 48% Calories OK

Dietary Fiber 19 g 11 g Under

Total Sugars No Daily Target or Limit

42 g No Daily Target or Limit

Added Sugars < 25 g 16 g OK

Total Fat 30 - 40% Calories 39% Calories OK

Saturated Fat < 10% Calories 13% Calories Over

9

Polyunsaturated Fat No Daily Target or Limit

6% Calories No Daily Target or Limit

Monounsaturated Fat No Daily Target or Limit

17% Calories No Daily Target or Limit

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

Linoleic Acid (% Calories)*** 5 - 10% Calories 6% Calories OK

α-Linolenic Acid (% Calories)*** 0.6 - 1.2% Calories 0.5% Calories Under

α-Linolenic Acid (g)*** 0.7 g 0.6 g 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 82 mg OK

Minerals Target Average Eaten Status

Calcium 700 mg 660 mg Under

Potassium 3000 mg 1400 mg Under

Sodium** < 1500 mg 1695 mg Over

Copper 340 µg 602 µg OK

Iron 7 mg 8 mg OK

Magnesium 80 mg 132 mg OK

Phosphorus 460 mg 797 mg OK

Selenium 20 µg 49 µg OK

Zinc 3 mg 5 mg OK

Vitamins Target Average Eaten Status

Vitamin A 300 µg RAE 275 µg RAE Under

Vitamin B6 0.5 mg 0.7 mg OK

Vitamin B12 0.9 µg 1.4 µg OK

Vitamin C 15 mg 11 mg Under

Vitamin D 15 µg 3 µg Under

Vitamin E 6 mg AT 2 mg AT Under

Vitamin K 30 µg 25 µg Under

Folate 150 µg DFE 243 µg DFE OK

Thiamin 0.5 mg 0.9 mg OK

10

Riboflavin 0.5 mg 1.0 mg OK

Niacin 6 mg 10 mg OK

Choline 200 mg 108 mg Under

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.

Meals from 03/01/16 - 03/01/16

Landon's Meals

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

Date Breakfast Lunch Dinner Snacks

03/01/16

1 small (2-1/2" across) Apples, raw

1 cup Chocolate milk, fat free (skim)

1 fast food kids' meal Chicken nuggets (McDonald's, Weaver Mini Drums, Tyson Chicken Sticks, Carl's Jr. Chicken Stars)

EMPTY

1 small (2-1/2 oz) Bagel

½ quesadilla Quesadilla with cheese (meatless)

1 portion (10 waffle fries) French fries, frozen, deep fried (fast food fries)

1 tablespoon Cream cheese

1 cup (8 fl oz) Water, tap

11

B. SUMMARIZE:

(1) Your subject’s macronutrient distributions (%) and whether the percentages are appropriate for his/her age based on macronutrient recommendations: Protein – 14% - Appropriate Fat – 39% - Appropriate Carbs – 48% - Appropriate (2) The number of MyPlate food group equivalents your subject consumed based on his/her actual intake and how he/she is meeting (or not meeting) his/her personalized MyPlate food group recommended levels Grains: 4.5oz – Meeting (over) Fruit: 1cup – Meeting Vegetables: 1/2 cup – Not Meeting (under) Dairy: 1 ¾ cup – Not Meeting (under) Protein: 1 ½oz – Not Meeting (under) (3) Your subject’s actual vitamin and mineral intake and 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).

Minerals Average Eaten Status

Calcium 660 mg Under

Potassium 1400 mg Under

Sodium** 1695 mg Over

Copper 602 µg OK

Iron 8 mg OK

Magnesium 132 mg OK

Phosphorus 797 mg OK

Selenium 49 µg OK

Zinc 5 mg OK

Vitamins Average Eaten Status

Vitamin A 275 µg RAE Under

Vitamin B6 0.7 mg OK

Vitamin B12 1.4 µg OK

Vitamin C 11 mg Under

Vitamin D 3 µg Under

12

Vitamin E 2 mg AT Under

Vitamin K 25 µg Under

Folate 243 µg DFE OK

Thiamin 0.9 mg OK

Riboflavin 1.0 mg OK

Niacin 10 mg OK

Choline 108 mg Under

C. Parental description of food habits - likes, dislikes, snacks, jags, pica.: Mom stated he is “not

picky”. He doesn’t like peanut butter and jelly sandwiches or oranges. He does like hot dogs, mac

and cheese, apple juice, chocolate milk.

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).: They usually eat together at the dinner

table.

E. Child’s intake of vitamin/mineral supplements?: N/A

F. Use of food assistance programs like WIC, SNAP, food bank, church resources, etc.: N/A

V. Nutritional care plan and implementation (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.

The most significant nutritional risk factors for Landon are to reduce sodium and get more

of the necessary vitamins. These include Vitamin A, Vitamin C, Vitamin D, and Vitamin K. The

major minerals that are inadequate are Calcium and Phosphorus. With a lack of these vitamins and

minerals he could be inhibiting proper growth and nutrition. One particular risk factor is that of

Calcium, and Vitamin D and A, all of which comes from milk. This worries me that he is not

getting enough nutrients for his bones to be healthy and strong. To reduce the risk of unhealthy

bones, he could drink more milk with added Vitamins D and A. To get the other necessary

vitamins and minerals, he needs to eat a wider variety of food, including fruits and vegetables. A

good reference would be Choose MyPlate. He is also over slightly in calories and sodium. This is

due to the fact that he ate so much fast food items which contains a lot of sodium, fat, and calories.

Having a more balanced meal would help reduce the risks of gaining too much weight and other

health risks from eating too much sodium.

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

child’s caregiver(s) and the rationale.

13

I would recommend that Landon follow the Choose MyPlate diet as it allows for adequate

nutrients in all areas that Landon is currently lacking. This diet would help him get the nutrients he

needs to be healthy and strong. Another suggestion I would give is for his caregiver to follow the

same healthy diet that is recommended since this is what Landon will most likely model and follow

in his eating habits. For specific suggestions I would recommend Landon to drink more milk to get

enough calcium and vitamins A and D. I would also suggest getting more vegetables and fruits into

his diet, as these will contain the majority of the vitamins and minerals he is lacking. I would also

suggest that he reduce his sodium intake, by eating more fresh foods, versus packaged or fast foods.

Another nutrient Landon is lacking in is protein, so I would suggest he eat more meat throughout

the week. My main concern with Landon is his lack of variety in his diet. If he added variety then it

will help him get the nutrients he needs. This in turn will help reduce his caloric intake, allowing for

a better balance overall.

14

PART II (Complete Section I – II):

I. Education:

It was very hard to get a hold of Landon’s mom, so I ended up emailing her and gave the following suggestions. After assessing Landon’s diet and growth patterns, I talked to Landon’s mom about following the Choose MyPlate diet. I discussed how he is lacking in vital nutrients such as calcium, potassium, vitamin A, E, D, and K, and how it is important to get a variety of food items in order to get these nutrients. I chose to give an overview of a general good diet instead of talking about certain foods to eat or limit, so it doesn’t confuse her. I talked about eating a colorful diet and how there are different nutrients in the different colors of foods. One nutrient I chose to specifically talk about was calcium. This is very important in keeping Landon’s bones strong and healthy. It is also provides vital calories, proteins, and added vitamin A and D. I explained this to Landon’s mom and suggested he get at least 1.5 cup of milk per day, or more if he isn’t getting any other calcium sources so he can get his 2 cups of dairy per day. Another nutrient I chose to talk about was protein. I suggested that he eat more meat throughout the week to get his recommended 2 oz. I gave options such as fish, hamburger, and chicken and to base it off of what Landon likes and will eat. Along with this, I suggested he reduce his intake of fast food items. I explained how this will reduce his total calories, fat intake, and excess sodium intake. The last thing I suggested was for Landon’s mom to eat a healthy diet, as Landon is more likely to eat a healthy diet if she is.

II. Reflection:

I never heard back from Landon’s mom but based on my initial analysis and assessment

from Part I, I have somewhat of an idea about how she would take the advice. I feel like she believes Landon is pretty healthy overall but there are a few areas they could improve in. This made it easy to discuss specific nutrients he is lacking and how getting an overall diet would help him. Although I didn’t see her reaction to this, I feel like she would agree and follow my advice in getting a wider variety of foods. I also think she would like the idea of getting a wide variety of colorful foods in his diet. I think she will incorporate my suggestion of drinking more milk to get more calcium, and other nutrients he needs. I also feel like she will try to cook different kinds of meats throughout the week to help him get the protein he needs.

Overall I feel like education part went well. I gave a lot of suggestions so I think it will take some time to incorporate all of them but I can imagine she agreed with all of them based on our initial assessment. I wish I could have met with her in order to see how much she knows about Choose MyPlate and which suggestions stood out the most to her. I feel like she will take them all really well, but if I could have met with her in person it would have be easier to suggest even more specific goals based on what she thought she could incorporate the most.