CASE STUDY: Preschool Child: Ricky 
Ricky, age 4 years, arrives in the clinic with his mother. Ricky lives with his mother and father, who both work full-time, and his infant sister. Their extended family lives in a different state more than 100 miles away. Both parents are of average height and in good health. Ricky’s mother mentions that Ricky often expresses frustration, particularly in regard to food. Conflict over food occurs every day. Mealtime is a battle to get him to eat, unless his mother feeds him. Ricky’s baby sister seems to tolerate all baby foods but requires her mother to spoon-feed. Ricky’s mother is quite frustrated and concerned that he will become malnourished.  
Reflective Questions 

What additional assessment information would you collect? 
What questions would you ask, and how would you further explore this issue with the mother?  
In what ways does the distance of the extended family influence this family’s approach to health promotion?  
What factors would you consider to determine whether malnourishment is a factor in this family?