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Isabel is a 2 1⁄2-year-old toddler who lives with her parents and 13-month-
old sister in a rural community. Her father is a migrant worker and her
mother stays at home with the children. Both parents are smokers. Both
Isabel and her sister experienced recurrent episodes of otitis media during
infancy although Isabel’s infections have become less frequent. Isabel’s
speech is delayed; however, her mother believes that this is due to her lack
of interactions with other children her age. Their culture and financial sit-
uation does not encourage daycare settings for children if the mother can
stay at home with them. Most of Isabel’s speech is not understandable
although she babbles “constantly.” Both children have received their sched-
uled immunizations at the local pediatric clinic. Isabel is brought to the
clinic by her parents when she places a small toy in her ear that her parents
are unable to remove.
Case Study
During the admission history, Isabel’s mother tells the nurse that she has
had “behavior problems” with Isabel since she was 11 months old although
she stated she had not mentioned this to the staff at the clinic because she
was embarrassed. On further questioning, Isabel’s mother explains that
Isabel “never listens to me and doesn’t even look at me when I talk to her.”
She further states that Isabel doesn’t talk so they can understand her even
though they have friends whose children not only talk all the time, but she
can understand what they are saying. “Isabel’s problems are probably my
fault because I didn’t raise her right. Now I’m afraid she is retarded and
I don’t know how to help her.” Isabel sits in her mother’s lap babbling dur-
ing the interview and does not make eye contact with her parents or the
nurse during their conversation or when addressed. She appears disinter-
ested in her surroundings.

10. Discuss your feelings about parents’
behavior that places their children at risk.
11. How could the nurse approach
Isabel’s parents about their cigarette
smoking and how it compromises their children?

SCIENCE
HEALTH SCIENCE
NURSING
NURSING 106

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