1. “Ako si Jayme. Payatot at malungkot!

2. Ahaa, ito pala si Jayme ang batang payatot!

5. Interventions

6. Medical Assessment History of Present Illness TWO YEARS PTC Diagnosed to have low weight based on age Enrolled in the feeding program yearly No improvement in weight With poor eating habits No associated signs and symptoms

7. URTI; Acute gastroenteritis URTI; Acute gastroenteritis No previous hospitalizations No previous hospitalizations No maintenance medications No maintenance medications No allergies to food and medications No allergies to food and medications Past Medical History

8. Birth and Maternal History Born full term via NSD to a 21 y/o G1P1 Attended by the hilot; born in the house BW: ~ 3 kg Denies any perinatal or neonatal complications One prenatal check-up in the health center

9. Nutritional History Breastfed until 2 years old Breastfed until 2 years old Weaned at the age of 6 (Cerelac and lugaw) Weaned at the age of 6 (Cerelac and lugaw) Food preferences: junkfoods, noodles, candies and chocolates Food preferences: junkfoods, noodles, candies and chocolates

10. Nutritional History 24 hour diet recall 24 hour diet recall BREAKFASTBiscuit or Bread 1 glass of chocolate milk MORNING SNACKS1 taho LUNCH½ cup of rice Noodles SNACKSJunkfoods or cookies DINNER½ cup of rice Soup

11. IMMUNIZATION HISTORY BCG: 1 dose BCG: 1 dose DPT/OPV: 2 doses DPT/OPV: 2 doses Hepa B: 3 doses Hepa B: 3 doses Measles: 1 dose Measles: 1 dose Influenza virus: 1 dose Influenza virus: 1 dose

12. Family History MATERNAL MATERNAL Sister of grandmother: Hypertension and Diabetes Sister of grandmother: Hypertension and Diabetes Cousin of mother: Hypertension and DM Cousin of mother: Hypertension and DM Second cousin: Primary Complex (treated for 3 months; lost to follow-up) Second cousin: Primary Complex (treated for 3 months; lost to follow-up) Grandmother: died of hemorrhagic shock secondary to child bearing Grandmother: died of hemorrhagic shock secondary to child bearing PATERNAL PATERNAL Uncle: Hepatitis Uncle: Hepatitis

13. PERSONAL-SOCIAL HISTORY Patient lives in a shanty house near the riverside in Ilugin. Patient lives in a shanty house near the riverside in Ilugin. 5 household members 5 household members Father is an elementary graduate Father is an elementary graduate Primary breadwinner (works as plywood delivery assistant) Primary breadwinner (works as plywood delivery assistant) Mother finished until second year high school Mother finished until second year high school Uncle: works in the soap making factory Uncle: works in the soap making factory

14. PERSONAL-SOCIAL HISTORY Environment Environment Water source: boiled tap water Water source: boiled tap water Garbage collected everyday Garbage collected everyday Has their own restroom Has their own restroom Near the river Near the river Exposure to internal pollution Exposure to internal pollution Cooks inside the home using coal Cooks inside the home using coal Father and Uncle smokes inside the house Father and Uncle smokes inside the house

15. Interventions

16. Malnutrition Identify other medical causes of malnutrition (including TB, parasitism, dental caries, etc.) Identify other medical causes of malnutrition (including TB, parasitism, dental caries, etc.) Changing eating behaviour Changing eating behaviour Educate the child and the whole family regarding healthy eating habits Educate the child and the whole family regarding healthy eating habits Discourage giving money as a reward Discourage giving money as a reward Discourage buying food from outside Discourage buying food from outside Encourage variation in food choices Encourage variation in food choices

17. Malnutrition Changing eating behavior Changing eating behavior Find cheap and healthy alternatives Find cheap and healthy alternatives Teach meal planning and budgeting Teach meal planning and budgeting Teach creative cooking. Teach creative cooking. Make eating time a pleasurable activity (e.g. good food presentation, incorporate games, encourage eating together, etc.) Make eating time a pleasurable activity (e.g. good food presentation, incorporate games, encourage eating together, etc.) Awareness of importance of growth and development monitoring Awareness of importance of growth and development monitoring

18. Malnutrition Encourage involvement in government or non government programs to address malnutrition Encourage involvement in government or non government programs to address malnutrition Religiously attending the feeding program set by the community center Religiously attending the feeding program set by the community center

19. Exposure to TB Screening for TB for all relatives and possibly neighbors too Screening for TB for all relatives and possibly neighbors too Encourage and emphasize compliance with treatment Encourage and emphasize compliance with treatment Educate the family regarding truths about TB, how it’s spread, its treatment and its complications Educate the family regarding truths about TB, how it’s spread, its treatment and its complications Educate family about importance of BCG vaccine Educate family about importance of BCG vaccine

20. Dental Caries Dental Caries Dental Caries Referral to Dentist Referral to Dentist Decrease intake of sugar-rich foods Decrease intake of sugar-rich foods Teach proper dental hygiene (including proper toothbrushing) Teach proper dental hygiene (including proper toothbrushing)

21. Poor Hygiene Educate the family regarding good hygiene Educate the family regarding good hygiene Promote handwashing and sanitation to prevent spread of diseases Promote handwashing and sanitation to prevent spread of diseases Educate family how to sterilized and store of their drinking water Educate family how to sterilized and store of their drinking water

22. Hazardous Environment Advise alternative cooking methods Advise alternative cooking methods Use of mosquito nets Use of mosquito nets Main goal: Encourage them to transfer to a safer and conducive place to live Main goal: Encourage them to transfer to a safer and conducive place to live

23. Health Misconceptions Addressing other social Issues Addressing other social Issues Health misconceptions Health misconceptions Educate Educate Create programs teaching all families regarding truths on health (including pulongs on health, health counseling, focus group discussions, etc.) Create programs teaching all families regarding truths on health (including pulongs on health, health counseling, focus group discussions, etc.)

24. Parenting Issues Family issues Family issues Establish a unified parenting style Establish a unified parenting style Call for a family meeting or dialogue with the parents Call for a family meeting or dialogue with the parents Encourage good communication between partners and children Encourage good communication between partners and children Advice good parenting styles Advice good parenting styles

25. Transtheoretical Model of Changeby Prochaska & DiClemente, 1983.

26. Pre-Contemplation Increasing awareness Increasing awareness Does the family recognize the need for a change? Does the family recognize the need for a change? Educate the family on the importance of a healthy lifestyle and diet Educate the family on the importance of a healthy lifestyle and diet Do they understand the consequences of unhealthy eating habits and opposing parenting styles? Do they understand the consequences of unhealthy eating habits and opposing parenting styles? Teach them about the short term and long term effects of being unhealthy Teach them about the short term and long term effects of being unhealthy Do they see the benefits of living a healthy lifestyle? Do they see the benefits of living a healthy lifestyle? ‘Quiz’ them on their learnings ‘Quiz’ them on their learnings

27. Contemplation Re-affirm the family’s decision to make changes Re-affirm the family’s decision to make changes Praise the family’s decision to commit to change Praise the family’s decision to commit to change State, once again, the benefits that they will gain from it State, once again, the benefits that they will gain from it Assure that you support their decision Assure that you support their decision

28. Preparation Target and build specific knowledge and specific skills Target and build specific knowledge and specific skills Make a list of objectives Make a list of objectives Set achievable goals for the family Set achievable goals for the family Start with small, realistic goals that are easy to attain Start with small, realistic goals that are easy to attain

29. Seed 3: Communicate Listen. Be open. Check for understanding. Listen. Be open. Check for understanding. To your partner To your partner To your child To your child Try to understand where the other person is coming from. Try to understand where the other person is coming from. Explain. Respond openly and honestly. Explain. Respond openly and honestly.

30. Action Child Child Start slowly but surely Start slowly but surely Introduce vegetable and fruits one at a time Introduce vegetable and fruits one at a time Encourage but not coerce Encourage but not coerce Use of coercive control tactics to counter children’s resistance during mealtimes resulted to problematic eaters (Sanders, et. al., 1993) Use of coercive control tactics to counter children’s resistance during mealtimes resulted to problematic eaters (Sanders, et. al., 1993)

31. Action Child Child Set simple cognitive rules Set simple cognitive rules Vague instruction giving was particularly likely to be associated with increased food refusal and decreased chewing (Sanders et. al, 1993) Vague instruction giving was particularly likely to be associated with increased food refusal and decreased chewing (Sanders et. al, 1993) “When, then” rule “When, then” rule

32. Action Parents Parents Establish a unified parenting style Establish a unified parenting style Authoritative parenting style Authoritative parenting style Communicate with one another Communicate with one another Set an example to children Set an example to children

33. Maintenance Are they aware of the change they have achieved? Are they aware of the change they have achieved? Are they aware of the things that they may tempt them to revert in their old behavior? Are they aware of the things that they may tempt them to revert in their old behavior?

34. Maintenance Operant conditioning: creating an environment that will support healthy eating habits and reduce exposure to bad eating healthy habits Operant conditioning: creating an environment that will support healthy eating habits and reduce exposure to bad eating healthy habits

35. Maintenance Availability of high fat, high sugar foods are considered antecedent of poor eating habits (Bowmann and Pratt, 2008) Availability of high fat, high sugar foods are considered antecedent of poor eating habits (Bowmann and Pratt, 2008) o Discourage buying junkfoods, chocolates and candies o Discourage buying noodles and other unhealthy alternatives

36. Maintenance Reinforce positive behavior by commending good behavior Reinforce positive behavior by commending good behavior Associate healthy eating with happiness. Make eating time a pleasurable activity Associate healthy eating with happiness. Make eating time a pleasurable activity Be involved in community programs that motivate them to continue the change. Be involved in community programs that motivate them to continue the change.

37. Maintenance Addressing other issues that will contribute to the problems (e.g. finances) Addressing other issues that will contribute to the problems (e.g. finances)

38. Seeds to Make the Perras Family Grow

39. Seeds to make the Perras family grow Attention giving Attention giving Building self-esteem Building self-esteem Communicating regularly and well Communicating regularly and well Disciplining with love Disciplining with love Enhance couple relationship Enhance couple relationship

40. Seed 1: Pay Attention! Regular fun time Regular fun time Cooking time Cooking time Eating together Eating together Making meal time a pleasurable experience Making meal time a pleasurable experience

41. Seed 2: Be happy. Accept and affirm Accept and affirm If child refuses to eat food, be patient. If child refuses to eat food, be patient. CEA: Ask why, avoid getting mad. CEA: Ask why, avoid getting mad. Encourage the child. Encourage the child.

42. Seed 3: Communicate Listen. Be open. Check for understanding. Listen. Be open. Check for understanding. To your partner To your partner To your child To your child Try to understand where the other person is coming from. Try to understand where the other person is coming from. Explain. Respond openly and honestly. Explain. Respond openly and honestly.

43. Seed 4: Discipline Set house rules, agree on consequences Set house rules, agree on consequences Rules on the dining table Rules on the dining table Hygiene, toothbrushing Hygiene, toothbrushing Reward good behavior Reward good behavior

44. Seed 5: Empower Be proactive. Be proactive. Finances Finances Health-seeking behavior Health-seeking behavior