RISK FOR DISPROPORTIONATE GROWTH
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
as chemical or radiation expo-
sure, lead exposure, passive
inhalation of tobacco smoke,
and exposure to air, water, or
· 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.)
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.
· Identify risk factors that may lead to disproportionate growth.
· State understanding of preventive measures to reduce risk of dis-
SUGGESTED NOC OUTCOMES
Appetite; Body Image; Child Development: Middle Childhood
Growth; Risk Control; Weight: Body Mass
INTERVENTIONS AND RATIONALES
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
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.
SUGGESTED NIC INTERVENTIONS
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,