The second problem that will be assessed in the Brown family is Olivia’s poor eating habits. In the scenario, Olivia who is two years old does not eat very well, sleeps poorly and has become withdrawn. She also has tantrums which annoy Scott and both of Sheila’s parents, Mary and Keith. The developmental milestones for children who are two years old include having tantrums and showing defiant behavior. This is because they are becoming more independent and aware of themselves as separate individuals. Temper tantrums in children can be caused by not feeling well, exhaustion, hunger and frustration, seeking attention from parents or caregivers and avoiding certain activities like picking up their toys from the floor (Daniels, Mandleco & Luthy, 2012).
During the early years of their life, children tend to have erratic eating habits although the eating habits of individual children may vary. After their infancy, toddlers face a period of rapid growth spurts which are at times characterized by decreased appetite and sporadic periods of eating (Linnard-Palmer, 2019). They are also developing a sense of autonomy at this age and they become selective in the type of foods they want to eat. For some children, refusing to eat their food might be a form of attention seeking and it can be an indicator of a difficult parent-child relationship. For others, their decision to eat might be influenced by copying their parents or role models food preferences (Leung, Marchand & Sauve, 2012).
Planning Nursing Care
A nursing care goal that can be used to address Olivia’s poor eating habits is that she will be able to eat three square meals in a day by the end of two weeks. This will require her mother Sheila to keep a journal that documents Olivia’s eating patterns over the course of the two weeks. The reasons for implementing this nursing goal is that children Olivia’s age tend to have poor appetites and eating habits because of slowing growth rates after the infancy period, an increasing sense of independence, preferring to select their own meals, psychological changes that might affect their dietary intakes and an increasing preference to feeding themselves (Walton, Kuczynski, Haycraft, Breen & Haines, 2017).
According to the American Academy of Pediatrics (Healthy Children, 2017), two year-old children should be eating three healthy meals in a day as well as one or two snacks. Because they are cognitively developed than infants, toddlers can become active participants during meal times and even feed themselves without prodding. Having three meals that are balanced is also important to prevent nutritional deficiencies such as iron deficiency. Many healthcare providers have now started screening toddlers for iron, hematocrit and hemoglobin levels to check for iron-deficiency anemia (Linnard-Palmer, 2019, p.91).
Implementing Nursing Care
A nursing strategy that can be used to improve Olivia’s eating habits is to provide patient teaching of the nutritional needs of children at her developmental stage. This will involve looking at her eating habits, the nutritional patterns of the family and her overall daily dietary intake. Assessing the family’s dietary and nutritional patterns is important because they affect the child’s development of eating habits (Ralph & Taylor, 2014, p.751) Once her eating patterns have been identified, the nurse can discuss the importance having three square meals in a day that are balanced and also how Sheila can limit Olivia’s snacks before breakfast, lunch and dinnertime.
The teaching lesson will also cover the portions or servings that Sheila should give her daughter in a day and what nutritious snacks she can give that are as important as meals. Some examples of these include carrot or celery sticks, cheese, crackers and boiled eggs. Sheila can also help Olivia create a food chart that monitors what she eats and how well she is eating by ticking-off meals that she has finished eating (Ralph & Taylor, 2014). An online resource that the nurse can recommend to Sheila is the Eat for Health website created by the Australian Government’s Department of Health. This website offers important information about the dietary guidelines for Australia in the form of electronic brochures that show specific dietary guidelines for infants, children, adults, indigenous people and pregnant mothers (EatforHealth.Gov, 2018). The dietary guideline for children shows the types of food children Olivia’s age should be fed, the portions to be served, foods to limit and how parents can encourage healthy eating especially during mealtimes (EatforHealth.Gov, 2018). Sheila can also be referred to a nutritionist that specializes with toddlers.
Evaluate Nursing Care
To evaluate whether the teaching session is effective, the nurse will schedule a follow-up appointment with Sheila in three weeks and she will be required to come with the journal and chart so that the nurse can check Olivia’s food consumption. Checking the journal will provide useful information on the types of foods Olivia likes eating and those she doesn’t eat as well as the servings she takes per meal. This information is useful in coming up with a dietary plan that incorporates foods she can take without a problem. It will also help the nurse calculate the nutritional intake Olivia has been receiving for the prior weeks before the visit and readjust the dietary plan if there are any deficiencies noted.
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