Ricky Ricky, age 4 years, arrives in the clinic with his mother. Ricky lives with his mother and father, who both work full-time, and his infant sister. Their extended family lives in a different state more than 100 miles away. Both parents are of average height and in good health. Ricky’s mother mentions that Ricky often expresses frustration, particularly in regard to food. Conflict over food occurs every day. Mealtime is a battle to get him to eat, unless his mother feeds him. Ricky’s baby sister seems to tolerate all baby foods but requires her mother to spoon-feed. Ricky’s mother is quite frustrated and concerned that he will become malnourished.   Reflective Questions  1. What additional assessment information would you collect?  2. What questions would you ask, and how would you further explore this issue with the mother?  3. In what ways does the distance of the extended family influence this family’s approach to health promotion?  4. What factors would you consider to determine whether malnourishment is a factor in this family? 

1. Other Assessment Information As a health care provider, you would collect additional information about the patient.

• Ricky’s growth and weight gain patterns over time
• Past medical conditions or illnesses which may have affected his appetite
• The dietary history of the patient, highlighting specific foods or drinks that they like or dislike
• Food allergies and intolerance in the family
• A history of stomach problems (such as reflux or constipation)
• A social history, including the family’s mealtime routine and any possible family or cultural beliefs or practices related to food.

2. Questions to Ask and Further Exploration: To further explore the issue of food conflict and Ricky’s frustration, the healthcare provider could ask the following questions:

• How would you describe the typical dinner at your home?
• Is there a favorite drink or food that Ricky enjoys?
• What will happen if he won’t eat?
• What strategies have you used to get him to eat more?
• Is there anything else that could be frustrating him, like difficulty using utensils?

It would also be important to explore any potential underlying psychological or emotional factors that may be contributing to Ricky’s behavior, such as anxiety or stress.

3. Influence of Extended Family Distance: The distance of the extended family may influence this family’s approach to health promotion in several ways. It is possible that they do not receive the same support and resources as those who are closer to their extended families. It could be that they have limited access to childcare, or need assistance for meals and transportation. Additionally, the extended family may not be able to provide as much emotional support, which could impact the parents’ ability to cope with the stress of raising young children.
4. Factors to Determine Malnourishment: To determine if malnourishment is a factor in this family, the healthcare provider would need to evaluate Ricky’s growth and weight gain patterns over time. Also, they would have to determine his dietary habits and nutritional state. Also, any medical or psychological conditions that could be affecting his appetite and ability consume adequate nutrients should be considered.