DELAYED GROWTH AND DEVELOPMENT Nursing Care Plan

Delayed Growth and Development

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NANDA-I Definition
Deviations from age-group norms
Defining Characteristics
Inability or difficulty performing skills or behaviors typical of
his or her age group
Altered physical growth*; weight lagging behind height by two
standard deviations; pattern of height and weight percentiles
indicate a drop in pattern
Inability to perform self-care or self-control activities appropriate
for age* (see Table II.2)
Flat affect*
Listlessness*
Decreased response time*
Slow social responses
Limited signs of satisfaction to caregiver
Limited eye contact
Difficulty feeding
Decreased appetite
Lethargy
Irritability
Negative mood
Regression in self-toileting
Regression in self-feeding
Infants: watchfulness, interrupted sleep pattern
Related Factors
Pathophysiologic
Related to compromised physical ability and dependence secondary to:
Disability related to trauma, mental health issues, Autism spectrum,
genetic syndromes, child abuse and neglect, unknown
causes
Cardiovascular defects or disease
Central nervous system dysfunction
Congenital anomalies of extremities
Cystic fibrosis
GI dysfunction
Inadequate nutritional intake
Malabsorption syndrome
Muscular dystrophy
Prolonged pain
Repeated acute or chronic illness or disability
Treatment Related
Related to separation from significant others or school, or inadequate
sensory stimulation secondary to:
Confinement for ongoing treatment
Isolation from disease
Prolonged bed rest
Prolonged, painful treatment
Traction or casts
Repeat or prolonged hospitalizations
Situational (Personal and Environmental)
Related to parental stressor secondary to:
Insufficient knowledge of child care, development, and growth
Change in usual environment
Separation from significant others (parents, primary caretaker)
School-related conflicts
Loss of significant other
Loss of control over environment (established rituals, activities,
established hours of contact with family)
Related to inadequate, inappropriate parental support (neglect,
abuse)
Related to inadequate sensory stimulation (neglect, isolation)
Related to cultural beliefs and practices
Maturational
Infant–Toddler (Birth to 3 Years)
Related to limited opportunities to meet social, play, or educational
needs secondary to:
Separation from parents/
significant others
Inadequate parental support
Inability to communicate
(e.g., deafness)
Restriction of activities of daily
living, to (specify)
Inability to trust significant
other
Multiple caregivers
Decreased sensory functions
(e.g., vision, hearing)
Excessive painful experiences
Preschool Age (4 to 6 Years)
Related to limited opportunities to meet self-care, social, play, or educational
needs secondary to:
Loss of ability to communicate
Lack of significant other
Lack of stimulation
Related to loss of significant other (death, divorce)
Related to loss of peer group
Related to removal from home environment
School Age (6 to 11 Years)
Related to limited opportunities to develop skills to achieve success
in school, social environment, or their physical abilities secondary
to (specify):
Related to loss of significant others:
Peer group
Strange environment
Adolescent (12 to 18 Years)
Related to loss of independence and autonomy secondary to (specify):
Related to disruption of peer relationships
Related to disruption of body image
Related to loss of significant others

Author's Notes
Specific developmental tasks are associated with various age groups
(e.g., to gain autonomy and self-control [e.g., toileting] from 1 to 3 years
of age and to establish lasting relationships from 18 to 30 years of
age). An adult’s failure to accomplish a developmental task may cause
or contribute to a change in functioning in a functional health pattern
(e.g., Impaired Social Interactions, Powerlessness). Because nursing interventions
focus on altered functioning rather than achievement of past
developmental tasks, the diagnosis Delayed Growth and Development has
limited uses for adults. It is most useful for a child or adolescent experiencing
difficulty achieving a developmental task.

Goal
The child will demonstrate increased age-appropriate behaviors
as evidenced by the following indicators (specify for age):
• Socialization
• Language
• Motor skills
• Self-care
• Cognitive skills

Interventions
Birth to 1 Year
• Encourage parental visits, calls, and, if possible, involvement
in care.
• Demonstrate methods that allow parents/family to participate
in child’s care.
• Provide child with age-appropriate communication and preparation
regarding procedures.
• Consider cultural practices and beliefs.
• Increase stimulation by using various-colored toys in crib
(e.g., mobiles, musical toys, stuffed toys of varied textures) and
frequently holding and speaking to the infant.
• Hold the infant while feeding him or her slowly and in a
relaxed environment.
• Provide rest periods before feeding.
• Observe mother and child during interaction, especially during
feeding.
• Investigate crying promptly and consistently.
• Assign a consistent caregiver and/or provide clear communication
to relay a consistent method of care-giving.
• Allow the infant’s hands and feet to be free, if possible.
1 to 3 Years
• Encourage and support parental or caregiver presence.
• Demonstrate
methods that allow parents/family to participate
in child’s care.
• Provide child with age-appropriate communication and preparation
regarding procedures.
• Assign a consistent caregiver and/or provide clear communication
to relay a consistent method of care-giving.
• Consider cultural practices and beliefs.
• Encourage self-care activities (e.g., self-feeding, self-dressing,
and bathing).
• Reinforce word development by repeating words the child
uses, naming objects, and speaking to the child often.
• Provide frequent periods of play with peers and various toys
(puzzles, books with pictures, manipulative toys, trucks, cars,
blocks, and bright colors).
• Demonstrate all procedures on a doll before you do them to
the child.
• Provide a safe area where the child can move around.
• Provide comfort measures after painful procedures.
3 to 5 Years
• Encourage and support parental or caregiver presence.
• Demonstrate
methods that allow parents/family to participate
in child’s care.
• Provide child with age-appropriate communication and preparation
regarding procedures.
• Assign a consistent caregiver and/or provide clear communication
to relay a consistent method of care-giving.
• Consider cultural practices and beliefs.
• Encourage self-care: self-grooming, self-dressing, mouth care,
hair care.
• Offer appropriate choices (e.g. “Which arm shall we put the
medicine in?”)
• Provide frequent playtime with others and various toys
(e.g., models, musical toys, dolls, puppets, books, mini-slides,
wagons, tricycles).
• Read stories aloud. Ask for verbal responses and requests.
• Say words for equipment, objects, and people; ask the child
to repeat them.
• Allow time for individual play and exploration of play
environment.
• Monitor use of television.
• Use familiar routines to help child understand time (e.g. “After
breakfast your mother will be here”).
5 to 11 Years
• Encourage and support parental or caregiver presence.
• Demonstrate
methods that allow parents/family to participate
in child’s care.
• Provide child with age-appropriate communication and preparation
regarding procedures.
• Assign a consistent caregiver and/or provide clear communication
to relay a consistent method of care-giving.
• Consider cultural practices and beliefs.
• Allow the child to wear his or her own clothes if possible.
• Provide periods of interaction with other children.
• Provide craft projects that the child can complete each day
or week.
• Continue schoolwork at intervals each day.
• Praise positive behaviors.
• Read stories and provide several independent games, puzzles,
books, video games, and art projects.
• Introduce the child by name to people involved in their care.
• Encourage visits with or telephone calls from parents, siblings,
and peers.
11 to 15 Years
• Encourage and support parental or caregiver presence.
• Demonstrate
methods that allow parents/family to participate
in child’s care.
• Provide child with age-appropriate communication and preparation
regarding procedures.
• Assign a consistent caregiver and/or provide clear communication
to relay a consistent method of care-giving.
• Consider cultural practices and beliefs.
• Speak frequently with child about feelings, ideas, and concerns
about condition or care.
• Provide an opportunity for interaction with others of the
same age.
• Identify an interest or a hobby that the unit can support, and
support it daily.
• Allow the health care facility routine to be altered to suit the
child’s schedule.
• Allow the child to wear his or her own clothes if possible.
• Involve the child in decisions about his or her care.
• Provide an opportunity for involvement in several activities
(e.g., reading, video games, movies, board games, art, and trips
outside or to other areas).
• Encourage visits or telephone calls from parents, siblings, and
peers.
Initiate Health Teaching and Referrals, When Indicated
• Provide anticipatory guidance for parents regarding constructive
handling of developmental problems and support of
developmental process (see Table II.2 and Impaired Parenting).
• Refer the family to the appropriate agency for counseling or
follow-up treatment of abuse, parent–child conflict, chemical
dependency, and so forth (see Disabled Family Coping).
• Refer the family to the appropriate agency for structured,
ongoing
stimulation program (e.g., schooling) when functioning
is likely to be impaired permanently.
• Refer the family to community programs specific to contributing
factors (e.g., Women, Infants, and Children Program
[WIC], social services, family services, counseling).
• Provide a list of parent support groups (e.g., Down Syndrome
Awareness, Muscular Dystrophy Association, National
Epilepsy
Association).

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