Learning Objectives
By the end of this section, you will be able to:
- Identify health risks of the conception and prenatal stage
- Recognize health risks of the neonate stage
- Describe health risks of the infant stage
- Recall health risks of the toddler stage
- Understand health risks of the preschool stage
- Analyze health risks of the school-age stage
- Verbalize health risks of the adolescent stage
Health risks vary depending on the stage of development. Nurses working in pediatrics or maternal-child health need to be knowledgeable about the specific health risks for each group. By having that baseline knowledge, nurses can anticipate what health needs are likely to occur and intervene early. Anticipatory guidance and early intervention are the basis of improving health outcomes and minimizing health risks.
Conception and Prenatal Health Risks
Women who would like to conceive need education, anticipatory guidance, and support before pregnancy, throughout the pregnancy, and after pregnancy. It is important to remember that there are specific health risks at every stage of this process. Nurses should be aware of the different health risks so that they can provide appropriate nursing care.
Infertility
The inability to conceive after twelve months of unprotected intercourse defines infertility. Across all socioeconomic groups, infertility is becoming more common. Infertility affects 10 to 15 percent of males and approximately 19 percent of females in the United States (Centers for Disease Control and Prevention [CDC], 2023c; Cleveland Clinic, 2024). The steady increase in infertility is related to several factors, including delayed childbearing, obesity, smoking, alcohol consumption, psychological stress, exposure to environmental toxins, and prevalence of STIs (CDC, 2023c).
Treatment for infertility depends on the underlying cause. Prior to beginning treatment, a baseline evaluation of a female’s reproductive health is usually conducted to rule out common causes of infertility, like thyroid disorder, coagulation problems, and fibroids. Treatment for infertility can be broken down into three main categories: lifestyle modifications, medications, and advanced fertility treatments. Lifestyle modifications that have a beneficial impact on fertility include maintaining a healthy weight, eating a diet low in saturated fat, and exercising on a regular basis. Medications for fertility include drugs that induce ovulation or facilitate implantation of a zygote. Advanced fertility treatments, like in vitro fertilization (IVF) involves creating an embryo in a laboratory and then transferring the embryo into a female’s uterus. Within the umbrella of advanced fertility treatments, infertile individuals have the option to use donated eggs or sperm to create healthy embryos. For some individuals, using donated genetic material is the only viable treatment for infertility.
High-Risk Pregnancy
Any pregnancy in which there are increased health risks for the pregnant person, the developing fetus, or both is known as a high-risk pregnancy. Just as the incidence of infertility has increased in the United States, so has the risk of having a high-risk pregnancy. Approximately 50,000 people in the United States experience severe pregnancy complications, and the risk of complications is higher among the Black population (Hawkins & Baum, 2023).
There are several factors that contribute to the increased incidence of high-risk pregnancies. The first is delayed childbearing or advanced age of the pregnant person. People over the age of 35 years who are pregnant are considered at advanced age and are more likely to have complications compared to those under 35 years. Common complications for pregnancies in persons with advanced age include early pregnancy loss, a fetus with chromosomal abnormalities, and gestational diabetes.
Young age, being less than age 17 years, also contributes to an increased risk of having a high-risk pregnancy. People under the age of 17 years are more likely to have anemia, are less likely to receive prenatal care, and are more likely to have untreated STIs (Collier & Molina, 2019).
In addition to age, several other factors contribute to an increased risk of high-risk pregnancy, including the following (Cleveland Clinic, 2021):
- autoimmune disease
- diabetes
- fibroids
- high blood pressure
- HIV
- kidney disease
- unhealthy body mass index
- thyroid disease
- depression and other mental health disorders
Patient Conversations
What if Your Patient Appears Scared about a Prenatal Diagnosis?
Scenario: Nurse enters the patient’s exam room to provide prenatal education and finds the patient and her husband huddled in the corner whispering to each other. Both the patient and her husband appear to be upset and anxious.
Nurse: Hi, my name is Samantha. I’m going to be your primary nurse at the clinic. Do you mind verifying your name, date of birth, and the first day of your last menstrual period?
Patient: Hi, Samantha. I’m Beth, and this is my husband, Jerry. My last name is Gonzalez-Smith, and the first date of my last period was February 4.
Nurse: Great. Thanks, Beth. Okay, so if your last period started February 4, that would make you about five weeks pregnant. Congratulations!
Patient: Thanks. We came in right away because I’ve had a few miscarriages, and I’m so scared something will go wrong.
Nurse: I’m so sorry you’ve lost other pregnancies. Can you tell me more about that? How many miscarriages have you had? About how many weeks into the pregnancies do you miscarry?
Patient: I’ve had four miscarriages in the past three years. All the miscarriages were before I was nine weeks pregnant. It seems like I would take a home pregnancy test, get excited, and then a week or two later, start bleeding.
Nurse: That must be really tough for you and your husband. Have you had any genetic testing or had a prenatal workup to try and figure out a cause?
Patient: No, we haven’t had health insurance, so I hated to go to the doctor and spend money if it wasn’t an emergency. I would just stay home when I had a miscarriage. I didn’t think I needed to go to the doctor because it felt like a heavy period. I just heard about your clinic that offers care for the uninsured.
Nurse: I see. I’m glad you found us. When we finish up today’s appointment, I’ll set you up with the clinical social worker to see if there is an insurance exchange program that you would qualify for. I’m not sure what the income requirements are, but the social worker can help with all of that. To start with, I’m going to give you some health history forms to fill out. Please fill them out as accurately as you can, and I’ll be back in a few minutes to talk about the next steps.
Patient: Thanks.
Nurse: Okay, looking over your forms, it looks like you have a history of hypothyroidism. Are you currently taking your medication?
Patient: No, I stopped taking the medication about five years ago. I felt better, and it was annoying to have to go and get my labs checked.
Nurse: I understand. I’m not sure why you’ve had multiple miscarriages, but having untreated thyroid disease can lead to miscarriages. To start with, I’d like to get a full set of screening labs that include thyroid function, coagulation studies, and various infectious studies. Women have miscarriages for a lot of different reasons. I’m not saying thyroid disease caused your miscarriages; I’m just saying that is one possibility. We’re going to work with you and get to the root cause of your fertility problems.
Patient: Okay. I really appreciate it. We’ve wanted a child for a few years now, and we’ve been so scared that it would never happen.
Nurse: It sounds like this has been a bumpy road for both of you. A lot of couples blame themselves for pregnancy problems. I want to make sure you both know this isn’t your fault. There is almost always an identifiable medical cause that we can treat. I’m going to ask the nurse practitioner to sign the lab requisition forms so that you can get started on the blood work ASAP. Once the results are back, we’ll have you come back to the clinic to discuss the next steps. In the meantime, if you have any unusual vaginal bleeding, vaginal discharge, fever, or any other symptoms you’re concerned about, please call us. During clinic hours, there is a triage nurse, and after hours there is a phone service that can page the on-call provider. We’re always available.
Patient: Thank you so much. I’m so glad we found this clinic.
Prenatal Malnutrition
Women have increased nutritional needs before and during pregnancy and while breastfeeding. Maternal prepregnancy weight has a direct link to birth outcomes. Women with lower weight are more likely to give birth to low-birth-weight babies, and women with higher weight are more likely to give birth to large-for-gestational-age infants. Being of a higher weight also places women at risk for gestational diabetes.
During pregnancy and breastfeeding, women need to have access to diets high in fruits and vegetables, dairy, and protein. From the second trimester until women are done breastfeeding, they need approximately 300 extra calories per day to support their energy needs. In addition to increased calories, specific nutrients are vital during pregnancy. Prenatal diets with insufficient iodine, iron, folate, calcium, and zinc can lead to maternal anemia, preeclampsia, hemorrhage, and maternal death. Inadequate maternal nutrition can also lead to low birth weight, developmental delays, and even stillbirth (United Nations International Children’s Emergency Fund [UNICEF], 2023).
Link to Learning
Some dietary guidelines to follow during pregnancy are provided by the American College of Obstetricians and Gynecologists.
Neonate Health Risks
Neonatal patients face a unique set of health risks. They are one of the most at-risk populations because they are completely dependent on their caregivers, have an immature immunity system, and are physically immature, making them more prone to trauma. The categories of health risks that are specific to this age group are increased risk of infection, birth trauma, congenital malformations, and in utero exposure.
Life-Stage Context
Risk for Infection in the Newborn Period
During the first twenty-eight days of a newborn’s life, the newborn is the most susceptible to infection. Neonatal sepsis refers to an infection in the bloodstream of an infant younger than 28 days old. Infants can contract an infection either from the birth process or via the transmission of pathogens from the environment. Neonatal sepsis presents differently than sepsis in other age groups. Common symptoms of neonatal sepsis include irritability, poor feeding, lethargy, and temperature instability, either hypothermia or hyperthermia (Singh et al., 2022). Neonates who are ill-appearing need a full septic workup, including blood, urine, and cerebral spinal fluid cultures. Broad-spectrum antibiotics should be started after cultures are obtained and then discontinued after forty-eight hours if all cultures are negative. If any culture is positive, antibiotics should be narrowed to treat the identified pathogen. To minimize the risk of newborn sepsis, parents should be advised to limit visitors for the first twenty-eight days. Also, they should avoid giving their newborn an antipyretic, like Tylenol, to prevent masking a fever. Any fever in a newborn must be reported to a healthcare provider for further evaluation (Fleiss et al., 2023).
Birth Trauma
Birth trauma can be a result of maternal complications, fetal abnormalities, or external forces. The presentation of birth trauma in a newborn depends on the type and severity of injury sustained. The most common sites for birth trauma are the head, neck, and shoulders. Head trauma includes superficial lesions, extracranial and intracranial hemorrhage, and skull fractures. In severe cases, head trauma during birth can lead to permanent brain damage or cerebral palsy. Brachial plexus nerve injuries are the most common nerve birth trauma related to the neck and shoulders. They occur in 2.5 per 1,000 live births and are the result of stretching of the cervical nerve roots during the birth process (Dumpa & Kamity, 2023). These injuries are usually unilateral, and severity ranges from upper arm weakness to total arm paralysis. Most cases of brachial plexus nerve injuries can be treated with physical therapy. Rarely, infants have permanent nerve damage (Dumpa & Kamity, 2023).
Congenital Malformations
Approximately 3 to 4 percent of infants born in the United States each year have a congenital malformation, otherwise known as a birth defect (Boston Children’s Hospital, 2023). A congenital malformation is any health problem or physical abnormality that is present at birth. The most common types of congenital malformations are heart defects, cleft lip/palate, Down syndrome, and spina bifida. Congenital heart defects encompass a wide range of problems that affect how blood flows through the heart and how blood exits the heart to both the body and the lungs. Cleft lip/palate is incomplete closure of the palate, or the roof of the mouth, and the upper lip. Down syndrome, also known as trisomy 21, is a chromosomal abnormality that causes intellectual developmental disorder and can be associated with problems in the gastrointestinal, cardiac, and endocrine systems. Spina bifida is when a section of the spinal column does not form normally, leaving a section of the spinal cord and the nerves exposed. Congenital malformations can be the result of a genetic defect or in utero exposure to a teratogen, or they can have an unknown cause (Boston Children’s Hospital, 2023).
Exposure In Utero
Fetal exposure to medications, alcohol, illicit drugs, environmental toxins, and certain infections can all cause birth defects. The fetus is at greatest risk for congenital malformations secondary to uterine exposure during the first ten weeks of pregnancy. During this time frame, all the major organ systems and the basic physical structure of the fetus are developing. After ten weeks’ gestation, the risk of in utero exposure to teratogens declines because the fetus is growing larger but not undergoing cellular differentiation. There are specific infections, known as the TORCH infections, that are associated with birth defects. Not all infections cause birth defects. However, the TORCH infections have a high probability of causing pregnancy complications. TORCH stands for toxoplasmosis, other (syphilis, hepatitis B), rubella, cytomegalovirus, and herpes simplex (Jaan & Rajnik, 2021).
Infant Health Risks
Infancy can be a particularly stressful time for parents. Infants are unable to verbally communicate their needs, and parents often feel like their baby is always crying or needing something. The stress of new parenthood can be exacerbated if the infant has any health problems that demand more attention from the caregivers or parents. Specific health problems in this age group that require nursing attention are colic and failure to thrive (FTT). Infants are also at risk for child abuse, accidental injuries, and sudden infant death syndrome (SIDS). Nurses must be aware of all these health risks to provide parents with the appropriate education and support.
Colic
Colic is when a baby cries for a long period of time without an identifiable medical reason. It is most common in the first six weeks of life and usually goes away on its own within three to four months of life. Colic is common, affecting approximately one in four newborns.
Possible causes of colic include pain from gas, hunger, overfeeding, milk intolerance, and sensitivity to certain stimuli. Even though babies with colic look like they have abdominal pain, they eat well and gain weight normally. If parents can identify a trigger for colic, they should avoid that trigger. Otherwise, caring for an infant with colic revolves around trying to comfort the baby. Swaddling the baby in a blanket or holding the baby may help. Many parents use an infant carrier to hold their baby close to their body during colic episodes.
Failure to Thrive
An inadequate weight gain or sudden weight loss is called failure to thrive (FTT). It is defined as a weight consistently below the fifth percentile for age and sex. Failure to thrive can be either organic, or caused by a medical condition, or nonorganic, or the result of an inability to obtain food (Raab, 2023). Examples of organic FTT include the following (Smith et al., 2023):
- food allergy
- malabsorption
- inborn errors of metabolism
- excessive calorie expenditure secondary to hyperthyroidism, congenital heart disease, chronic lung disease, and chronic immunodeficiency
Examples of nonorganic FTT include the following (Smith et al., 2023):
- incorrect formula preparation
- breastfeeding problems
- neglect
- eating a fad diet
- behavior problems affecting eating
The diagnosis of FTT is made after a thorough evaluation of the child’s diet, home environment, and risk factors for illness affecting calorie use. Common information that is obtained is a five-day diet food journal, information about food allergies, or food restrictions that are placed on the child. A social work consult to evaluate the home environment and parent-child interactions may also be warranted. If it is determined that the FTT is organic, additional medical tests will be ordered to determine the specific cause of growth failure. Possible diagnostic tests include serum lead and zinc levels, complete blood count to look for anemia, stool-reducing substances to evaluate for malabsorption, and ova and parasite tests to evaluate for parasitic infections (Smith et al., 2023).
Many cases of FTT are multifactorial and are best managed with a multidisciplinary team of physicians, nurses, dietitians, child life specialists, pediatric feeding specialists, and social workers or mental health professionals. The overall goal of FTT management is to reverse the cause of slow growth and provide enough calories to allow for catch-up growth. The specific treatment will depend on the underlying cause. Nonorganic FTT requires extensive parent teaching about correct food preparation and close follow-up. A social services referral may be warranted. Organic FTT management depends on the underlying medical condition. Children with FTT may be hospitalized for several weeks to determine the cause of growth failure and reverse the trend prior to discharge (Smith et al., 2023).
Accidental Injuries
Given the fact that infants do not walk, the mechanism of accidental injury in infants differs from older children and adults. Falls represent the greatest cause of accidental injury in this age group. Infants who accidentally fall should be evaluated by a healthcare provider. If there has been loss of consciousness, vomiting, or seizures, the infant will likely need a head computed tomography. Since subtle changes in consciousness in an infant may be hard to detect, it is important for parents to seek medical care if their infant has had an accidental fall or injury (Saltzman & Skube, 2021).
Sudden Infant Death Syndrome
The sudden death of an infant that does not have an identifiable cause, even after a full investigation, is known as sudden infant death syndrome (SIDS). In the United States, SIDS is the third leading cause of death in infants under 1 year of age (Kochanek et al., 2024). In most cases, the infant appears healthy before the event, which usually occurs during sleep. Risk factors for SIDS include premature or low birth weight, overheating during sleep, allowing the baby to sleep with loose blankets or on a soft surface, and having a family history of SIDS. The primary prevention technique for SIDS is to encourage safe sleep practices. Infants should be placed on their back to sleep on a firm mattress with one fitted sheet (Figure 39.9). To minimize the risk of suffocation, stuffed animals, pillows, and blankets should not be in the crib. With parent education and public awareness, the incidence of SIDS has declined from 130 deaths per 100,000 live births in 1990 to 38.4 deaths per 100,000 live births in 2020 (CDC, 2023b).
Abuse or Neglect
Infants are fully dependent on their caregivers for survival, which makes them more susceptible to abuse and neglect than older children. Abuse and neglect in infancy can vary from accidental underfeeding to intentional physical abuse. Infants are at risk for shaken baby syndrome, a serious type of abuse that usually occurs when a parent or caregiver shakes a baby out of anger or frustration. Babies have weak neck muscles that are unable to fully support their large heads, allowing the head to move forward and backward quickly when shaken. This movement can cause serious brain injury, including subdural hematomas and subarachnoid hemorrhages. It can also cause other injuries like retinal hemorrhages, skull fractures, and fractures to other bones in the face (American Association of Neurological Surgeons, 2019).
Toddler Health Risks
Toddlers have specific health risks related to their stage of growth and development. Toddlers are becoming more mobile, and their diet is changing, which places them at risk for accidental injuries and malnutrition. They are also at increased risk for child abuse because children typically potty train during this age range. Potty training can be stressful for parents, and they may lash out and abuse their children (Chung et al., 2019).
Accidental Injuries
The hallmark of the toddler years is exploration and rapid acceleration of gross motor skills. Children in this age group are on the go, which places them at increased risk for accidental injuries. According to the Centers for Disease Control and Prevention (CDC), the leading causes of accidental injuries in this age group are suffocation, drowning, poisoning, fires, and falls (CDC, 2021). Most accidental injuries are preventable. It is important to remind parents and caregivers about the importance of supervision in this age group. Although toddlers need to learn autonomy and independence, they still must be supervised at all times (CDC, 2021).
Malnutrition
Malnutrition is a health condition that results from consuming food that contains either insufficient or too many carbohydrates, vitamins, proteins, and/or minerals. Toddlers are at-risk of malnutrition because their feeding patterns change as they become less dependent on caregivers to feed them. A common cause of malnutrition in toddlers is excess cow’s milk consumption. During this age range, children should drink between 2 and 2.5 cups (473 to 592 mL) of milk per day. Consuming an excess of that amount can lead to iron deficiency anemia. Milk is not an iron-rich food source, and children who drink milk in excess often do not eat enough other iron-rich foods. Also, milk inhibits the absorption of iron, further lending to iron deficiency anemia. Because it is filling, drinking an excess of milk can also hinder establishing healthy eating patterns.
Life-Stage Context
Iron Deficiency Anemia
Iron deficiency anemia adversely impacts childhood development because it is associated with learning and memory problems and fatigue. Prevention of iron deficiency anemia is a crucial element of primary health in this age group. Parents should be instructed on including iron-rich food in their child’s diet and minimizing consumption of milk. If parents choose to follow a restrictive or a fad diet, the pros and cons of this should be discussed in detail (Sundararajan & Rabe, 2021). If a family meets the income requirements for assistance, a referral to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a good resource. The WIC program provides nutritional education and food supplements for families with children under the age of 5 years (U.S. Department of Agriculture [USDA], 2023).
Abuse or Neglect
Child abuse and neglect can happen in any age group and in families from all socioeconomic backgrounds. However, certain age groups and familial patterns place children at an increased risk of abuse or neglect. Family stresses, such as food insecurity, poverty, intimate partner violence, social isolation, parental mental health issues, or substance use disorder, are all factors that increase the likelihood of abuse and neglect (Pekarsky, 2022).
One of the developmental tasks of the toddler years that places this age group at particular risk of abuse is toilet training accidents. A common physical examination finding consistent with child abuse related to toilet training is an immersion burn. This refers to a burn of the buttocks and genital region. Parents and caregivers may immerse their child in hot water as punishment for soiling themselves and making themselves “dirty.” A recent retrospective study of characteristics of abusive childhood burns found that burns to the buttocks or groin region are highly indicative of nonaccidental injury (Rosado et al., 2019).
Clinical Safety and Procedures (QSEN)
QSEN Competency: How to File a Report to Child Protective Services if There Is Concern for Child Abuse
Disclaimer: Always follow agency’s policy for documenting and reporting suspected child abuse or neglect.
| Steps | Description/Rationale |
|---|---|
| Children may present with an isolated injury, like a broken arm, but on further review they have other injuries like bruises on other parts of their body. Always perform a complete assessment, even if the caregivers are insistent that just the injury needs to be addressed. | Children who experience abuse are frequently seen in the emergency department with injuries. Nurses need to be aware of the signs and symptoms of child abuse. One of the hallmarks of abuse is having injuries in various stages of healing, for example, various bruises of different colors. |
| Document all examination findings using a nonjudgmental tone. | Even if the nurse notices examination findings that are suspicious for abuse, they should not assume the child had been abused. Treating parents with respect builds rapport and trust. Use a respectful tone when talking with parents and when documenting in their child’s medical chart. Once the patient has been evaluated and stabilized, the emergency room staff can move forward with filing a report with Child Protective Services (CPS). |
| File a report to CPS. | If a child comes into the emergency department with suspected child abuse, additional nursing staff will need to be assigned to the patient. The nurse who evaluates the patient needs to file a report with CPS. An additional nurse should be assigned to the patient to make sure the primary nurse has time to document the findings and file the report. Once the patient has been stabilized and the documentation is complete, the primary nurse should step away to contact CPS. Different states have different methods of filing a report. However, nurses are mandatory reporters in all fifty states. |
Preschool Health Risks
Most children in the preschool age range are around other children their age in large groups. This grouping of children into groups could be preschool, Sunday school classes, and/or meeting with other children for playdates. As a result of this increased activity and being around other children, they have specific health risks, including accidental injuries and exposure to communicable disease. They are also becoming more autonomous in their eating habits, so they should have their food selection choices monitored to make sure they are eating a healthy, balanced diet.
Accidental Injuries
Unintentional injuries are a leading cause of serious harm and even death among preschool-age children (CDC, 2020). Motor vehicle accidents are a leading cause of unintentional injury, causing approximately 4,600 deaths per year (CDC, 2020). Research has shown that many childhood injuries occur in or around the home, which highlights the importance of anticipatory guidance for parents about making the home environment safe (CDC, 2020). Other common accidental injuries in this age group include suffocation, drowning, poisoning, fire/burn injuries, falls, cuts and puncture wounds, foreign bodies in a body orifice, and swimming injuries (CDC, 2020).
Risk for Obesity
In the United States, childhood obesity rates have tripled in the past decade. Historically, obesity in preschool-age children is rare. However, in the United States, approximately 15 percent of children aged 2 to 5 years have higher weight (Sanyaolu et al., 2019). A recent study indicates specific factors that place preschool-age children at greater risk for being of higher weight. The three factors identified were a high-calorie diet, increased screen time, and decreased physical activity. The education level of parents was also a risk factor. Parents with a lower education level were more likely to have children with higher weight (Rosado et al., 2019).
Exposure to Communicable Diseases
As children enter the preschool years, it is more likely that they will spend time with large groups of children, either by attending preschool or by being in play groups. Children in this age group are also notorious for getting sick all the time, in part because they are frequently in large groups of children where germs can spread easily and because their immune systems have not been exposed to many pathogens, so they do not have much innate immunity. Common health risks in this age group include viral illnesses like the common cold, head lice, gastroenteritis, and hepatitis A. Parents can help stop the spread of infections by keeping their children up to date on their immunizations, encouraging handwashing after going to the bathroom and before eating, and in general, focusing on hygiene.
School-Aged Health Risks
As children start school, their level of independence from their parents changes rapidly. With each passing year, they are more responsible for feeding themselves, dressing themselves, and taking responsibility for their personal hygiene. There are specific health risks associated with this increased level of independence, such as poor food choices resulting in obesity and health conditions related to lack of personal hygiene. This is also a time in life when learning disabilities, if a child has one, are often diagnosed. Teachers and nurses need to be on the lookout for the specific health risks for school-age children so they can intervene and get the child the appropriate therapy or help.
Learning Disabilities
Children who have a difficult time learning could have medical problems like hearing or vision deficits or have a more complex problem like a learning disability. If children are having a hard time paying attention or staying organized, and/or they are having problems with reading or math, they should be evaluated for learning disabilities and have their vision and hearing checked. The most common learning disability is dyslexia. People with dyslexia have trouble making the connection between letters and sounds and recognizing words. Other signs of dyslexia include the following:
- delay in being able to speak
- difficult time understanding what others are saying
- difficulty expressing thoughts or feelings
- problems remembering numbers in a sequence
- trouble telling left from right
- poor spelling and reading skills
In addition to dyslexia, school-age children can present with other learning disabilities, such as dysgraphia or dyscalculia. Dysgraphia is a learning disability that affects the individual’s ability to write. Dyscalculia is a learning disability that affects the child’s ability to understand numbers and math. Children suspected of having a learning disability need to be referred to a specialist. Early diagnosis and treatment can minimize the impact the learning disability has on the child’s academic performance (National Institutes of Health, 2018).
Risk for Obesity
The incidence of obesity in school-age children has more than tripled since the 1970s. As of 2018 in the United States, one in five school-age children were of higher weight (CDC, 2022). There are multiple factors that contribute to the increase in obesity, including consumption of high-calorie foods, decreased activity level, short sleep duration, and experiencing trauma during childhood (CDC, 2022).
Having a comprehensive approach to obesity in the public school system may be an effective tool to decrease obesity rates. A comprehensive approach involves changing food items in the cafeteria, increasing physical activity during school hours, involving school nurses and after-school program professionals, and providing education to parents and caregivers.
Poor Hygiene Practices
The process by which a person cares for their health by cleaning and caring for their body is called hygiene. Starting from birth, parents are responsible for their child’s hygiene. However, as children mature, they must acquire independent hygiene habits. In some families, caregivers do not have adequate knowledge to instruct children in adequate hygiene practices. Common areas where school-age children lack hygiene practices include teeth brushing and oral care, bathing, and wearing clean clothes. Children who come to school with evidence of poor hygiene should be referred to the school nurse or a social worker to evaluate for possible neglect at home and/or provide the family with additional education and resources (Pérez Pico et al., 2022).
Adolescent Health Risks
In the adolescent stage of development, teens are forming their personal identity that is unique from the family of origin. In this stage, peer groups are paramount to the adolescent’s development. Adolescents tend to go along with the decisions of their peer group and focus on the opinions of their peers. During this stage, many adolescents experiment with drugs, alcohol, sex, learning to drive, and other risky behavior. Their bodies are also changing rapidly, which can lead to body image disturbances and eating disorders. All these life changes play into the specific health risks of the adolescent patient.
Risk-Prone Behaviors
Risk-taking behavior tends to be low in childhood, starts to increase around puberty, and peaks in late adolescence. Psychosocial research proposes that risk-prone behavior reflects a gap between an adolescent’s biological and social maturity. Adolescents frequently underestimate risks while simultaneously believing that there is a greater potential benefit to risky behavior. On the other hand, adults tend to make decisions based on education and experiences. Adolescents lack the necessary experience to use that logic. As a result, they are more likely to use drugs or alcohol, have unprotected sex, and pursue relationships with people with violent tendencies (CDC, 2024).
Distress with Personal Identity
Identity formation is one of the principal tasks of adolescent development. During this age group, teens frequently try out different identities by making friends in different peer groups. A teen could be into playing soccer one year and obsessed with music the next. Adolescents tend to rely heavily on their peer group to help them form an identity. If they are unable to find a close group of friends, identity formation can be difficult, which can lead to loneliness and a sense of despair (Lindekilde et al., 2018).
Patient Conversations
What if Your Adolescent Patient Appears Anxious about Applying for College?
Scenario: Nurse walks into the exam room to talk to an 18-year-old patient who has come in for a sports physical prior to starting his senior year of high school. When the nurse asks open-ended questions about school and plans for the future, the teen gets anxious and looks at the floor. He acts like he doesn’t want to discuss life after high school.
Nurse: Hi, my name is Rebecca. I’m one of the nurses at the clinic. I’m going to check your vital signs and ask a few questions before the doctor comes in to see you.
Patient: Hi, Rebecca. My name is Brandon.
Nurse: It’s nice to meet you, Brandon. Can you confirm your full name and date of birth?
Patient: Sure, Brandon Harrison, January 14, 2006.
Nurse: Thanks. It looks like you play several sports: football, basketball, and tennis. Do you plan to continue sports in college next year?
Patient: Ummm, I’m not sure about next year.
Nurse: Okay. A lot of students like to get a fresh start after they finish high school. It’s not unusual to want to try new things. Have you thought about what you’d like to do next year?
Patient: My dad wants me to go to his alma mater and major in business administration.
Nurse: I see. Business administration is a great major. It opens the door for a lot of different career options. Having said that, there are several different majors available to you. Have you thought of studying anything else?
Patient: I haven’t thought about it. To be honest, I’m not sure I’m ready to go to college. [Looks anxious and stares at the floor.] Please don’t tell my dad!
Nurse: Don’t worry, Brandon. This conversation is confidential. I won’t discuss anything that you tell me with your parents. If you’re not sure about starting college next year, have you considered taking a gap year?
Patient: What’s a gap year?
Nurse: It’s when students take a break between high school and college. They might get an entry-level job in an industry they’re interested in, volunteer, travel, or just work full time while they consider their options.
Patient: Interesting. I’d like that, but I don’t think my parents would agree. They talked about college as if it’s my destiny. I don’t think they’ve considered the possibility that I might want to do something different.
Nurse: Well, maybe you should have a talk with them. College isn’t for everyone, and if you take a break for a few months and decide you really want to go, you can apply at that time. Students tend to do better at their university studies if they’re focused and driven to be there. If you want some tips on how to bring up this topic with your parents, let me know. I’m happy to help in any way I can.
Patient: Thanks. I’m going to think about what I want. Taking some time off might make sense. I’m not sure what I want to study in college. Maybe I’ll get a job and save up some money while I explore my options.
Risk for Self-Harm
The risk for self-harm is high in adolescents. Reported self-harm prevalence rates in this age group range from 17 to 60 percent (Brown & Plener, 2017). The high rate of self-harm in adolescents is likely multifactorial. Adolescents feel emotionally liable in response to the surging hormones of puberty. At the same time, they are struggling with an identity crisis as they attempt to form a personal identity that is unique from their family of origin. Known risk factors for adolescent self-harm behavior include female gender, being an only child, poor school performance, harsh parenting styles, and poor mental health (Brown & Plener, 2017).
Substance Use
Alcohol or drug use, also substance use, is common in U.S. adolescents. According to a recent government survey, 52 percent of twelfth graders reported using alcohol within the last twelve months (Miech et al., 2023). In addition, 41 percent report having the opportunity to use any illicit drugs (Miech et al., 2023). Tobacco use in any form (smoking, smokeless, and e-cigarettes) is an additional concern for substance use and abuse in this population. The ease of availability of alcohol and illicit drugs combined with the risk-taking behavior associated with the adolescent period makes substance use a significant problem. Teens who misuse either alcohol or illicit drugs are more likely to develop a substance use disorder later in life (Miech et al., 2023).
Sexually Transmitted Infections
Although STIs affect people in all age groups, the burden is particularly high in adolescents. According to statistics from the CDC, nearly half of all STIs in the United States occur in individuals ages 15 to 24 years (CDC, 2024). The risk-taking behavior that is common among adolescents and young adults contributes to this high rate of infection. Many adolescents underestimate the risk of having unprotected sex and/or believe that they are invincible and unlikely to get an infection (CDC, 2024).
Pregnancy
Teen pregnancy and childbearing are associated with economic hardship in both the short term and in the long term. One of the main indicators of this is high school graduation rates. High school graduation rates are significantly lower among teen moms. According to the CDC, only 50 percent of teen moms receive a high school diploma by age 22 years, whereas approximately 90 percent of other adolescent females graduate from high school (Youth.gov, n.d.). Teen fathers are also 25 percent less likely to graduate from high school (Youth.gov, n.d.). Teenage pregnancy is also associated with having more health problems, being incarcerated, and being unemployed (Youth.gov, n.d.). The good news is the rate of teenage pregnancy dropped by 78 percent between 1991 and 2021 (CDC, 2023a). The drop in pregnancy rates is believed to be associated with education and better access to birth control.