Question

1. Steven, a 4-year-old boy, is seen in the pediatric office for a well-child exam. He is a healthy, active boy who attends extended-day preschool as his mother works long hours. His mother states she has some questions about Steven. She says she is concerned about Steven’s growth, his language skills, and disciplining him. Steven’s mother tells you that “he seems heavier than my other children did at his age.” Upon measuring Steven you note his height to be 38.5 inches (98 cm) and his weight to be 46 pounds (20.9 kg). His calculated BMI of 21.76 plots well above the 95^th percentile for age. After further discussion with Steven’s mother, you determine that he has an excessive daily intake of fruit juice and whole milk, and eats numerous fast-food meals weekly.

1. Describe teaching about diet and activity that you will do with Steven’s mother.

Steven’s mother asks if there is something wrong with Steven because he stutters and says “um” a lot.

2. What type of education or support will you give Steven’s mother?
3. When questioned about the type of discipline used in the home, Steven’s mother states that she feels bad when she spanks him, because he becomes so withdrawn afterwards and that it doesn’t really seem to work anyway. She states she just doesn’t know what else to do. What kind of anticipatory guidance can you provide?

2. Gina has come into the primary care center with her mother Kris for an 11-year-old wellness examination. As the nurse prepares Gina for her examination, Kris asks to speak to the nurse outside the examination room. Kris shares with the nurse her concerns about recent changes she has noticed in Gina. She explains that Gina’s body is beginning to change and she has made a number of comments about her body image. Kris is concerned about Gina’s self-esteem and emotional development.

a. What are some of the prepubescent changes school-age children experience that the nurse can share with Kris?

b. What are some of the issues regarding body image that the nurse can teach Kris about?

c. What can the nurse teach Kris regarding self-esteem in school-age children to address her concerns?

Answer 1

1.

Steven, 4yr old boy is a preschooler( 4-6 years) and given that his calculated BMI is normal (more than 95 % of for age ).

Also given he attends extended-day preschool as his mother work long hour which shows that Steven is getting less attention from his mother.

(a) Teaching about diet and activity for Stevens mother:

(i). For preschoolers nutritional habits are developed in this period. Mealtime promotes socialization and helps learn appropriate mealtime behaviour and language skills. So meal time require special attention. That is tell Stevens mother to take extra care of him for at least during the meal time.

(ii). The child needs all food items as taken by adults but in smaller quantities with all nutritive values as required for a balanced diet. Emphasis should be on quality rather than quantity. Here it is okay for Steven.

(iii). Education regarding Stuttering:

_most children of this age have stuttering, but it goes on their own within 12-24 months. So don't worry.

-teach to talk very slowly which help the child to develop self conscious. Stuttering happens when the child tries to talk too fast.

- model them a slow relaxed way of speaking.

(b) Anticipatory guidance:

According to Eric Erikson psychosocial stage, preschoolers have to develop a sense of initiative if you scold them or sprank them then counterpart guilt will occur.

(i). Be a role model.

(ii) Listen and encourage

(iii) Show them how to do things alone by themselves but never do things for them that they can do for them self.

(iv) Put them into practice.

(v). Setting up a favorable environment for them.

(vi). Let them think what needs to happen.