Topic 5 Cases
A 5-year-old boy who goes to kindergarten applies to a primary health care institution with his family. It is learned that he eats a lot of packaged convenience foods (chips, chocolate, etc.), avoids vegetable foods, eats fast food at least once a day, spends most of his time at home playing computer games, has little physical activity and the family wants to plan a healthy diet for him. It is also learned that he does not have any chronic diseases. He is 23 kg and 116 cm.
- What kind of recommendations can be given to this family to transform this child’s existing dietary habits into healthy ones?
- With which components and in what way an ideal portion can be prepared?
- What are the recommendations that can be given other than nutrition advices in order to ensure the energy balance?
BMI for the applicant child: 17.1 kg/m2
According to WHO reference values for children aged 5-19:
Overweight is BMI for age greater than 1 standard deviation above the WHO Growth Reference median; and
Obesity is more than 2 standard deviations of the WHO Growth Reference median.
In this case, when we consider the table for the 5-year-old male gender, we observe a value above 1 SD. This child is considered ‘overweight’
- It should be explained to the family that an adequate and balanced diet is the foundation for health, and that childhood obesity is a risk for the child’s health in both short and long term.
- It should be explained to the family that healthy dietary habits are acquired since pre-school stage and this will have an impact throughout child’s life.
- Various games and activities may be offered to help the child distinguish between healthy and unhealthy foods.
- The child should be provided with 3 main meals and snacks per day. The importance of breakfast should be emphasized and the family should be warned about the fact that, particularly in this age group, a large amount of food intake in a single meal may cause other meals to be skipped. It should be advised that no meal should be skipped and chips, chocolate and any kind of packaged food may be replaced by fresh fruits, milk, yoghurt, homemade cake (by paying attention to the amount) in snack times.
For a child who is classified as ‘overweight’ in this age group, a diet restricting energy intake is not recommended as it may cause negative effects on growth and development.
45-60% of the daily energy should be provided from carbohydrates, 12-15% from proteins, and 20-35% from fats. The daily calorie requirement is approximately 1200 kcal, depending on the daily physical activity, age, and gender.
Regarding portions, sufficient amounts of the 5 basic food groups should be consumed in order to ensure a balanced diet, and the meals should be prepared in line with this rule. It is recommended to consume 3-4 servings of milk and dairy products per day for this age. However, the applicant family must be informed that they should prefer especially reduced-fat dairy products for this child. It is recommended to consume 2 servings from the protein group per day, in particular legumes. It is recommended to consume about 5 servings of fresh vegetables and fruits per day
Salt intake should be limited. Sugary drinks in particular should be avoided. It is recommended to drink 8-10 glasses of water per day.
It is important to increase physical activity in addition to the nutritional program.
A 10-year-old girl applies to the 1st Step Health Institution with her family. They have complaints of excessive weight gain in recent months. It is learnt that she recently started to go to school without having breakfast, and that she wanted to eat dinner alone in her room. Her success at school has begun to decline as well. It is stated that she was 140 cm in height and 41 kg in weight in her follow-up 3 months ago. Her menarche has not arrived yet. In the measurements, her height is 142 cm, her weight is 45 kg and her BMI: 22.3 kg/m2. This child, who is stated to have no chronic disease, is found to be within the normal range in laboratory tests.
- What additional questions can be asked about the history of this child in terms of energy balance and nutrition?
- What is the daily energy requirement for this age group?
- What kind of menu can be given for consuming balanced and sufficient foods on a daily basis?
- What can be recommended in addition to nutrition?
First of all, since one of the main factors of energy balance is the energy expenditure, it should be questioned whether she does daily physical activities. Since children in this age group spend most of their time at school, it should be found out what their diet includes at the school, the amount of water they consume daily, and whether they consume sugary drinks. .(It is understood that she avoids physical activity and spends most of her time in front of the TV or computer)
The daily energy requirement of a sedentary 10-year-old girl is determined as 1600 kcal. There should be no calorie restriction for this child, even if overweight, and she should be followed up after the recommendations are given.
In this age group, breakfast is very important in terms of growth, development, and school success.
3 main meals and 3 snacks daily should be eaten, and sugary drinks and unhealthy snacks have to be avoided. It should be explained that fresh vegetables and fruits need to be consumed every day.
Apart from nutrition, the importance of physical activity should be explained. Activities such as cycling and walking for at least 1 hour per day should be recommended.
Healthy snacks for school can be prepared at home. Milk, yoghurt, dried fruits and fresh fruit are suitable for consumption at school.
| Create sample menu for the girl |
Then click Here to see an example of menu
A 6-year-old girl applies to a first step health care institution with her family. Her parents say that their daughter has been consuming a lot of packaged food lately and doesn’t finish her plate at meals. It is learned that she is physically active at a moderate level. The family states that they want to receive nutritional counseling for their daughter to gain regular and balanced eating habits. The measurements show that her height is 116 cm, weight is 21 kg, and BMI is 15.6 kg/m2.
- What is the daily energy requirement for this child?
- Considering the age group, create a sample menu by calculating the portions for a day.
The daily requirement of a physically active 6-year-old girl is 1400 kcal. We need to distribute this calorie requirement in a balanced way by calculating the portions that should be taken from each food group.
On a daily basis approximately;
- 2.5-3 portions from milk and dairy products
- 2.5 portions from the bread and cereal group
- 1.5-2 portions from the meat, fish, eggs, legumes, oilseeds group
- 2 portions from the vegetable group
It should be recommended to increase physical activity.
| Create a sample menu for this girl |
Then click Here to see an example of menu
