Question

1. Steven, a 4-year-old boy, is seen in the pediatric office for a well-child exam. He is a healthy, active boy who attends extended-day preschool as his mother works long hours. His mother states she has some questions about Steven. She says she is concerned about Steven’s growth, his language skills, and disciplining him. Steven’s mother tells you that “he seems heavier than my other children did at his age.” Upon measuring Steven you note his height to be 38.5 inches (98 cm) and his weight to be 46 pounds (20.9 kg). His calculated BMI of 21.76 plots well above the 95^th percentile for age. After further discussion with Steven’s mother, you determine that he has an excessive daily intake of fruit juice and whole milk, and eats numerous fast-food meals weekly.

1. Describe teaching about diet and activity that you will do with Steven’s mother.

Steven’s mother asks if there is something wrong with Steven because he stutters and says “um” a lot.

2. What type of education or support will you give Steven’s mother?
3. When questioned about the type of discipline used in the home, Steven’s mother states that she feels bad when she spanks him, because he becomes so withdrawn afterwards and that it doesn’t really seem to work anyway. She states she just doesn’t know what else to do. What kind of anticipatory guidance can you provide?

Answer 1

1. Diet and Activity:

A four year old child should have a weight around 40 pounds and a height of 40 inches. They should have a healthy  BMI of equal or greater than 5th percentile and less than 85th percentile for age ,gender and height. A BMI between 85th percentile and 95th percentile category are overweight  and a BMI equal or above 95th percentile kids are in obese category. Steve has a BMI above 95th percentile. Steve's mother has to be educated regarding the healthy  diet for a four year old child and their activity:

* A four year child should eat a healthy range of food that contain low fat milk and dairy products, fresh vegetables, fruits , whole grain cereals and bread , lean protein such as poultry, beans , Turkey. So that they will get a variety of vitamins and nutrients for their age.

* Maintain a regular mealtime and snack time, don't allow them to eat between the main eating times.

* Switch off the T.V while eating and encourage the child to sit together with the family members for meals.

* Avoid sugary drinks ; soda, juice ,sports drinks, lemonade etc and processed food for the child .

* Teach table manners and offer small portions of food for the child.

* Encourage the child to drink more water .

* Encourage the child should participate in outdoor games and activities rather than sitting with video games or TV.

* A four year child can engage in running, jumping , swimming etc, with supervision so that their excessive body fat may get burned.

* They should be active about 3 hours a day.

* Being physically active is important for their growth and development.  

2. Steven's stuttering nature:

Stuttering is more common in children, especially when they start to tell sentences instead of words. Until the age of Five the child may stutter or may say the word ' um' a lot. Steven's mother can take care of few things, that promote the child's speaking capacity.

* Try to provide a relaxed environment for the child to speak.  

* Encourage the child to speak some easy and funny topics.

* Don't react in a negative way to the child while he stutters.

* Save time for the child to talk in a relaxed manner and communicate with him.

* Don't talk inbetween, while the child is speaking

3. Education and support to Steven's mother:

* Educate about the importance of mother and child bonding in the growth and development of the child .

* Instruct her about the healthy diet and Nutrients for the preschooler.  

* Educate her about the importance of physical activity for the child .

* Encourage her to discipline the child in a positive way. Avoid harsh punishments and shouting and yelling at them .

* Instruct about the importance of the amount of time that she saves for the child .

4. Anticipatory guidance:

When disciplining a four year child, the mother has to take care of few things such as:

* Use ' Do' s rather than Don't s: Children may get confused with most of the Don't s, instead tell them what they have to do.

Example: Instead of telling " Don't run in the hall " , tell them " Please walk in the hall" .

* Get on their level, when you want him to do something: Instead of shouting from the kitchen or from the laundry, have a minute and come to the child and get on to his level and speak to him face to face. So you can see his eyes and the face. It will work more than a shouting.

* Try to say " more yes " rather than 'No' :

Parents has to try for saying 'Yes' , when a child ask for something in a desirable way. If a Child ask for an Ice cream, Instead of telling ' No' or " Not today " ,tell them " Ice cream is tasty ! would you like to have it on Saturday or sunday evening "

* Make sure the child's understanding or comprehension: Ask the child to repeat what you have told them . You can understand that how much the child has comprehended your words.

* Shorten the speech: Dont lengthen your advices , instead offer the advice in positive and short manner.  

* Be a role model for the child

* Praise and reinforce the child for his good behaviour.