Scenario 2 - continued

Since it is evident that Julie's rate of weight gain needs to be slowed, you work with her parents to develop some guidelines for decreasing Julie's energy intake. You explain that you can provide more information once you receive her food record.

The food record arrives and you review it over the phone with Julie's mother. It appears to be complete (items like margarine on toast and drinks between meals are recorded), but her intake is still less than the Estimated Energy Requirement (EER). With what you know about Prader-Willi syndrome and about Julie's growth pattern, you decide:  

You also evaluate Julie's food record for other nutrients. Her protein intake is greater than the DRI for age, which you decide is not inappropriate. Her intake, with the multiple vitamin supplement she takes, is adequate for vitamins and minerals.

You identify some specific areas where the family can make changes (for example, using nonfat milk instead of low fat milk and offering raw vegetables at snacks instead of chips and crackers). You encourage Julie's parents to share this information with Julie's other caregivers.

Finally, you schedule a follow-up appointment with Julie's family to monitor her growth and intake.