Deviations from age-group norms


• Altered physical growth

• Delay or difficulty in performing motor, social, or expressive skills

typical of age group

• Flat affect

• Listlessness and decreased response

• Inability to perform self-care activities or maintain self-control at

age-appropriate level


• Effect of physical disability

• Multiple caretakers

• Environmental deficiencies

• Prescribed dependence

• Inadequate caretaking

• Separation from significant

• Inconsistent responsiveness


• Indifference

• Stimulation deficiencies

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity

• Family roles and responsibilities

• Cardiac function

• Nutrition

• Communication

• Sleep


The child will

• Demonstrate skills appropriate for age.

• Participate in developmental stimulation program to increase skill


The parents will

• Express understanding of norms for growth and development.

• Use community resources to promote child’s development.

• Provide play activities to promote child’s development.


Child Development: Middle Childhood; Growth; Physical

Maturation: Female; Physical Maturation: Male


Determine: Monitor weight and height weekly. Monitor nutritional

intake, activity level, and sleep patterns. Documentation of these

factors will help measure progress over time.

Assess cardiac functioning and respiratory status to ensure that

child is healthy enough to participate in activities.

Assess child’s motor skills, communication patterns, social skills, and

cognitive abilities to evaluate where skill development may be needed.

Assess support systems available to child and parents. Where there

are gaps, other sources of support may need to be put in place.


Perform: Establish a meal program to promote nutritional needs.

Weigh and measure child weekly and review growth-chart curve to

monitor progress.

Establish a routine sleep schedule for child to ensure that the

child is healthy enough to participate in an activity.

List age-appropriate activities and exercises to stimulate bone and

muscle development and promote cardiovascular health. Provide

appropriate play activities, such as building blocks, dolls, crayons,

or games to promote development.

Administer prescribed drugs and treatments as ordered. Ensure

parents and child understand intended action and possible side effects

to ensure therapy will continue as planned.

Provide an environment that is conducive to promote changes the

child must make. Environment can be a powerful motivator.

Inform: Provide parents with information about the causes of

delayed growth and development. Provide written information to

help them know what they can expect as a result of treatment.

Discuss age appropriate nutritional requirements with parents and

child and teach additional risk factors associated with delayed

growth (e.g., lack of regular sleep, environmental hazards). Teach

appropriate activities and encourage frequent play with child. These

measures promote continuity of care.

Attend: Five child positive reinforcement for demonstrating appropri-

ate skills and behavior and encourage parents to do the same to

encourage the child to continue developing skills.

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 need to be encouraged first to accept the

child as he is and then encourage the child to develop new skills

Development can occur only when parents and staff are both realis-

tic about the child’s present stage of development.

Manage: Provide parents with referrals to appropriate community

resources, including sources for financial assistance, child care, and

suppliers of adaptive equipment, to ensure the child’s right to receive

remedial and educational support in accordance with the disability,

as guaranteed by federal law.


Developmental Enhancement: Child; Health Screening; Nutrition

Management; Risk Identification; Self-Responsibility Facilitation


Wagner, J., et al. (2006, September–October). Nurses’ utilization of parent

questionnaires for developmental screening. Pediatric Nursing, 32(5),




At risk for delay of 25% or more in one or more of the areas of

social or self-regulatory behavior, or in cognitive, language, gross or

fine motor skills


• Adopted child

• Hearing impairment

• Behavior disorders

• Inadequate nutrition

• Brain damage

• Genetic disorders

• Chemotherapy

• Lead poisoning

• Chronic illness

• Substance abuse

• Congenital disorders

• Vision impairment

• Failure to thrive

• Poverty

• Foster child

• Violence

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Coping

• Roles/relationship

• Communication

• Values/beliefs

• Emotional


The child will

• Continue to grow and gain weight in accordance with growth

chart of age and sex.

• Consume _____ calories and ________ ml of fluids representing

________ servings (specify for each food group).

• Participate in activities and be provided with a supervised, uncon-

fined environment that includes age-appropriate toys and fosters
interaction with child’s development.

The parents will

• Express understanding of measures to reduce child’s risk for

delayed development.

• Identify risk factors that may interfere with child’s development.


Family Functioning; Growth; Parenting Performance; Personal

Health Status; Risk Control


Determine: Assess family’s developmental stage; family roles; family

rules; socioeconomic status; family health history; history of substance

abuse; history of sexual abuse of spouse or children; problem-solving

and decision-making skills; religious affiliation; ethnicity. Assessment

information will aid in developing a workable plan of care.

Perform: Weigh and measure child. Review growth chart to establish

current height and weight values.

Establish a meal program to meet the child’s nutritional needs.

Create an environment in which family members can express

themselves openly and honestly. Establish rules for communication

during meetings with the family. Having rules allows everyone to

participate and keep the discussion on the designated topic.

Inform: Teach parents about nutritional requirements needed for

child of specific weight and age. Discuss various meal choices avail-

able to the child. Providing instruction in writing simplifies the par-

ents’ role in selecting healthy foods.

Educate parents about child’s need for quality interaction with

family members and others. Inform parents about age-appropriate

activities and toys as well as potential playmates for a child of spe-

cific age. Emphasize importance of providing an unconfined, super-

vised environment in which the child can play to encourage play

that encourages the child to move freely.

Educate parents about risk factors that may lead to delayed devel-

opment, such as lack of supportive interactions or age-appropriate

activities. The ability to recognize risk factors will promote getting

help for the parents and child sooner.

Teach coping skills to parents to enable them to deal effectively

with the child’s needs.

Attend: Encourage parents to listen to the child and communicate in

a loving, supportive way in order to allow the child to maintain a

positive attitude.

Encourage parents to identify preventive measures they may initi-

ate at home to ensure continuity of care. Consistency in providing

care will help the child understand that the plan carries over to all

aspects of his or her life.

Manage: Provide parents with a copy of child’s teaching plan. This

helps to reinforce what the child is learning.

Refer to case manager/social worker to ensure that a home assess-

ment is done.

Refer to nutritionist for follow-up with food issues.


Nutrition Management; Family Process Maintenance; Coping

Enhancement; Family Integrity Promotion; Maintenance; Normaliza-

tion Promotion; Substance Use Prevention; Substance Use Treatment;

Risk Identification


Moss, J. (2005, March). Development of a functional ability scale for children

and young people with myalgic encephalopathy (ME)/chronic fatigue syn-
drome (CFS). Journal of Child Health Care, 9(1), 20–30.