NUR 630

NUR 630 Weekly Discussion

Submission Instructions:

• Your initial post should be at least 500 words or more,

1. Introduction to Child Psychiatry

After studying Module 1: Lecture Materials & Resources, address the following in a well-written discussion post:

• Should we be “diagnosing” children with psychological disorders?  Use current US scholarly journals to support your opinion.

2. Psychiatric Assessment of Children Under 18 

After studying Module 2: Lecture Materials & Resources, address the following in a well-written discussion post:

• One common dilemma faced by psychiatric nurse practitioners is determining who the “client” is. Given that children are typically brought for treatment by their parents, describe how the psychiatric nurse practitioner would respond to a child who discloses they are indulging in illicit behavior and asks you not to tell his or her parents.

3. Internalizing Disorders

Can children in elementary school become depressed?  After studying Module 3: Lecture Materials & Resources, address the following in a well-written discussion post:

• What makes childhood depression difficult to assess? • Identify your ethnicity and culture, then explain your answer by comparing your

cultural beliefs regarding depression and anxiety and those of another ethnicity and culture.

4. Externalizing Disorders 

Some commonly followed treatments for Attention Deficit Disorder (ADD) have not been scientifically substantiated, including restricted or modified diets, treatments for allergies, treatment for inner ear problems, treatments for yeast infections, megavitamins, chiropractic adjustment and bone alignment, eye training, special- colored glasses, and biofeedback.

After studying Module 4: Lecture Materials & Resources, address the following in a well-written discussion post:

• Discuss four non-pharmacological treatments that you would recommend for a 6 year old child with ADD.

• Use the US clinical guidelines to support your response.

5. Autism Spectrum Disorder, Intellectual Disabilities, or Childhood-Onset Schizophrenia

In recent years, there have been reports linking autism to vaccinations. After studying Module 5: Lecture Materials & Resources, address the following in a well- written discussion post:

• Explain the controversy regarding vaccines as a possible cause of autism spectrum disorder.

• Does the current US based research the "other causes" of autism better explain autistic spectrum disorder?

• Use US scholarly journal articles to explain your response.

6. Health-Related Disorders, Substance Use Disorders, or Feeding/Eating Disorder

After studying Module 6: Lecture Materials & Resources, address the following in a well-written discussion post:

• Explain why some cultural/ethnic groups are disproportionately affected by childhood obesity.

• Identify your ethnicity and culture. Then, list three health promotion strategies that can be taken to address this obesity in your culture/ethnicity.

• Use the US clinical guidelines to support your response.

7. Gender Identity Disorder or Trauma/Stress-Related Disorders 

After studying Module 7: Lecture Materials & Resources, address the following in a well-written discussion post:

• Explain your views on allowing a minor to explore their gender identity. • Discuss how a psychiatric nurse practitioner could create space for a minor to

discuss their gender identities and expressions during a session? • Use the US clinical guidelines to support your response. 

Maidel

The Unequal Impact of Childhood Obesity

 

        Obesity in childhood is a problem in the United States for all ethnicities and cultures but in different magnitudes and diversities. National data indicate the rates of childhood obesity are highest in children of Hispanic origin (approx 26%) and Black Hispanics (approx 25%) while Hispanic whites are at 17% and Hispanic Asians are at 9%. The reasons for these differences are a combination of structural, environmental, and socio-cultural factors as opposed to individual “willpower.”

 

         Black and Hispanic children and youth of the earlier generation are at greater risk for a number of factors. Some of these factors include rapid weight gain in infancy, less exclusive breast feeding, an earlier introduction of solid food, short sleeping hours, a higher sugar and soda intake, a greater consumption of junk food, and longer screens. Early life exposure to these factors is important to the higher child minimum index (BMI) and higher body fat in these children in elementary schools and youth. In addition, many families are living in communities where there are no affordable and healthy food stores and where there are no safe and healthy spaces for exercising. Also, there is a greater availability of unhealthy foods that are high in calories and low in nutrients. The lower income of families, working long hours, and the high levels of stress that is related to racism and structural discrimination also make it difficult to maintain healthy lifestyles.

 

          U.S. clinical policies increasingly recognize these inconsistencies. The 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline describes pediatric obesity as \"a serious and complex chronic disease\" and states that treatment must address the child’s family system, community context, and structural obstacles, and not just the individual. The guideline suggests that early identification of obesity and assessment of social determinants of health, family-based and intensive behavioral interventions ought to be the first-line treatment. Likewise, the 2024 U.S. Preventive Services Task Force (USPSTF) advocates for children and adolescents aged 6 years and older with BMI ≥95th percentile to be referred to comprehensive and intensive behavioral intervention (≥26 contact hours) which frequently addresses nutrition, physical activity, and behavioral modifications and ideally, in a family- based structure.

 

           I have chosen to focus on the Hispanic/Latina population, since I identify myself as Hispanic/Latina. In my culture, the role of food to family and celebratory gatherings is paramount. Eating customs include the consumption of higher calorie food, as well as large portion sizes. At the same time, a large number of Hispanic families have additional challenges to face, such as low income, lack of safe areas to play and communicate, and healthcare disparities. Considering the evidence, as well as the guideline recommendations, three culturally relevant health promotion strategies to my community include:

 

Tailored Nutrition Education Focused on the Family

         One of the distinct facets of the Hispanic culture is the great emphasis on family and communal dining. Programs to promote health and behavior change are more effective when

they include entire families, children, grandparents, and parents. In accordance with recommendations and the guidance of the AAP and USPSTF, one of the best methods is to provide family- centered, multi-component behavioral programs in which traditional foods are not eliminated, but rather modified to be healthier—for instance, to prepare arroz con pollo, which is a traditional Hispanic food, with less oil, and baked rather than fried, stews with more vegetables, and sugary drinks are replaced with water. Health literacy can be addressed and improved through engagement by conducting these programs in Spanish, and with examples they can easily relate to.

 

Collaborating with Local Organizations and Schools to Promote Physical Exercise

         Having trained personnel and tailored programs with the necessary tools and facilities to offer active physical sessions and to create more supportive communities are very important to the development and effectiveness of the program. In Hispanic communities, this might resemble after-school care programs with children-participation programs such as dance and soccer interspersed with children-family exercise sessions, and programs organized from exercise modules from centers for communities or churches. Working with schools to provide daily physical education, active recess, adequate playgrounds, and “walking school bus” programs work to provide substantial and frequent physical activity and addresses the important issue of neighborhood safety that often limits outdoor play.

 

Culturally sensitive clinical screening and counseling

         In clinical practice, AAP recommends performing routine BMI percentile calculations and initiating weight discussions at an early stage in a non-stigmatizing manner. Concerning

Hispanic families, this involves offering bilingual educational resources, engaging interpreters, and bearing in mind that some families may consider a “chubby” child to be healthy. In using motivational interviewing, clinicians may assess a family’s values regarding weight, present growth chart trends in a non- threatening manner, and collaboratively set goals such as decreasing sugary drink consumption, screen-free family meals, or a family walk that is incorporated after dinner. Referrals to WIC, SNAP, or other community food resources align with the structural barriers that the guidelines indicate are necessary to effective management.

 

          The Hispanic and Black children’s obesity epidemic is a product of intertwined multiple early life adversity weight-related risk factors, structural inequities, and the sociocultural milieu. U.S. clinical guidelines call for the prompt identification of these children and a family-centered, intensive behavioral treatment approach to managing childhood obesity that is adaptable to the child’s sociocultural environment. In addressing obesity, as well as the lifelong consequences of obesity, it is in the Hispanic community that the incorporation of culturally traditional foods, enhanced family and community-sustained physical activity, and respectful, bilingual clinical service are necessary.

Kelly,

Obesity is defined as a body mass index (BMI) at or above the 95th percentile. More than 14 million U.S. children, including 22% of adolescents, meet criteria for obesity (Lin & McKenna, 2023.) Certain cultural or ethnic groups are more affected than others, such as African American, Hispanic, Native American and Pacific Islander. Research studies have shown that this disparity exists for several different reasons. Social determinants include economic barriers like healthy foods costing more than inexpensive, highly processed foods that are calorically dense, yet at the same time offering little nutritional value. Within these communities’ food desserts can exist, where access to grocery stores are geographically limited and fast food and/or convenience stores often thrive. Obesity is a complex, chronic stigmatized disease whereby abnormal or excess body fat may impair health or increase the risk of medical complications and can reduce quality of life and shorten lifespan in children and families (Ball et al., 2025.) Other factors attributed to the increasing childhood obesity are the limited play spaces that children can safely play, along with the lack of sidewalks. A lack of after school programs and recreational programs can limit children from playing together and encourages more sedentary activities inside like video games. Sedentary behaviors are prevalent in obese children causing difficulties to perform minor tasks and engaging in sports activities (Fenin et al., 2021.) Furthermore, some traditional or culturally respected foods are more calorically dense, fried or portion sizes are large, leading to unintentional increased caloric intake. Lastly, some communities face language barriers or limited access to healthcare in their cities. Obesity had adverse metabolic effects leading to insulin resistance and high blood pressure. Obesity is also linked to mental health conditions like increased anxiety and depression. Childhood obesity can result in bullying as well. The AAP guidelines highlight the

effect of neighborhood, community and population-level factors and the role of structural racism and health inequities in creating disparities and presenting barriers to treatment (Hampl et al., 2023.)

My mother was Italian, first generation born in this country. One of my favorite childhood memories is my Nana making and drying pasta on racks in her kitchen after mass on Sundays. In the Italian culture food and family are central to any get-together, holiday or celebration. Meals were typically very large with multiple meat and pasta dishes served in courses. Having seconds or even thirds were a given, not an option in our house. It was considered impolite to pass on a dish being served at the table, an insult to my Nana. The ultimate insult was to not clean your plate, heavens forbid. There was always more than one dessert option to finish the meal as well, often sitting around the table talking. Leftovers were always packed to go home with for lunch or dinner the next day. In Italy, 25.2% of children and adolescents from 3 to 17 years old are obese with a higher incidence in the southern regions (Vandoni et al., 2021.) A health promotion strategy that would respect my Italian culture would be to limit the portion sizes or even using smaller plates. Portions could be limited to the recommended serving size of three to four ounces for meat. Sauces could be tomato based instead of cream based too. Of course, downsizing the overall meal and not serving courses could be an additional strategy to reduce overall calories per meal. Also, only serving a singular meat dish and focusing on less fatty cuts of meat like ham, sausage, salami and prosciutto. Instead of having a lot of side pasta dishes, centering the side dishes to include more vegetable options. Lastly, not serving multiple options of simple carbohydrates like bread and pasta together too. Another opportunity to eat less and move more would be after the meal, instead of sitting in front of multiple desserts and talking, we could have a leisurely walk outside while talking together. Incorporating these small changes in increments could have an overall impact on improving our diet while maintaining our cultural traditions.