At risk for growth above the 97th percentile or below the 3rd per-

centile for age, crossing the percentile channels


· Altered nutritional status

· Inability to digest and absorb

· Any disease that persists over


time, especially during critical

periods of development

· Neuroendocrine factors, such

as altered levels of growth or

· Environmental hazards, such

thyroid hormones

as chemical or radiation expo-

sure, lead exposure, passive

inhalation of tobacco smoke,

and exposure to air, water, or

food contaminants

· Prenatal influences, such as

maternal exposure to drugs or

alcohol, severe maternal malnu-

trition, and maternal smoking

· Financial or socioeconomic

· Genetic abnormalities


ASSESSMENT FOCUS                           (Refer  to  comprehensive  assessment  parameters.)

· Nutrition

· Sleep

· Activity

· Coping


The child will

· Grow and gain weight as expected on the basis of growth-chart

norms for age and gender.

· Consume _____ calories and ___ml of fluids representing ____

servings (specify for each food group).

· Achieve ____ hours of uninterrupted sleep daily.

· Maintain age-appropriate activity level.

Parents will

· Identify risk factors that may lead to disproportionate growth.

· State understanding of preventive measures to reduce risk of dis-

proportionate growth.


Appetite; Body Image; Child Development: Middle Childhood

Growth; Risk Control; Weight: Body Mass


Determine: Monitor weight and height weekly to evaluate progress.

Monitor temperature, activity levels, sleep patterns, and changes

in nutritional status. Monitor prescribed and over-the-counter med-

ications taken. Determine exposure to tobacco smoke and/or other

environmental contaminants. These assessment parameters will assist

in developing appropriate interventions.

Perform: Weigh and measure the child weekly to evaluate progress.

Review growth-chart curve to compare with growth history.


Establish meal program that meets the child’s nutritional needs.

Establish routine sleep schedule for the child. Help child keep a

chart to encourage increased levels of self-care.

List age-appropriate activities and exercises for the child to stimu-

late bone and muscle development and promote cardiovascular health.

Administer prescribed drugs and treatments as ordered. Ensure

that the child and parents understand the intended action and side

effects that may occur to ensure that therapy can continue without


Provide an environment that is conducive to promote changes the

child must make. Environment can be a powerful motivator.

Inform: Educate child and parents on nutritional requirements for

child’s age and gender. Discuss meals available to the child at home

to promote growth.

Teach child and parents about risk factors associated with dispro-

portionate growth, such as poor nutrition, lack of regular sleep,

environmental hazards, or lack of age-appropriate activities. Help to

identify preventive measures to be taken in the home to promote

continuity of care.

Attend: Encourage healthy, loving interactions between child and

other family members. Demonstrate healthy and positive interactions

with the child. Disproportionate growth may be associated with

emotional deprivation.

Encourage child and parents to express feelings about present

state of child’s health. Listen attentively with understanding about

the self-esteem associated with what is considered by peers to be

other than normal. Parents will need help in supporting the child

through difficulties coping with normal peers.

Manage: If a medical or psychiatric illness places child at risk for dis-

proportionate growth, make sure child gets adequate follow-up med-

ical care and ensure that the care is appropriate and professional.

This will ensure the child’s right to receive remedial and educational

care in accordance with his disability, as guaranteed by federal law.

If financial hardship interferes with the family’s ability to provide

for child with disproportionate growth, offer a referral to a social

worker to improve the family’s access to community resources.


Active Listening; Behavior Modification; Coping Enhancement;

Counseling; Nutritional Management; Patient Contracting; Weight



Gregory, K. (2005, January–February). Update on nutrition for pre-term and

full term infants. Journal of Obstetric, Gynecology, and Neonatal Nursing,

34(1), 98–108.