Question: Post 1: For this week's discussion, I chose the 5-year old girl with normal weight with obese parents. Unfortunately, this topic hits close to home as our youngest daughter is 4 ½ and both my husband and I have gained significant weight over the past few years and are in the obese category. Most children are able to self-regulate diet and balance what they eat with the amount of energy that they are expending. Parental influence at a young age can have a significant effect on the child's ability to regulate on their own. Obesity places adults and children alike at a higher risk for hypertension and diabetes than those of normal weight. A child who has obese parents is at a higher risk of becoming obese due to unhealthy eating habits that are learned at home. Obesity is defined in the course text as BMI > 95th percentile for age and gender in children ages 2-18 (Ball, Dains, Flynn, Solomon and Stewart, 2015).

During the child's health assessment the provider needs to be watchful for any signs of malnutrition as well as over-nutrition. In addition to standard screening using height, weight and BMI, additional nutritional screening should be performed. Below are three specific questions that could be utilized to further assess nutrition and risk for obesity.

1. Can you describe to me all of the foods that the child has eaten in the past 24-48 hours? How many sugary drinks such as soda and juice, does the child drink each day?

2. How many minutes/hours of screen time does your child have per day?

3. Do you have a standard bedtime? How many hours of sleep does the child typically get per night?

Describing the foods that the child has eaten over 24-48 hours will provide a more accurate account of overall nutrition. Specifically asking about sugary drinks such as soda and juice can provide opportunity to discuss the health risks that can be associated with too much sugar intake. Specific questions related to amounts of fruits and vegetables are important as well. Determining if the child is receiving adequate nutrients from the food that they are eating is important. If there is concern that the child may not be receiving enough vitamins and minerals from food, it may be necessary to recommend a multi-vitamin to supplement what the child is missing from diet.

There are multiple studies that have shown that an increased amount of screen time can have devastating effects on children's health. High volume of screen time whether that is from television, video games, computers or other hand-held devices can lead to increased risk of obesity as well as behavioral problems. Asking questions related to screen time also provides the opportunity to determine where the child eats most of their meals. Does the family eat together at the table? Do they eat while watching television? How often do they eat in the car or on the go due to busy schedules? These factors can be used to determine the risk of the normal weight child at age 5 becoming overweight or obese as they get older. These questions also provide an opportunity to educate parents on healthy eating habits that they can utilize as well to improve the overall health of the family.

Another important factor to determine overall health of the child is determining if the child is getting enough sleep each night. Children are in a period of rapid growth in early childhood and the body needs time to rest so that it can develop appropriately. Asking if the child has a standard bedtime and how many hours of sleep the child gets each night can help determine if the child is getting adequate sleep. In relation to screen time it is important to discuss bedtime habits that the child and parents may have as well. Does the child have their own bedroom? Or do they share with an older sibling or parent? Is there a television in the room? Video games in the room? There are many children whose parents will tell providers that their children are in bed by 8 pm each evening and while that may be a true statement, the child may not actually be going to sleep until much later due to television or other distractions present in the room. This again provides the opportunity to educate family members on the importance of a good night sleep for overall family health.

Strategies to encourage parents to be proactive about child's health

In addition to the above strategies, maintaining a food dairy can be an excellent tool to determine over time whether there is adequate nutrition for both the child and parents. There are many tools that can be utilized to keep a food diary. A simple notebook and pen works well and with all of the technology available, there are multiple apps such as My Fitness Pal that can be used to track more than the type of food. They can help track calories, fat, cholesterol, sugar as well as exercise. These apps are only as good as the information that the user puts in them. "Parents influence a child's weight through interactions that shape the development of child eating behaviors." (Pietrobelli and Agosti, 2017). Parents can be educated on modeling good habits of eating such as eating at the table versus in the care or while watching television. Avoid using food as a reward that can lead to child becoming an emotional eater when they are older. (Pietrobelli and Agosti, 2017). Providing good habits that can be passed on to children can also decrease their risk of depression and eating disorders such as anorexia and bulimia.

Reference: Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Pietrobelli, A., & Agosti, M. (2017). Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science. International Journal Of Environmental Research And Public Health, 14(12), doi:10.3390/ijerph14121491

Rub, G., Marderfeld, L., Poraz, I., Hartman, C., Amsel, S., Rosenbaum, I., & ... Shamir, R. (2016). Validation of a Nutritional Screening Tool for Ambulatory Use in Pediatrics. Journal Of Pediatric Gastroenterology And Nutrition, 62(5), 771-775. doi:10.1097/MPG.0000000000001046
Watkins, F., & Jones, S. (2015). Reducing Adult Obesity in Childhood: Parental Influence on the Food Choices of Children. Health Education Journal, 74(4), 473-484

Post 2: Diagnostic Tests: Mammography

Mammography is an effective diagnostic test that can help practitioners identify breast cancer at an early stage (Jerome-D'Emilia & Chittams, 2015). Typically, a mammogram is a series of x-ray images capable of detecting tumors too small to be palpated as well as calcium microcalcifications that are associated with breast cancer growth (National Cancer Institute, 2016). Screening mammograms are performed routinely and diagnostic mammograms, specific targeted imaging, are used when changes are identified on screening exams or when visibility is compromised, for example with breast implants (National Cancer Institute, 2016).

It is important to evaluate the validity and reliability of important screening tests like mammography to ensure proper screening and early diagnosis and treatment in affected patients. This early detection allows for a greater array of treatment options and an improved overall prognosis (Jerome-D'Emilia & Chittams, 2015). The reliability and validity of the mammogram increases when used in accordance to recommendations, for instance, in patients over the age of 30, as younger women have increased breast density that affects the diagnostic value (Dains, Baumann, & Scheibel, 2016). In addition, for best results, it is important to adhere to regularly scheduled mammograms, typically done annually for women over the age of 40 (National Cancer Institute, 2016). The National Health Service Breast Screening Programme has developed national guidelines to standardize image assessments and screening programs (Hill & Robinson, 2015). The Breast Imaging Reporting and Database System provides radiologists a uniform way to describe and report findings from mammograms, which helps physicians to appropriately coordinate necessary plans of care (National Cancer Institute, 2016).

At times, mammogram imaging can lead to false-positive results, when radiologists identify abnormalities without the presence of cancer. This can result in over treatment with follow up diagnostic mammograms, ultrasounds, and biopsies to rule out findings (National Cancer Institute, 2016). Predictive values can change if screening is not done properly, and Taylor et al. describes breast positioning as being the most important factor in producing quality mammography images (2017). Ensuring that diagnostic tests provide valuable, accurate, and useful information is key to preventative health care services and early management and treatment of identified disease processes.

References: Jerome-D'Emilia, B., & Chittams, J. (2015). Validation of a cultural cancer screening scale for mammogram utilization in a sample of African American women. Cancer Nursing, 38(2), 83-88.

National Cancer Institute. (2016). Mammograms.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Hill, C., & Robinson, L. (2015). Mammography image assessment; validity and reliability of current scheme. Radiography, 21, 304-307.

Taylor, K., Parashar, D., Bouverat, G., Poulos, A., Gullien, R., Stewart, E., & ... Wallis, M. (2017). Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment. Radiography, 23(4), 343-349.