Counseling Problems, Case Study Example

Mr. and Mrs. Quam are going on a trip and are going to leave their 10 week old baby at home with relatives. They want to know how to arrange for feeding the baby.

Chief or primary concerns: The primary concern in this scenario is to determine how to manage the feeding schedule for the baby while the parents are away, and this requires them to recognize the baby’s feeding patterns and what has been successful for the child thus far in managing feeding in an effective manner.

Hunch regarding main problem/concern: It is believed that the child will best benefit from a feeding regimen that will be as close as possible to the current strategy so that the child’s routine is not disrupted, as this is likely to prevent further complications or other challenges that impact the child’s overall nutrition and level of comfort (Lauwers & Swisher, 2010, p. 34)

Additional questions to ask:

• What is the child’s current feeding schedule?
• How many times per day is the child currently fed?
• Do you breastfeed all the time or is a combination of pumped milk/bottle feeding and breast feeding?

What might be found in exam or interview: In an exam or interview, it is important to address questions regarding the child’s feeding patterns in order to better gauge what might be most successful for the child in moving forward while the parents are away.

Three suggestions: Mom: 1) Recognize the appropriate times in which to pump in order to prepare for the time away (What to Expect, 2015); Feeding Session: 2) Establish a feeding schedule for those who will be caring for the child while the parents are away and write it down in a clear and concise manner; Baby: 3) As part of the schedule, provide any suggestions that might guide the family when the child becomes fussy and it may be difficult to understand why the child is unhappy for any number of reasons.

Irma Rodriguez, a 15 year old WIC participant is having her first baby in 3 weeks. She doesn’t want to breastfeed because it will tie her down and she won’t be able to have Depo.

Chief or primary concerns: The client’s primary concern is that she will not be able to continue to take Depo-Provera shots and breastfeed at the same time; therefore, she is hesitant to give up her method of birth control and to breastfeed her child.

Hunch regarding main problem/concern: It is known that Depo-Provera may limit the amount of milk that is produced by a woman’s breast; therefore, it is not recommended to breastfeed and take this type of medication at the same time (Lauwers & Swisher, 2010, p. 125).

Additional questions to ask: Based upon this information regarding the use of Depo-Provera and breastfeeding, it is important to ask the client the following:

• Is there another method of birth control that you might be willing to substitute so that you are able to breastfeed?
• Do you believe that the benefits of taking Depo-Provera will override the benefits of breastfeeding?
• How would the child respond to other types of milk rather than breastmilk and do you accept any possible risks that this might entail?

What might be found in exam or interview:  During the interview process, it is important to identify specific areas where the client might be able to better understand her position regarding Depo-Provera. This requires questions regarding the period of time that the drug has been used, any possible side effects that have occurred in relation to the drug, and what steps may be required to ensure that the client is effectively prepared to manage any risks related to using milk products rather than breast milk.

Three suggestions: Mom: 1)Consider the benefits of Depo-Provera versus the risks of not breastfeeding; Baby: 2) Evaluate other birth control methods that would not interfere with breastfeeding; and Feeding Session: 3) Examine other milk options in detail prior to making any final decisions.

Madeline Suez has a 10 day old infant who never acts hungry, sleeps most of the day, and is sleeping 6-7 hours at night. The baby rarely cries. The baby is 7% below birth weight.

Chief or primary concerns: The child is below birth weight, does not seem to be hungry and is consistently sleeping the majority of the day without complications.

Hunch regarding main problem/concern: It is suspected that the child is facing a phenomenon known as Failure to Thrive, which is characterized by a birth weight that is below the norm and for which other behaviors are atypical at this stage (MedlinePlus, 2015).

Additional questions to ask: It is important to ask the following questions regarding the child’s level of development at this early stage: 1) Describe a typical day in the child’s life; 2) How much is the child eating at this this stage and how frequently are the feeding times? 3) Does the child appear to be developmentally normal in other areas?

What might be found in exam or interview: In an exam or interview, it is likely that questions regarding the child’s level of development will be questioned, along with other factors that may be indicative of early problems or concerns for the child at this stage. In addition, feeding levels and times must also be evaluated at this level.

Three suggestions: Mom:

• Monitor how much the child eats and if there is an increased need for feeding at a higher level;
• Monitor the child’s behavior in order to determine if there are any signs of developmental problems at this stage;
• Determine if the child’s feeding patterns are too excessive and if changes are necessary.

Mrs. Tao calls to rent a breast pump because the pediatrician at the clinic says her baby isn’t gaining weight fast enough. Her baby is 16 days old and she supplements with traditional juice.

Chief or primary concerns: For this child, there is a lack of weight gain at an early age that is causing concern for the mother, and she requires further guidance with the use of a breast pump in order to attempt to stimulate weight gain at a more rapid pace.

Hunch regarding main problem/concern: For the child, it is suspected that the child may not be consuming the appropriate combination of nutrients and calories on a regular basis, and furthermore, juice supplementation is not providing any additional support to the child at this level (Kirkland, 2015). In this context, the child faces an uphill battle that requires further nutritional evaluation and recommendations.

Additional questions to ask:

• How much does the child eat currently?
• How much juice is given to the child on a supplemental basis?
• What benefits do you believe that the breast pump will provide for the child in terms of feeding and general nutritional value?

What might be found in exam or interview: During the exam process, the child should be weighed to determine current weight and where this falls with respect to traditional weight patterns at this age. In addition, the mother should be asked questions regarding the child’s current feeding patterns, how much is consumed, and how much juice is used to supplement the child’s diet.

Three suggestions: Feeding Session:

• It is recommended to eliminate juice from the child’s diet because it does not provide any real nutritional value;
• Begin to utilize the breast pump in order to increase the amount of milk that is administered to the child;
• Aim to increase the frequency of the feeding schedule to support the child’s feeding pattern.

References

Kirkland, R.T. (2015). Patient information: poor weight gain in infants and children (Beyond the basics). Retrieved from http://www.uptodate.com/contents/poor-weight-gain-in-infants-and-children-beyond-the-basics

Lauwers, J., & Swisher, A. (2010). Counseling the Nursing Mother: A Lactation Consultant’s Guide. Jones & Bartlett Learning.

MedlinePlus (2015). Failure to thrive. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000991.htm

What to expect (2015). Feeding baby when you’re away. Retrieved from http://www.whattoexpect.com/first-year/feeding-baby-when-youre-away