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. Additional Assessment Information: As a healthcare provider, additional assessment information that would be collected includes:

• Ricky’s growth and weight gain patterns over time
• Any past medical history or chronic illnesses that may affect his appetite
• A dietary history, including specific foods and drinks that he likes or dislikes
• A family history of food allergies or intolerance
• Any history of gastrointestinal 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:

• Can you describe a typical mealtime at home?
• Does Ricky have any favorite foods or drinks?
• What happens when he refuses to eat?
• Have you tried any strategies to encourage him to eat?
• Are there any other issues that may be causing his frustration, such as difficulty with utensils or chewing?

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. They may not have the same level of support or resources available to them as families who live in closer proximity to their extended family. This could include limited access to child care or assistance with meals or 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. They would also need to assess his dietary intake and nutritional status. Additionally, it would be important to consider any underlying medical conditions or psychological factors that may be impacting his appetite and ability to consume an adequate amount of nutrients.