Parents inform the nurse that their 4½-year-old daughter “stutters a lot.” The nurse should advise the parents to do which of the following? Select all that apply

Mild stuttering is common in children aged 3–5 years as they experience rapid language development. This developmental disfluency often resolves on its own. The goal is to support the child’s confidence and reduce any anxiety or pressure around speaking.

Rationale for correct answers:

1. Waiting patiently shows the child that her words are valued. Interrupting or rushing can increase anxiety and worsen stuttering.

3. Making eye contact while listening conveys attention, acceptance, and support, helping the child feel understood and confident.

4. Speaking slowly and clearly models fluent speech and creates a calm environment. It encourages the child to slow down without needing direct correction.

5. Avoiding comments about stuttering prevents the child from becoming self-conscious, which can exacerbate the problem. Keeping communication natural and pressure-free is key.

Rationale for incorrect answer:

2. Giving treats for clear speech turns normal communication into a performance and may cause the child to feel pressure or shame when stuttering occurs. This approach is counterproductive and may lead to increased anxiety or reluctance to speak.

Take home points

• Developmental stuttering is common and usually temporary in preschoolers.
• Encourage speech by being attentive, patient, and supportive, not by correcting or rewarding.
• Avoid drawing attention to the stuttering, pressure can worsen disfluency.
• If stuttering persists beyond age 6, worsens, or is accompanied by physical tension or frustration, referral to a speech-language pathologist is appropriate.

Visual acuity refers to the clarity or sharpness of vision. Visual acuity improves with age, reaching 20/20 by approximately age 6–7. Early detection of vision problems is important to prevent conditions like amblyopia, which can be treated more effectively when caught early.

Rationale for correct answer:
3. At age 4, 20/40 vision is developmentally normal. This means the child can see at 20 feet what a person with perfect vision sees at 40 feet. It reflects typical visual development at this age.

Rationale for incorrect answers:

1. 10/10 is not a standard measurement in vision testing and is not used clinically in the U.S.

2. 20/20 vision is ideal but not expected for most 4-year-olds. While some may achieve it, it is more typical for older children, around 6 years and above.

4. 40/40 is not a valid or recognized measure of visual acuity. Standard measurements use 20 as the baseline.

Take home points

• 20/40 is normal visual acuity for a 4-year-old, with gradual improvement expected as the child grows.
• Routine vision screening begins in the preschool years to identify early issues.
• Nurses should recognize age-based norms to properly evaluate developmental progress and guide parental expectations.
• Referral is needed if visual acuity is worse than age norms or if there's evidence of strabismus or other visual concerns.