PrepUs for Pediatrics Chapter 26

A mother calls the pediatric nurse practitioner about her 7-year-old daughter's dental hygiene. The daughter has had three cavities. She does not know what to do and asks the nurse for guidance. How should the nurse respond?

"Are you able to supervise her brushing?" The number one dental problem in middle childhood is tooth decay. Until age seven, the child may need assistance brushing their teeth. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those overlooked are brushed carefully.

A nurse is assisting in a parent education class on accident prevention. Which statement by a parent indicates that further education is needed?

"My son should only wear his helmet when he goes on long rides around the neighborhood." Bike helmets are intended to wear anytime a child is on a bike, regardless of the distance they are going. Many serious accidents occur in the family driveway. All other responses are appropriate.

Typical development for the school-aged child includes playing games with friends. At what age are children typically ready for games that include playing on a team that has a winner or loser?

10 years Consider growth and development when advising. Erikson's stages can be helpful in determining. Before about 10 years, children are unable to lose a game and still maintain the self-concept that they are good people

The nurse is collecting data on a 7-year-old child who weighed 7 lb 2 oz (3.2 kg) at birth. If the child is following a normal pattern of weight gain, the nurse would anticipate the child would weigh approximately:

50 pounds By age 7, the child weighs about 7 times as much as at birth.

A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?

A feeling of inferiority Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority.

The nurse at an elementary school is explaining the concept of industry versus inferiority to a group of nursing students. What is part of this stage of Erikson's theory?

A sense of competence, mastery, and worth Erikson states that school-agers receive satisfaction from developing new skills and successfully using them to accomplish goals (industry). Failing (without adult support) or being unable to meet expectations that are set too high can result in feelings of inferiority. Lacking the ability for abstract thought is a cognitive skill and part of Piaget's theory, as is the principle of conservation. The conventional stage belongs to Kohlberg's theory of moral development.

The nurse is talking with a mother who is concerned that a school-age child is experiencing stress and has been biting the fingernails since beginning the first grade. What should the nurse advise the mother to do about this problem?

Allow some time every day for the child to talk about new experiences. Many first-graders are capable of mature action at school but appear less mature when they return home. They may bite their fingernails. Scolding, nagging, threatening, or punishing does not stop nail biting and may make the problem worse. This behavior will stop when the underlying stress is discovered and alleviated. The mother should be encouraged to spend some time with a child after school or in the evening so the child continues to feel secured in the family and does not feel pushed out by being sent to school. Drinking milk will not help alleviate the child's stress. Using rewards or teaching new skills will not relieve the child's stress.

What foods could a parent provide that would be the most beneficial to support healthy dentition for a school-aged child?

Fish, spinach salad and a glass of milk A well-balanced diet rich in calcium and phosphorus fosters healthy teeth. Minimal sugar, a diet of whole grain breads, and fish and cheeses are all good sources of calcium and/or phosphorus. Sugary soda drinks and juices, pretzels and bagels, beef and sherbet do not provide substantial amounts of calcium or phosphorus.

A nurse is caring for a hospitalized 6-year-old with pneumonia. The child frequently requests peanut butter crackers during the day and evening hours. What does the nurse understand about food intake for children of this age group?

Increased appetite and a tendency to go on "food jags" are typical. Increased appetite and a tendency to go on food "jags" (the desire for only one kind of food for awhile) are typical of 6 year olds. This stage soon passes and is unimportant if the child generally gets the necessary nutrients.

When providing anticipatory guidance to a group of parents with school-aged children, what would the nurse describe as the most important aspect of social interaction?

Peer relationships Although school, family, and temperament are important influences on social interaction, peer relationships at this time provide the most important social interaction for school-age children.

A nurse in the clinic observes a school-age child pushing another child. The parent is watching without disciplining the child and tells the nurse, "He just does what he wants to and doesn't listen to anything I say." What can the nurse inform that parent about the development of self-confidence in the child? Select all that apply

The child needs consistent rules to develop self-confidence. The child needs clear expectations to develop self-confidence. The child needs positive attention to develop self-confidence. The school-aged child needs consistent rules, positive attention, and clear expectations in order to develop self-confidence.

A group of 10-year-old girls have formed a "girls only" club. It is only open to girls who still like to play with dolls. How should this behavior be interpreted?

appropriate social development Nine-year-olds take the values of their peer group seriously. They are interested in being with peers of like mind and activities. Clubs are formed with specific exclusions of peers. Such clubs typically have a secret password and secret meeting place. Membership is generally all girls or all boys. These groups are not based on the immaturity of the children nor do they encourage sexism and bullying.

What physiological changes would the nurse expect to address in a 10-year-old child? Select all that apply.

eruption of permanent teeth pulse rate 70 to 80 bpm 20/20 vision By 10 years of age, the eye globe reaches its final shape and adult vision is achieved. The eruption of permanent teeth and growth of the jaw correlate with final head growth. The immune globulins IgG and IgA reach adult levels. The left ventricle of the heart enlarges to be strong enough to pump blood to the growing body. As a result, the heart rate decreases to 70 to 80 beats per minute and the blood pressure rises to 112/60 mm Hg.

The nurse is assessing the gross motor skills of an 8-year-old boy. Which interview question would facilitate this assessment?

"Do you participate in any sports?" To assess the gross motor skills of school-age children, the nurse should ask questions about participation in sports and after-school activities. For fine motor skills, the nurse could ask questions about band membership, constructing models, and writing skills.

The nurse is teaching a group of school age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching?

"I will grow an average of 2 inches per year" During the school age years, the child will grow an average of 1 to 2 inches per year and gain approximately 3 to 5 pounds each year. As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined.

The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child?

"My child sleeps between 11 and 12 hours a night." Sleep for the school-age child varies with the age of the child. A child between the ages 6 to 8 years needs 12 hours of sleep each night. The child between the ages of 8 to 10 years needs 10 to 12 hours of sleep each night. The 10 to 12 year old needs 9 to 10 hours of sleep each night. Staying up late after taking an after-school nap, not knowing when the child is tired, and sleeping more than a teenager when compared with a school-age child refer to sleep behaviors and needs of children of younger and older ages.

The nurse is caring for a school-aged child in the primary care setting. The parent of the child asks how often the child should see the dentist. Which is the best response made by the nurse?

"The child should see a dentist twice a year." A school-aged child should see the dentist twice a year for preventive care. Seeing the dentist once a year, when adult teeth erupt, or only when a problem is encountered does not provide recommended preventive care.

During an annual visit of a 6-year-old boy, the nurse observes dental caries on two of the child's primary teeth. Which response by the parents suggests more education is needed regarding the importance of primary teeth?

"These are only his baby teeth so we are not worried." Parents need to understand the value of the primary teeth and not see them only as temporary and soon-to-be replaced. Referral to a pediatric dentist and parental supervision of tooth brushing both lead to dental health and may be better appreciated once parents understand the importance of the primary teeth. Fluoride supplementation is not necessary if fluoride is part of the local water supply.

The mother and her 8-year-old daughter come to the clinic for a well-child visit. The mother asks the nurse, "About how much sleep should my daughter be getting?" The nurse responds by saying:

10-12 hours. An 8-year-old typically needs 10 to 12 hours of sleep each day. This amount decreases to 8 to 10 hours per day when the child reaches the age of 10 years

The nurse observes a school-age child categorize specific desk and clothing items in his hospital room. What cognitive behavior has this child mastered?

Class inclusion Class inclusion is the ability to understand that objects can belong to more than one classification. A school-age child can categorize objects in many ways. Decentering is the ability to project oneself into another person's situation. Accommodation is the ability to adapt thought processes to fit what is perceived. Conservation is the ability to appreciate that a change in shape does not mean a change in size.

What action by a parent would be least likely to foster development of self-confidence in a school-age child?

Comparing the child to an older sibling regarding academic achievements A school-age child needs consistency, clearly defined expectations and positive attention in order to develop self-confidence. By being accepting of mistakes the child makes, focusing on the child whenever they are talking and making sure the child understands behavioral expectations, the parents are fostering self-confidence in the child.

A mother suspects that her 11-year-old son is experimenting with deliriants with his friends. Which symptoms would the nurse advise the mother to look for that would validate her concerns?

Giddiness and coughing Inhalation of substances can cause numerous symptoms, including giddiness and coughing. The child will not experience diarrhea, hyperactivity or develop bad breath from experimenting with inhalants

A nurse is teaching the parent of a 6-year-old with decay in several deciduous teeth about tooth care and the importance of seeing a dentist. What instruction is best for the nurse to inform the parent about the new 6-year molars?

If the 6-year molars become decayed and have to be pulled, the child could have dental problems later. The 6-year molars are of the utmost importance: they are the key or pivot teeth that help to shape the jaw and affect the alignment of the permanent teeth. If these molars are allowed to decay so severely that they must be removed, the child will have dental problems later.

The nurse has determined that an 8-year-old girl is at risk for being overweight. Which intervention would be a priority prior to developing the care plan?

Interviewing the parents about their eating habits The nurse would need to find out what the parents' eating habits are like. It would not be necessary to determine the need for additional caloric intake. Developing a multidisciplinary plan is an intervention for a child with growth and development problems. Discussing the influence of peers is an intervention used for preventing injury.

The mother of a school-age child is distraught because the child has been diagnosed with obesity. What actions should the nurse suggest to the mother to help the child with this problem? Select all that apply

Maintain a balanced eating approach in the home. Encourage increased activity such as walking the dog after school. Seek out a preteen weight loss group for the child to participate. Strategies to help the school-age child with obesity include maintaining a healthy eating approach in the home, seeking a weight loss group with other preteens for the child to attend, and encouraging increased activity. Explaining that obesity will lead to an early death could cause the child to become obsessed with dieting and create an eating disorder. The child should not be encouraged to use fad diets to lose weight.

A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter.

What activities would a nurse recommend to the families of school-aged children to promote attainment of Erikson's developmental stage of industry vs. inferiority? Select all that apply

Praising the child for their academic efforts Allowing the child to assist her teacher in straightening up the classroom Participating on the school soccer team School-age children need support in order to achieve attainment of the developmental stage of industry vs. inferiority; parents can play a large role in the child accomplishing this. Encouraging participation in group sports, allowing children to assist their teacher and praising their academic efforts, even though they may not have made the best grade, are all ways to help the child accomplish this task. Expressing doubts about the child's abilities or defending them when they are not successful in accomplishing a skill only increases the chance the child will develop a sense of inferiority.

An 11-year-old female child is at the pediatrician's office for a well-child check-up. Which health screening would the nurse anticipate that the child would undergo today?

Scoliosis screening Initial screening for scoliosis begins at age 10 to 11 years; the child is monitored into adolescence for development of scoliosis (or progression if scoliosis is already noted).

The school-age child develops the ability to recognize that if a block of clay is in a round ball and then is flattened, the shape changes but not the amount of clay. What understanding has this child developed?

conservation Piaget described concrete operational thought occurring in the child ages 7 to 10 years. During this time the child develops various skills to see objects and the world. The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass. Using reversability the child can understand that processes can be reversed or cancelled out by other things. Decentration is developed when the child can pay attention to multiple attributes of an object or situation instead of only one. In classification the child is able to put objects together by shared qualities or characteristics.

When preparing a care plan for an overweight child, the nurse should include what goal? Select all that apply

exercise plan support groups family counseling Children who are overweight need a daily caloric intake of about 1,200 calories per day that consist of no more than 30% fat. Total caloric intake should not be reduced too drastically in children because they need the calories to form new body tissue for continued growth. These children need an active exercise program, including monitoring and limiting the time spent in physical inactivity. Lifestyle changes should include structured family meals and involving the family in counseling. Support groups are helpful to the child because they form a social network. Weight loss occurs best if children have a short-term goal for the loss rather than a long-term goal. Short-term goals coincide best with the child's task of developing industry.

The family who are vegetarian voice concern that their child is not growing well. The nurse should suggest which food to increase the calcium intake for adequate bone growth?

kale The consumption of adequate protein and calcium is important for muscle, bone, and dental development. Foods highest in calcium are green leafy vegetables, enriched breads, and cereals. Soybeans, legumes, grains, and immature seeds are high in protein. Oatmeal and quinoa are both high in protein. Sweet potatoes are high in fiber, vitamin A, and potassium.

When planning activities for school-age children, the nurse organizes games that include competition. At which age are these kinds of games preferred by children?

10 years old During the 10th year, children become very interested in rules and fairness. Before this time, they gave younger children breaks in games, allowing extra turns or hints. Now, they strictly enforce rules. At age 7 years, imaginative play decreases and more props are used. Children who are 8 years old like table games but avoid competitive ones because they hate to lose. Twelve-year-olds enjoy all types of activities that may or may not include competition

The nurse is teaching the parents of a 9-year-old girl about the socialization that is occurring in their child through school contacts. Which information would the nurse include in her teaching plan?

Continuous peer relationships provide the most important social interaction for school-age children. Continuous peer relationships provide the most important social interaction for school-age children. Peer and peer-group identification are most essential to the socialization of the school-age child. Peer groups establish norms and standards that signify acceptance or rejection. Valuable lessons are learned from interactions with children their own age. A characteristic of school-age children is their formation of groups with rules and values.

A nurse is working with a family that has two children who were identified as overweight based on screening. Which of the following strategies would be important for the nurse to include in assisting the family? Select all that apply

Emphasizing that the family not skip meals Encouraging moderate exercise for 60 minutes/day Involving the entire family in the program The entire family needs to be involved in the treatment plan, with emphasis on long-term permanent changes, not rapid weight loss and promoting moderate exercise for all for 60 minutes/day. Additionally, the nurse would encourage meal planning and discourage skipping meals and counsel the family not to use food as punishment or reward.

What teaching points would a nurse provide for families of school-aged children to help prevent substance abuse? Select all that apply.

Give the child "what if" examples to situations they may face. Encourage decision-making and discuss family values. Set firm rules regarding alcohol and other drug usage and discuss consequences associated with breaking the rules. Children mimic what adults do so it is important to set good examples for behavior regarding substance abuse. Offering children opportunities to think through " what if" situations allows the child to have already thought about difficult situations they may find themselves in. Although threats are not productive, setting strict rules regarding substance abuse are very important. Also encourage decision-making by the child based upon previous good decisions. Reference:

The nurse is preparing a presentation for a local parent-teacher organization about the growth and development of school-age children. Which of the following would the nurse include?

Secondary sex characteristics are often embarrassing for both sexes. Secondary sex characteristics are often a source of embarrassment for both sexes because preadolescent boys and girls do not want to be different from their peers of the same or opposite sex. In the later school years, girls begin to surpass boys in both height and weight. During this time, children grow an average of 2 inches (5 cm) per year. Physical maturity is not necessarily associated with emotional or social maturity.

The nurse is teaching a growth and development class to parents of school-age children. What does the nurse teach the parents about the cognitive abilities of their children?

They are able to classify objects. The period from 5 to 11 years is a transitional stage where children undergo a shift from preoperational thought to concrete operational thought. During this stage, children decenter (have the ability to project one's self into other people's situations), accommodate (develop an understanding there can be more than one reason for people's actions), conserve (the ability to appreciate a change in shape does not necessarily mean a change in size), and develop class inclusion (the ability to understand objects can belong to more than one classification). Class inclusion is necessary for learning mathematics and reading. Children do not develop abstract thinking until adolescence. Cognitive development includes the child's ability to reason through any problem he or she can actually visualize.

The nurse is conducting a support group for parents of 9- and 10-year-olds. The parents express concern about the amount of time their children want to spend with friends outside the home. What should the nurse teach the parents that peer groups provide?

a sense of security as children gain independence Nine-year-olds take their peer group seriously. They are more interested in how other children dress than what their parents want them to wear. This is the club age where groups are formed and others are excluded from the club. This age group is imitating their peers as they develop their own identity and separate from their parents. Groups are fluid as they change regularly due to many reasons: each member lives on the same street, each member plays on the same ball team, or one member has fewer material things than the others, etc. Security is gained through these clubs because it helps the school-age child develop independence away from the family. Most of the time in the school-age-child peer groups relationships are with the same-sex friends. Children do not become self-sufficient through these clubs. They remain dependent on their families for their physical needs.

A parent tells the nurse that the 6-year-old child has been biting the fingernails since beginning first grade. After analysis, the cause is determined to be increased stress. What advice would the nurse give the parent regarding this behavior?

allow some time every day for the child to talk about new experiences The developmental task of the school-age child is industry. They are busy learning, achieving and exploring. With school comes separation from the parents, new people, new activities. Beginning school can be a time of extreme stress for children. Biting the nails can be a symptom that something is concerning the child. Spending time with the child and allowing the child time to discuss these new experiences of school helps the child to put experiences in perspective and begin to deal with them. Allowing the child a reward for not biting the nails does not address the underlying issue of why the child is biting the nails in the first place. The underlying issue is emotionally based, so adding milk or providing a distraction will not correct the problem.

An overly tired school-aged child enters the school clinic. The nurse asks the child to state the times he/she usually goes to bed at night and wakes up in the morning. The child answers 11:00 PM and 6:00 AM. Which is the best response made by the nurse?

"That is not enough sleep. You should get at least 8 to 10 hours of sleep each night." The school-aged child needs 8 to 10 hours of sleep per night. Six hours of sleep is not enough sleep for this child. It is not appropriate to ask judgmental questions concerning parenting skills.

What resource should school-aged children be taught to use whenever they have questions about sex education, if their parents will not discuss the subject?

School nurse School-aged children need to have correct information regarding sex education and the best source is their parents. However, not all parents are comfortable discussing this topic with their children. If the parent is not available, the school nurse is the next best resource. Siblings, friends and resources found on the internet are not reliable sources of information.

The nurse is caring for a 9-year-old who belongs to a spite club. The chief characteristics of a 9-year-old spite club are:

they have a secret word; they exclude someone Nine-year-old gangs are typically one sex, exclude someone, and have secret codes or passwords.

During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress?

"How well does your son communicate or follow instructions?" Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary.

A 7-year-old child has taken money from the sibling's dresser on two occasions. When counseling the parent mother about this behavoir, what would the nurse advise?

"You may need to remind your child about property rights." Antisocial behaviors develop during the school-age years. Between the ages of 6 and 8 years, the child has difficulty understanding the concept of ownership and property rights. At this age, children often take things because they like the look of an item. By age 9, children learn to respect other's possessions and property. Buying a more secure bank may keep the child from taking the money, but it does not take into consideration the child's developmental level. The behavior is a developmental issue not an emotional issue of having too much pressure.

A parent is concerned about nutrition for her school-age child, voicing questions on how to encourage a healthy diet. The nurse would recommend which action? Select all that apply.

Allow the child to voice food dislikes and respect them. Limit fat intake to no more than 35% of total calories to help control weight Parents are encouraged to offer healthy foods to children, allow them to choose their foods and not encourage frequent snacking, especially with non-nutritious foods. Fat intake needs to be limited to less than 35% of the total daily calories to avoid obesity. Forcing a child to "clean his or her plate" is not a good idea either, since it forces the child to eat more than they often want to eat. Eating fast food more than twice a week is discouraged because fast food contributes to obesity.

The school-aged child understands that a change in an object's shape does not necessitate a change in size. The nurse knows that this is an example of which type of cognitive development of the school-aged child?

Conservation Conservation is a type of logical thinking in which it is understood that a change in an object's shape does not necessarily mean a change in the object's size. Decentering is the ability for a child to see the world from another's viewpoint. Accommodation is the ability to see that there may be more than one reason for another person's actions. Class inclusion is the ability to understand that an object can belong to more that just one classification.

An anxious 12-year-old girl receives an injection from the nurse and sighs with relief when it is done. After a moment of reflection, the girl asks the nurse, "Is it hard to give someone an injection?" This girl's question is evidence that she has developed which cognitive skill?

Decentering Decentering is the ability to project one's self into other people's situations and see the world from their viewpoint rather than focusing only on their own, which is what the girl in this scenario demonstrates in her ability to consider the injection from the nurse's point of view instead of just her own. Accommodation is the ability to adapt thought processes to fit what is perceived such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Class inclusion is the ability to understand that objects can belong to more than one classification.

A parent informs the school nurse that a child has not had any experiences with day care or school programs prior to starting first grade. What suggestions can the nurse make to the parent to help with the transition from home to school?

Have the parent bring the child to the school for a visit to experience the separation from home. Children who have attended a day care center, preschool, kindergarten, or Head Start program usually make the transition into first grade with pleasure, excitement, and little anxiety. Those without that experience may find it helpful to visit the school to experience separation from home and caregivers and to try getting along with other children on a trial basis.

A mother states that her 6-year-old has starting biting nails and regressing to baby talk since beginning school. What instructions are best for the nurse to give the mother regarding this behavior?

Make time each day to spend with the child individually.

On physical examination, the nurse discovers that a 6-year-old child's palatine tonsils are somewhat enlarged in the back of the throat. What would be the nurse's best action?

Record this as a normal finding in an early school-age child. Lymphoid tissue reaches maximum growth in early school-aged children. The tonsils may decrease in size somewhat from the preschool years but they remain larger than those of adolescents. The tonsils and adenoids may appear larger than normal even in the absence of infection. The nurse would be correct to document this as a normal finding. The child would not need pain medication or to be examined for respiratory problems if this a normal finding.

The nurse is caring for a 9-year-old patient in the hospital. Which project should the nurse provide to help this child achieve the developmental task of industry?

Sew a purse that will take one afternoon Hobbies and projects are best enjoyed if they are small and can be finished within a short time. Most school-age children prefer putting together something fairly simple rather than something that is more complicated because the complicated one will delay the reward, and the child may become bored and never complete it. Watching television does not help the child achieve the developmental task of industry.

A nurse in the clinic observes a school-age child pushing another child. The parent is watching without disciplining the child and tells the nurse, "He just does what he wants to and doesn't listen to anything I say." What can the nurse inform that parent about the development of self-confidence in the child? Select all that apply.

The child needs consistent rules to develop self-confidence. The child needs clear expectations to develop self-confidence. The child needs positive attention to develop self-confidence. The school-aged child needs consistent rules, positive attention, and clear expectations in order to develop self-confidence

An 8-year-old child is being seen for a well-child visit. His weight 2 years ago was 44 lb (20 kg) and his height was 3 ft, 10 in (116 cm). If he is developing normally, what would be his expected findings for this visit?

The child weighs 57 lb (26 kg). Normal physical growth for school-age children is a gain in weight of 2 to 3 kg per year and gain in height of 5 to 6 cm each year. Thus, a weight of 26 kg is an expected norm. The growth in height is not within normal parameters. A 7-year-old child should weigh seven times his birth weight. Adult teeth do not normally come in until age 10 to 12.

A mother tells the nurse she is having difficulty getting her 6-year-old to do chores. Based on the child's developmental level, what activity would be best for the nurse to recommend to the mother?

putting books on shelf School age children need rewards for their accomplishments. Small chores which can be completed quickly give this type of reward. Children can survey their finished work and see they have done a good job. Picking up toys or putting books on the shelf offers a reward because children can clearly see the result of their work. Vacuuming is a chore children do not necessarily like because once finished the rug looks the same before they started. There is no reward for the process. Raking leaves serves as only a temporary reward because even though the child can see the result of the leaves in a pile the leaves still need to be bagged or disposed. Folding clothes also offers small reward because for many 6-year-olds larger pieces of clothing can be too cumbersome to fold correctly and they are not rewarded as the clothes still need to be put away.