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pain or changes that may occur to his or her body. It is important for physicians and family members to be honest and open with the school-age child. The school-age child may miss school and the interactions with his or her peers. The school-age child may regress and exhibit behaviors of a younger child, such as needing special comfort toys or demanding attention from his or her parents. Hospitalization for the school-age child can bring with it a loss of control. The school-age child is used to controlling his or her self-care and making choices about his or her meals and activities. When caring for the hospitalized school-age child, the nurse must use knowledge of normal growth and development to recognize potential delays, promote continued appropriate growth and development, and interact successfully with the school-age child. Provide opportunities for the school-age child to maintain independence, gain control, and increase self-esteem. NURSING PROCESS OVERVIEW Upon completion of assessment of the school-age child’s current growth and development status, problems or issues related to growth and development may be identified. The nurse may then identify one or more nursing diagnoses, including: • Risk for disproportionate growth • Imbalanced nutrition: more than body requirements • Delayed growth and development • Risk for caregiver role strain • Risk for injury Nursing care planning for the school-age child with growth and development issues should be individualized based on the school-age child’s and family’s needs. The nursing care plan can be used as a guide in planning nursing care for the school-age child with a growth and development concern. The nurse may choose the appropriate nursing diagnoses from Nursing Care Plan 6.1 and individualize them as needed. The nursing care plan is intended to serve as a guide, not to be an allinclusive growth and development care plan. Promoting Healthy Growth and Development The family plays a critical role in promoting healthy growth and development of the school-age child. Respectful interchange of communication between the parent and child will foster self-esteem and self-confidence. This respect will give the child confidence in achieving personal, educational, and social goals appropriate for his or her age. The nurse should study interactions between parents and school-age children to observe for this respect or lack of respect (”putting the child down”). The nurse can model appropriate behaviors by listening to the child and making appropriate responses. The nurse can be a resource for parents and an advocate for the child in promoting healthy growth and development. Promoting Growth and Development Through Play Cooperative play is exhibited by the school-age child. Play for the school-age child includes both organized cooperative activities (such as team sports) and solitary activities. School-age children have the coordination and intellect to participate with other children their age in sports such as soccer, baseball, football, and tennis. The school-age child comprehends that his or her cooperation with others will lead to a unified whole for the team. Additionally, the child learns rules and the value of playing by the rules. NURSING CAREPLAN 6.1 Growth and Development Issues of the School-Age Child NURSING DIAGNOSIS: Risk for disproportionate growth (risk factors: caregiver knowledge deficit, frequent illnesses) Outcome Identification and Evaluation School-age child will demonstrate adequate growth: appropriate weight gain and increases in height for age and gender Interventions: Promoting Proportionate Growth • Assess parent’s knowledge of nutritional needs of school-age children to determine need for further education. • Plot out height, weight, and body mass index (BMI) to detect possible pattern. • Determine need for additional caloric intake if necessary (if very active in sports, if have a chronic illness). • Educate mother about appropriate serving sizes and foods so that mother is aware of what to expect for school-age children. NURSING DIAGNOSIS: Ineffective Health Maintenance related to lack of exercise, increased caloric intake, poor food choices Outcome Identification and Evaluation School-age child will engage in health maintenance behaviors and lose weight at an appropriate rate: increase amount of exercise, make appropriate eating choices, decrease caloric intake to appropriate amount for age and gender Interventions: Promoting Appropriate Health Maintenance Behaviors • Assess knowledge of parents and child about nutritional needs of school-age children to determine deficits in knowledge. • Plot out height, weight, and BMI to detect weight loss or weight gain. • Have child keep food and exercise diary for 1 week to determine current patterns of eating and exercise. • Interview parents in relationship to their eating habits and exercise habits to determine where adjustments might need to be made. • Analyze preceding data, and base recommendations for changes on these data. • Discuss ways to decrease temptation to overeat and to make good meal choices (see Teaching Guideline 6.2). • Have child assist in meal planning and grocery shopping to allow him or her some sense of control in process. • Incorporate increase in daily exercise, which will stress sense of self-improvement, to increase

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