A 9-year-old child with autism spectrum disorder has been admitted to the hospital. Which of the
following interventions is important for the nurse to perform during the child’s stay?

Down syndrome is a genetic condition caused by the presence of an extra copy of chromosome 21, which is why it's also called trisomy 2A. This additional genetic material affects how the body and brain develop, leading to a range of physical, cognitive, and developmental differences.

Rationale for correct answer:

A. A single transverse palmar crease is a common finding in infants with Down syndrome. While it can also appear in healthy infants, its presence along with other physical characteristics supports the diagnosis of trisomy 2A.

Rationale for incorrect answers:
B. The presence of extra digits is associated more with trisomy 13 (Patau syndrome), not trisomy 2A.

C. A transient skin color change (half red, half pale) due to immature blood vessel regulation in newborns. It is a benign and temporary finding, not specific to Down syndrome.

D. Benign bluish pigmentation commonly found on the sacral area of infants with darker skin tones. These are unrelated to chromosomal abnormalities.

Take home points

• Simian crease is a key physical finding in Down syndrome, though not diagnostic on its own.
• Other common Down syndrome features: hypotonia, upslanting palpebral fissures, epicanthal folds, flat nasal bridge, and small ears.
• Distinguish Down syndrome features from findings related to other syndromes (e.g., polydactyly in trisomy 13).
• Early recognition allows prompt evaluation for associated conditions (e.g., congenital heart disease, GI anomalies).

Safe and compassionate care during the transition from curative to palliative treatment in pediatric oncology emphasizes supporting both the child and family. Nurses play a key role in ensuring that families remain central to decision-making, honoring their values, preferences, and cultural beliefs.

Rationale for correct answer:
C. Families are the primary caregivers and advocates for the child. Including them ensures respect for their values, promotes understanding of the goals of care, and helps them adjust emotionally to the transition. This approach enhances shared decision-making, maintains dignity, and strengthens coping mechanisms.

Rationale for incorrect answers:

A. The health care professionals should make the decision about the child’s care excludes the family, undermines trust, and disregards their role as the child’s advocate. Ethical pediatric care requires family participation in all major decisions.

B. Continuing aggressive treatment without benefit may increase suffering, prolong distress, and is not consistent with palliative principles. Hope can be reframed toward comfort, quality of life, and meaningful moments.

C. Palliative care is available across settings, including hospitals, hospices, and home. The choice depends on family preference, resources, and the child’s needs.

Take home points

• In pediatric palliative care, family-centered decision-making is essential.
• Nurses should support the family by providing honest information, emotional support, and guidance.
• Hope is not lost, rather, it is redirected toward comfort, dignity, and quality of life.
• Palliative care can occur in hospitals, hospices, or at home depending on the child and family’s wishes.