A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father which symptom would you expect him to report he has noticed?

A. Encouraging conformity to peers does not foster authentic self-esteem. Relying on external approval can undermine the development of self-worth and independence, which are critical during the school-age period.

B. Simply allowing the child to quit may temporarily reduce stress but does not build competence, skill mastery, or resilience, which are essential components of healthy self-esteem. School-age children benefit from support and encouragement to persist in activities where they can develop mastery and confidence.

C. Participation in structured group activities, such as school clubs or team sports, allows school-aged children (ages 6–12, Erikson’s Industry vs. Inferiority stage) to develop skills, achieve goals, and receive recognition for accomplishments. This fosters a sense of competence and enhances self-esteem by providing opportunities for mastery, social engagement, and positive feedback from adults and peers.

D. While allowances may teach financial responsibility, they do not inherently promote self-esteem. Self-worth in school-aged children is more strongly influenced by skill mastery, achievement, social competence, and opportunities for meaningful contribution rather than monetary rewards.

A. Frequent visitors increase the risk of exposure to infectious agents. Children with immunosuppression should have limited exposure to people with illnesses, and visitors should practice hand hygiene and avoid visiting if sick.

B. Maintaining oral hygiene is crucial because the mouth is a common site for infections, including bacterial and fungal infections. Chemotherapy can cause mucositis, gingivitis, and oral ulcers, which increase the risk of systemic infection. Using a soft-bristled toothbrush and gentle technique reduces trauma while maintaining cleanliness.

C. Children undergoing chemotherapy require adequate protein and calories to support growth, healing, and immune function. Restricting carbohydrates and protein would be detrimental and does not reduce infection risk.

D. Fresh fruits and flowers may harbor bacteria and fungi that can cause infections in immunocompromised children. While mood support is important, safe alternatives include sterile or washed fruits, packaged snacks, or other forms of entertainment.