Question

answer questions 2-4

A 2.5-year-old girl, Mia, was seen at your clinic with her 22-year-old mother, the child's aunt, and a young cousin. She was developing normally but had not grown as expected over four months, which was concerning. The pediatrician did not find a medical basis for the growth plateau. Mia was offered appropriate foods in appropriate serving sizes, but she mostly was throwing it on the floor or refusing it with crying tantrums. She liked to drink juices from her sippy cup throughout the day. She carried the cup with her most of the time. The family was sure it was not enough for her, but did not limit her intake because she ate little else. Eventually the aunt mentioned that Mia used to eat well when living with her grandparents. With sensitive review of the child's social history, it became clear that the child had been living with her grandparents while the mother was incarcerated. Her mother had cared for Mia until eight months of age. Mia then went to live with her grandparents for 18 months until her mother's release, at which time she and her mother moved into their own apartment. Mia had not seen her grandparents for the last several months. Assessment and recommendation: After confirming that no nutritional or medical basis was involved, family disruption was considered the basis for the growth plateau, as a result of interfering with Mia's hunger and appetite. The change in Mia's eating coincided with the time of a sudden change in her life. From the child's viewpoint, her grandparents and their home were suddenly replaced by a new person and a new setting.

Answer 1

2. Mia is at risk for Failure To Thrive. The main causes of Failure To Thrive are

• Organic FTT
• Nonorganic FTT

Mia is at risk for Nonorganic FTT for which the main reason inadequate supply of breast milk and the family disruption that affected the child the most. she is predisposed to the childhood mind where she used to drink with her sip bottle and liked juices to drink. the sudden change in her caregivers( grandparents whom she loved the most from her 8 months) makes her nervous. more over the shift from the place where she lived, the environment all affected her habits of eating.

3. possible eating approaches to Mia

• identify her likes and dislikes in diet
• provide her nutritional counselling.
• provide high calorie, protein and vitamin rich juices since she likes them well
• make her menu in such a way that most of the nutrients can reach in juice form
• don't force her to eat.
• give her chances to make decisions and tell her positives and negatives in a friendly manner.

4. make her menu in such a way that most of the nutrients can reach in juice form.

• most of the food items that we suppose to give Mia can be simply planned to be provided in liquid form in a sippy bottle for the first few days.
• a sudden change in the way she is used to fed create anxiety in her.
• it is possible to replace her diet with soups, mashed gruel with cooked vegetables, different types of weight gaining shakes such as badam, cahews, banana shakes.
• offer the food in sippy bottle so that she doesn't feel hesitation to have feed.
• once she tolerates well move to soft diet.
• if she is still reluctant, arrange a meeting with her grand parents. their influence can bring drastic changes in her mind.