Care Plan Age 6-10

Transition Guidelines
Age 6 - 10

Health Promotion & Disease Prevention

Outcomes	Interventions
School-age child receives appropriate well-child care with visit to primary care provider at: 6 years 8 years 10 years	Assess if school-age child has an appropriate medical home (physician or nurse practitioner) Provide assistance in finding a primary care provider (PCP) if no medical home Encourage appropriate well-child visits to primary care provider Assess funding for well-child care through Medicaid, private insurance, or other resources Refer to Medicaid, CHIP or other resources as appropriate
Immunizations are up-to-date	Assess immunizations status Provide information regarding recommended immunizations and their importance Refer to PCP or health department as appropriate
Vision and hearing are assessed as needed if risk factors exist or problems identified	Ask child or caretaker if child squints, has problems reading, complains of eye fatigue, pain in or around the eye, blurred vision, sits very close to the TV Ask child or caretaker if any problems with hearing Conduct whisper test to screen for hearing problem Refer to PCP or CSHCN program for vision and hearing assessment as appropriate
Height/weight ratio is greater than 10^th percentile and less than 75^th percentile Growth rate steady and child is following his/her curve School age child can select nutritious foods including snacks School-age child demonstrates good nutrition (three meals daily; low fat, low sugar and nutritious snacks)	Weigh and measure child at least yearly and plot on growth chart Evaluate growth curve at 24-hour dietary recall Refer to nutritionist if weight is above 75^th percentile or below the 10^th percentile OR weight to height ratio is below 10^th percentile Teach how to choose healthy foods including fruits and vegetables Encourage family to eat some meals together

School-age child has normal bowel elimination pattern as evidenced by soft BM at least every other day and no symptoms of chronic constipation or diarrhea School-age child has normal urinary elimination pattern as evidenced by no enuresis or urinary retention, urinary tract infections or reflux	Assess bowel and bladder elimination pattern with focus on high-risk populations As needed, teach child and caretaker how to prevent constipation and simple measures to correct constipation such as increasing fluids, fiber, raw fruits and vegetables Take measures to promote increasing independence in bowel and bladder movement Refer or coordinate with PCP as appropriate
School-age child has good oral hygiene and no untreated dental caries School-age child brushes twice daily and flosses teeth daily	Assess oral health practices and fluoride status Provide with pamphlet on dental hygiene practices appropriate for age/development Teach how to brush and floss teeth as needed Encourage regular visits to the dentist Emphasize the importance of controlling hyperplasia of the gums among children with seizure disorders receiving Dilantin Refer to dentist as needed Find resources for families who cannot afford dental care Ensure that children scheduled for surgery do not have untreated oral health problems
School-age child engages in appropriate health promoting behaviors such as: exercise 3X weekly or more limited TV viewing, video games, etc. adequate sleep or rest consistent car seat belt or WC restraint	Assess health promotion activities Provide teaching and pamphlets as appropriate to interest and need Refer to physical and occupational therapy to assess exercise needs and develop program Assess sleep pattern (school-age child needs between 8-12 hours) Provide teaching regarding the importance of seat belt use

School-age child's risk for developing hyperlipdemia or adult coronary heart disease is assessed	Assess BP yearly on children who are obese, have compromised renal function, or positive family history Provide teaching regarding the importance of prevention of coronary heart disease (diet, exercise) Refer to PCP for elevated BP, BMI > 95 % or positive family history of heart disease
School-age child and caretaker demonstrate appropriate childhood injury prevention behaviors such as: consistent use of seatbelt in back seat of car use of bike helmet pedestrian and playground safety use of sunscreen prevention of poisonings keeping matches and guns locked and out of reach safety and supervision after school stranger safety safe touch anger management	Assess knowledge and understanding of child and caretaker Provide with appropriate anticipatory guidance as indicated Provide with written materials regarding childhood safety
School-age child has questions and concerns addressed concerning physical and emotional changes of puberty	Assess level of understanding and readiness to learn Provide privacy and protect confidentiality Provide with information related to puberty as appropriate to developmental age
School-age child's specialty care is coordinated with the primary care physician	Ensure primary physician is identified on the release of information form Coordinate care with the PCP provider through appropriate exchange of information in the medical record and physician-to-physician or care coordinator-to-physician communication

Health Problem Management

Outcomes	Interventions
Child begins interacting directly with doctors, nurses and therapists	Direct questions to child as well as caretaker
Child and caretaker are knowledgeable about health condition/disability Child and caretaker demonstrates competence in health problem management skills such as: treatments medications therapy/exercise orthopedic appliance latex allergy bowel program bladder program prevention of skin breakdown	Assess current level of understanding of both child and caretakers Assess competence with appropriate health care skills check list and/or observation Teach child about health problem(s) and how to manage care Provide with culturally appropriate written information Re-educate as child develops cognitively Encourage increasing independence in health problem management
Child and caretakers demonstrate health practices which will prevent secondary disabilities such as: obesity contractures skin problems constipation urinary tract infections The child is free of secondary disabilities	Assess risk status for secondary disabilities Teach child about risk of secondary disabilities associated with health condition and cues to early identification Teach to monitor for secondary disabilities
Child and caretakers identify signs and symptoms which require prompt medical assessment or intervention	Assess level of understanding Teach young person to recognize signs and symptoms which require prompt medical assessment and intervention such as: infection problems breathing skin break down high fever allergic reactions

Child and caretakers develop an appropriate plan for medical emergencies child and caretakers can state signs and symptoms of medical emergencies child and caretakers can activate EMS or another community-based emergency system	Teach signs and symptoms of medical emergencies related to health condition Teach how to activate EMS Develop emergency care plan as appropriate
Child wears medic-alert ID as appropriate: latex drug allergies foods others	Assess if medical alert for allergies or life threatening condition is needed Provide information about how to obtain medical alert ID
Caretakers can access needed equipment, supplies, therapies and other needed services	Assess for need for additional equipment, supplies, therapies or technology based on age/ developmental or functional changes/status Ensure funding source for equipment, supplies, therapies and other needed services Obtain prior authorization with third party payors or manage care organization Facilitate referrals to public and private agencies for equipment, supplies, therapies and services Coordinate care with other providers
Caretaker has payment source for health care (either private insurance, Medicaid, CHIP, or other resources) Caretaker is knowledgeable about how to access and use third party payer understands prior authorization process understands gatekeeper concept understands how to use third party case management	Assess current third party resource Provide information on SSI, Medicaid, and CHIP as needed Assess knowledge of how to work with third-party payors Teach how to work with third party gatekeepers or case management systems Teach how to advocate for self with third party resources
Caretaker is knowledgeable about how to apply for Medicaid, SSI, and CHIP benefits	Assess knowledge and understanding of Medicaid, SSI, and CHIP Provide information related to Medicaid, SSI, and CHIP as appropriate Provide with information about how to apply for Medicaid, SSI or CHIP and assist with the application process as needed Provide needed medical evidence for SSI decision

Development & Self-Care

Outcomes	Interventions
School-age child is able to communicate needs, concerns and priorities	Ask school-age child to identify needs, concerns and priorities Direct questions to school-age child as appropriate to age and development Involve in planning care
School-age child has independent mobility	Assess mobility status/needs Optimize mobility at home, school and the community Encourage exercise and recreational opportunities which promote mobility
School-age child demonstrates competence in self-care skills and/or has an appropriate long-range goal for developing a plan for self-care skills such as: feeding bathing dressing grooming toileting (clean intermittent catheterization and/or bowel program) inspecting skin transferring to toilet, tub, car mobility at home, school, community	Assess level of competence in activities of daily living (ADLs) at least yearly Encourage family and school-age child to make self-care a top priority Discuss with parents developmental issues surrounding the need for privacy during school-age child years and the importance of self-care Refer to physical or occupational therapy for evaluation and intervention as needed Evaluate need for inpatient admission for self-care skills training Coordinate pre-admission and discharge planning related to in-patient habilitation admission or summer camp programs
School age child knows name, address and phone number and how to ask an adult for help	Assess if child knows name, address, phone number, and how to ask an adult for help

School-age child demonstrates developmentally appropriate competence and/or has an appropriate plan to develop home management skills such as:

fixing simple meals or snacks

cleaning room

doing laundry

assisting with grocery shopping

managing an allowance

Assess level of competence in home management skills

Encourage family and school-age child to make learning home management skills a priority

Assign school-age child chores appropriate for his/her developmental level

Encourage parents to take child shopping and to involve in making choices about purchases

Encourage parents to allow child to make decision about how to spend his/her allowances

Encourage parents to let child learn consequences from good and poor choices

Encourage independence in all home management skills

Evaluate the need for an inpatient admission to learn selected home management skills

Coordinate pre-admission and discharge planning related to in-patient habilitation admissions or summer camp

School-age child and caretakers state what accommodations are needed in home, school and community to promote full inclusion

Architectural barriers which limit independence are removed

School-age child and family understand rights and responsibilities under the ADA

Assess home accessibility and architectural
barriers

Assess vehicle accessibility

Assess school accessibility

Provide information about ADA

Teach to advocate for rights under ADA

Refer to independent living centers for assistance with accessibility issues as needed

Self-Perception

Outcomes	Interventions
School-age child exhibits planning and decision making appropriate to developmental age	Assess planning and decision making skills Problem solve directly with the child Involve the child in planning and making decisions to the greatest extent possible Encourage taking responsibility for positive and negative outcomes of decisions
School-age child can advocate for self	Assess advocacy skills Encourage school-age child to advocate for his/her needs at school and with health care personnel
School-age child reports having a positive self-concept can identify positive attributes can identify special talents reports that "my life has a purpose" School-age child has a plan for his/her future and is optimistic about the future	Assess self-concept by asking "What do you like most about yourself?", "What do you do well?" Refer children with low self-esteem to community resources as appropriate Ask "What would you like to do when you grow up?" Encourage children to take concrete steps to make their future something positive Relate present activities to the future Provide the school-age child with support and encouragement about the future

Coping & Stress

Outcomes	Interventions
School age child can identify what causes stress in his/her life School age child can identify effective stress reduction activities such as: exercise music hobbies talking with parents and others	Assess for perceived level of stress Assess effectiveness of stress reduction and coping strategies Provide information on stress reduction activities
School-age child does not exhibit signs and symptoms of severe anxiety or depression such as: somatic complaints declining school grades lack of interest in school or peer group activities excessive weight loss or gain excessive sleep or insomnia aggression or behavioral problems suicidal thoughts, plans or attempts	Provide privacy Assess for signs and symptoms of high levels of stress anxiety or depression either by history or written self-assessment Refer to psychologist or local health and social service programs if signs or symptoms of depression are noted
School-age child does not report or demonstrate symptoms of emotional, physical or sexual abuse	Provide privacy Assess for potential or actual abuse Refer to appropriate state agency if risk factors are present or abuse signs/symptoms are noted

Family & Community Support

Outcomes	Interventions
School-age child receives consistent love, comfort, encouragement and support from caretakers	Assess parent-child relationship Encourage parents and other caretakers (including health care professionals) to provide the school-age child with love, comfort, encouragement and support Assess family communication patterns Encourage children as they learn new skills When children and adults disagree, encourage the adults involved to assure the child of their continued love/care
School-age child can discuss future plans and concerns with caretaker and one other non-parental adult	Encourage caretaker to be open and a "good listener" Encourage caretaker to promote relationships with trusted adults
School-age child is included in family decisions and given useful home and community roles	Ask school-age children about what they like and don't like about their daily routine Make changes based on their ideas and input Involve school-age children in meaningful household chores. Be clear in expectations and standards Help school-age children find ways to help others in their family, school, or community
Family has clear rules and consequences and monitors the child's activities and friends School-age child respects parental limits	Assess parenting approach. Are there rules, expectations and boundaries? Are they equal for all children in the family? Encourage caretakers to be consistent and firm about expectations and boundaries

School & Work

Outcomes	Interventions
School-age child and caretakers express satisfaction with school program, student attendance and performance School-age child attends school regularly School-age child is placed in program appropriate for academic skills and social integration	Assess school placement, program, attendance and performance Encourage school attendance and counsel against "homebound" programming
School-age child does homework when assigned School-age child is motivated to do well in school	Assess level of motivation Teach caretakers the importance of children doing their best in school Assess if homework is a priority Encourage caretakers to create time and space for homework Encourage caretakers to monitor homework completion Encourage caretakers to make homework the child's responsibility to the greatest extent possible
School accommodates to facilitate health problem or disability School-age child receives needed therapy or treatments at school by qualified provider	Assess if accommodations made Assess if nurses and therapists available to meet health needs

School-age child has up-to-date IEP which addresses health/disability needs and concerns School-age child and family participate in the development of the IEP	Assess if child has an IEP and obtain copy of IEP for medical record Encourage school-age child to participate in IEP development as appropriate Encourage self-advocacy Provide with information relating to educational rights under IDEA and section 504 of the Rehabilitation Act as needed
School-age child reads for pleasure	Encourage parents to set aside a time when the school-age child reads to them
School-age child considers career possibilities	Ask "what would you like to do when you grow up?" Take child to places of work Provide encouragement to dream Provide parents with information about Vocational Rehabilitation, School to Work and other opportunities for young people with disabilities
School-age child has an occasional job for pay or business adventure	Encourage parents to look for and create opportunities for small paying jobs (taking care of pets, lemonade stand, etc.)

Burns, C. E., Barber, N., Brady, M., Dunn, A. M. (1996). Pediatric primary care: A handbook for nurses. Philadelphia: WB Saunders.

Garwick, A., & Miller, H. (1996). Promoting resilience in youth with chronic conditions and their families. Maternal and Child Health Bureau. Health Resources and Services Administration, U.S. Public Health Service.

Green, M. (Ed.). (1994). Bright futures: Guidelines for health supervision of infants, children, and adolescents. Arlington, VA: National Center for Education in Maternal and Child Health.

Whaley, L.F., & Wong, D. L. (1995). Whaley & Wong’s nursing care of infants and children. St. Louis: Mosby.