NTR 3755 Childhood Case Study

Review the following client description and answer the questions below:

Jacob:
 Jacob is an 8-year old male who is present in your office because his parents are concerned
about his eating habits. Both of his parents are present. They inform you Jacob plays soccer in
the Fall and Spring through the park district on Tuesdays/Thursdays from 5-6pm and has a game
every Saturday for an hour. Both seasons are for 8 weeks. Over the summer he plays baseball, in
which the practices are Monday-Thursday for 1 hour and games are once per week on top of his
practice for 1 hour. This season is also for 8 weeks. For the past year, they have noticed a change
in his eating and preoccupation with his image. According to the pediatrician, his weight has
decreased slightly, but not to be alarmed. He currently is 51” tall and weighs 53 pounds. His
height last year was 49” and his weight was 56 pounds. His parents provide you with a typical
diet of what Jacob eats:

o Breakfast: 2 pieces of whole-wheat toast with 1 teaspoon of fresh Strawberry jam (mom
made it) and 8 oz of 2% milk
o Lunch: 2 pieces of whole wheat bread, 1oz of Cheddar cheese, 2oz of skinless chicken
thigh; 8 oz water, 1 apple, 6oz plain yogurt
o Afternoon Snack: At the after school program, 1 bag of pretzels and 1/2 cup of apple
juice
o Dinner: 3oz of chicken (skinless), 1 small sweet potato, 1 cup Romaine lettuce with
carrots, tomatoes, cucumber, and 2 tsp olive oil as a dressing, ½ cup rice, and 8oz of 2%
milk
o Evening snack: some type of fruit (orange, banana, strawberry)
o Beverages: tends to only drink 2% milk, juice (only at afterschool program), and water

 Jacob informs you he sees all the kids who are chubby at school and does not want to be like
them. He does not think he has changed his eating but eats what his mom and dad do. Also, he
knows his mom and dad are always exercising and eating right, so he figures if he does that he
will stay slender like his parents.

1) (5 points) Would you consider Jacob is considered overweight, normal weight, or underweight?
How did you determine his weight status?

Based on the BMI for Age Percentile Growth Chart, his BMI is 14.3 placing him on the 13t h
percentile for 8-year-old boys.

BMI = wght(lb)/stature(in)/stature(in) x 703 = 14.3

This indicates that he is considered a normal weight within the BMI category.
 2) (5 points) Are you concerned with his weight loss, why or why not?

I am concerned with his weight loss because he is very worried about becoming fat. He has indicated
that he looks at other children as chubby and does not want to become like them. His eating habits
seem to be healthy, but his emphasis on weight isn’t. I would be worried that as he ages his concern
with weight will increase and could lead to an eating disorder. In addition, last year his BMI was 16.4
which placed him at the 71st percentile for 7-year-old boys. This means that he has crossed more than
two percentile lines which is potentially a sign of growth disturbance. He has also lost more than 5% of
his body weight which is significant for a child.

% body weight loss = ((56-53)/56 )x100 = 5.36%

3) (5 points) How many calories, carbohydrates, proteins, and fats would you recommend Jacob?
(show your work)

EER = 88.5-(61.9x8) + 1.42(26.7X 24) + (903 x 1.30) + 20 = 1697.14 = 1700 kcal

Fat = 25%-35% = .30x1700/9 = 56.6 = 60g fat
Carb = 45%-65% = .50x1700/4 = 212.5 = 215g carb
Protein = 15%-30% = .20x1700/4 = 85g protein

Fluids = Holliday Segar equation For > 20 kg = 1500 mL + 20cc for each kg over 20
53/2.2 = 24.09 = 1500ml + (20 x 4) = 1580mL

4) (10 points) Create a 1-day meal plan for Jacob that includes specific portion sizes of each food.
Include the total calories, total carbohydrates, total protein, and total fat based on question 4.

o Breakfast: 2 pieces of whole-wheat toast with 1 teaspoon of fresh Strawberry jam, 1tbs
peanut butter and 8 oz of 2% milk
o Lunch: 100g of brown rice, 1oz of Cheddar cheese, 2oz of skinless chicken thigh; 8 oz
water, 1 apple, 6oz plain yogurt
o Afternoon Snack: At the after-school program, 1 bag of pretzels and 1/2 cup of apple
juice
o Dinner: 50g whole wheat pasta, 1 cup homemade pasta sauce, 50g turkey meatballs,
2tbs mozzarella cheese, 1 cup Romaine lettuce with carrots, tomatoes, cucumber, ½
avocado, and 2 tsp olive oil as a dressing, and water
o Evening snack: whatever wasn’t finished at dinner or a piece of fruit or vegetable
o After sports: 1 cup of chocolate milk
o Beverages: 2% milk and chocolate milk, juice, and water

Total calories: 1800kcal

Protein: 90.3g
Carbs: 217g
Fat: 58g
5) (15 points) Write out an ADIME note