Clinical Nutrition
860.610.4286
www.connecticutchildrens.org OPEN-ENDED QUESTIONS
As dietitians, we often have lots of information we need to gather to complete a nutrition assessment. How can we
get the answers we need in the context of a motivational interviewing style?
Below is an outline of some questions on a typical initial nutrition assessment (adapted from Connecticut Children’s
Medical Center intake form for overweight/obese children). Working with another dietitian, go through the form and
brainstorm ways to get answers using open ended questions. Then, look at the next page for some suggestions and
compare. Did you think of any of these? Did you come up with some other ideas? You can use your own forms and
go through the same exercise. Practice with a patient or two, then meet again with your peer (or group) to discuss
reactions and outcomes.
Reason for Visit/Dx:_________________________________________________________________________________
Medical History:____________________________ GI issues:_______________________________________________
Allergies:__________________________________ Lab Data: _______________________________________________
Meds/MVI/Herbal:__________________________________________________________________________________
Fm Med hx:________________________________________________________________________________________
Pt/family main concern:______________________________________________________________________________
Present at visit:_____________________________________________________________________________________
Growth history/recent changes in anthropometrics: ______________________________________________________
Eating Patterns/Behaviors:
Food refusal
Grazing pattern
Excessive fluid intake
Frequent snacking
Dieting
Excessive portions
Food restriction
Hoarding/Sneaking
Eats out of boredom
Eats in front of TV
Emotional eating
Disordered eating behaviors
Physical Activity/Exercise:
Sedentary
Limited
Adequate (minimum of 1 hour/day)
Excessive
Hobbies/Interests:___________________________________________________________________________________
TV/Video Games/Computer: ................................................................................................................................................. _____________ hours/day
Lifestyle:
Family meals together:
Hours of sleep:
seldom
Adequate
1-2x/week
Insufficient
3-4x/week
Sleep Pattern:
5 or more x/week
Normal
Interrupted
Previous attempts at wt loss:___________________________________________________________________________
Barriers to success:__________________________________________________________________________________
282 Washington Street, Hartford, CT 06106 • © 2011 Connecticut Children’s Medical Center. All rights reserved. 11-298/11 New 8-11
EXAMPLES OF OPEN-ENDED QUESTIONS:
Is it ok if I go through some routine questions? But first….
Reason for Visit/Dx: Tell
me what brings you here…..__________________________________________
Medical History:____________________________ GI issues:_______________________________________________
Allergies:__________________________________ Lab Data: _______________________________________________
Meds/MVI/Herbal:__________________________________________________________________________________
Fm Med hx:________________________________________________________________________________________
Pt/family main concern:
would you describe for me your major concerns about your
child’s eating?_________________________________________________________________________________
Present at visit:_____________________________________________________________________________________
Growth history/recent changes in anthropometrics: Tell
me about your child’s growth, and any
changes recently…___________________________________________________________________________
Eating Patterns/Behaviors: Can
I ask you about some specific eating behaviors some
people struggle with? (If the answer is Yes to any of the items below, ask “tell
me what happens” or “tell me what you mean”)
Food refusal
Grazing pattern
Excessive fluid intake
Frequent snacking
Dieting
Excessive portions
Food restriction
Hoarding/Sneaking
Eats out of boredom
Eats in front of TV
Emotional eating
Disordered eating behaviors
Physical Activity/Exercise: What do you like to do for fun?
Sedentary
Limited
Adequate (minimum of 1 hour/day)
Excessive
Hobbies/Interests:___________________________________________________________________________________
TV/Video Games/Computer: ................................................................................................................................................. _____________ hours/day
Lifestyle: Would
you mind describing what your family meals are like? What is
hard about getting meals together?
Family meals together:
Hours of sleep:
seldom
Adequate
1-2x/week
Insufficient
3-4x/week
Sleep Pattern:
5 or more x/week
Normal
Interrupted
Previous attempts at wt loss: What
kind of things have you done to try to eat
healthier? What is hard about it? What have you been struggling with?__________
Barriers to success:__________________________________________________________________________________
282 Washington Street, Hartford, CT 06106 • © 2011 Connecticut Children’s Medical Center. All rights reserved. 11-298/11 New 8-11