Risk factors may include
Separation from parents and family, peer group
Environmental and stimulation deficiencies, effects of physical disability or confinement
Inadequate care; multiple caretakers; prolonged, painful treatments
Possibly evidenced by
(Not applicable, presence of signs and symptoms establishes an actual diagnosis)
Desired Outcomes/Evaluation Criteria—Child Will
Child Development: [specify age group]
Perform motor, social, and/or expressive skills typical of age group within scope of present capabilities.
Demonstrate weight and growth-stabilization or progress toward age-appropriate size.
Nursing intervention with rationale:
1. Determine existing factors or condition(s) that could contribute to growth or development deviation, such as chronic illness, substance use or abuse, familial history of pituitary tumors, Marfan’s syndrome, and genetic anomalies.
Rationale: Plan of care will be based on individual factors present, immediacy of threat, and potential long-term complications. Note: Tobacco, alcohol, or other drug use are major healthcare concerns for children.
2. Determine child’s birth weight and length and compare present growth with norms.
Rationale: Identifies the child’s status compared with other children of the same age.
3. Note chronological age and familial factors, such as body build and stature. Review expectations for current height and weight percentiles and degree of deviation.
Rationale: Aids in determining growth expectations (Sutter Health, n.d.).
4. Measure developmental level using age-appropriate tests, such as the Denver Developmental Screening Test. Note reported losses or alterations in functional level.
Rationale: Provides comparative baseline and basis for choosing developmentally appropriate interventions.
5. Determine child’s cognitive and perceptual level, such as grade level in school. Note behavioral reaction to environment and stimuli, such as withdrawal or aggression.
Rationale: Illness or injury can lead to a temporary increase in level of dependency and a decline in functional level. Although this may not be of major concern for the short term, chronic and recurrent conditions may delay acquisition of important developmental milestones.
6. Note severity and pervasiveness of situation. For example, is the child showing effects of long-term physical or emotional abuse or neglect versus experiencing recent onset situational disruption or inadequate resources during period of crisis or transition?
Rationale: Problems existing over a long period may have more severe effects and require longer course of treatment to reverse.
7. Determine occurrence and frequency of significant stressful events in the child’s life, including losses, separation, and environmental changes, such as abandonment, divorce, death of parent or sibling, and relocation.
Rationale: Lack of resolution or repetition of stressor can have a cumulative effect over time and result in regression in, or deterioration of, functional level.
8. Discuss nature and effectiveness of parenting and caregiving activities, noting inadequate, inconsistent, unrealistic, or insufficient expectations as well as lack of stimulation, limit setting, or responsiveness.
Rationale: Assessment of parenting and potential for conflict and negative interaction between parent or caregiver and child identifies interventions needed to maximize care.
9. Assist with therapy to treat or correct underlying conditions, such as Crohn’s disease, cardiac problems, or renal disease; endocrine problems, such as hypothyroidism, type 1 diabetes mellitus, or growth hormone abnormalities; and genetic or intrauterine growth retardation, infant feeding problems, or nutritional deficits.
Rationale: Illness, hospitalization, treatments, and separation from parents and family have a negative effect on physical and psychological growth and development.
10. Refer to available community resources as appropriate such as public health programs, medical equipment suppliers, nutritionist, substance abuse program, and specialist in endocrine conditions or genetics.
Rationale: Although acute situations may be readily resolved with limited support and few ill effects, chronic or recurrent conditions require many resources to maximize growth potential of child and family.