CLIENT OVERVIEW
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Kirk is a seven year old white boy whose referral problems included delayed speech, short attention span, poor appetite and slow physical and mental development.
His natural father, Steve, was his grandfather's son from a previous marriage that ended in divorce. At 21, Steve met his wife, Karen, on a blind date and they were married when she was only 16. Kirk's mother, Karen, feared weight gain during pregnancy and consequently restricted her diet. She seldom ate breakfast and drank a great deal of coffee. She also was drinking beer. She smoked a pack of cigarettes daily.
Kirk had a low birth weight despite the fact that he was born full term. By his first birthday, he had been admitted to the hospital several times.
Steve and Karen had a violent marriage that on several occasions necessitated police intervention. Kirk was a battered child who, at age two, was taken from his parents by the state police. Kirk's grandparents offered to keep him since they felt that the maternal grandparent's home would be "just as bad as where he came from." When they took him he had multiple bruises and weighed only 21 lbs. He would simply lie quietly, unable to lift his head.
A year later, Kirk was legally adopted by his grandparents on his father's side. They were in their early fifties and had been married for 18 years. Kirk's parents were both amenable to the adoption. Mrs. R., Kirk's grandmother and adoptive mother, left her job as a supermarket cashier to take care of Kirk full-time. Aware of Kirk's limited intelligence, she was determined that he would not be labeled "retarded."
Kirk
appeared happy in his new living situation. Mr. and Mrs. R. had provided a
stable, adequate life for him. Mrs. R., however, was very concerned about
Kirk's poor appetite; he did not appear to care for food and he would pick
at his food during mealtimes. Mrs. R. even tried to give him some of the so-called
reward foods such as candies or carbonated beverages, but he did not care
for these either. He also disliked dry beef or pork.
At age seven, a comparison of Kirk's Day 2 food record to the Food Guide Pyramid showed that his meat intake was almost adequate, but his fruit-vegetable and cereal-bread intakes were only 50 per cent of his needs. He also did not drink water.
Although Kirk's parents were both tall, his height and weight were below normal range. At age five he was small but well proportioned. At seven, his size corresponded to that of an average five year old. It was noted that after moving to his grandparent's house there were improvements in his height and weight.
At age seven, Kirk recieved a physical examination. He was observed to be lethargic and refused to complete the interview on his food preferences in which a food picture book and hand puppets were used. His oral hygiene needed to be improved and a couple of carious teeth were identified. His face was slightly pale and no skeletal abnormalities were observed.
Kirk was one of many children who received comprehensive nutrition assessment through an agency that provided funding for the necessary tests. Kirk's blood thyroxine, proteins, fasting sugar, hemoglobin, hematocrit, vitamin A, and carotene were all within normal range. Ascorbic acid load tests indicated that he was a moderate excretor and the tryptophan load test revealed borderline pyridoxine status.
