A school nurse is preparing to support children who have a chronic illness in a middle school setting. The nurse should be aware of which of the following challenges chronically a children may face? (Select All that Apply)

A. Bullying. Children with chronic illnesses may be at higher risk of bullying due to visible symptoms, medical devices (e.g., insulin pumps, braces), or frequent absences. Bullying can negatively impact their self-esteem and emotional well-being. B. Absenteeism. Chronic illnesses often require frequent medical appointments, hospitalizations, or rest periods, leading to increased school absences. This can affect academic performance and social integration. C. Decreased intelligence quotient (IQ) score. While chronic illness can affect cognitive function in some cases (e.g., severe epilepsy, untreated hypothyroidism), most children with chronic illnesses do not inherently have lower IQ scores. Learning difficulties are more often linked to fatigue, medication side effects, or missed instruction time rather than a direct decrease in intelligence. D. Behavioral issues toward other students. While some children may struggle with frustration or emotional distress due to their illness, chronic illness does not inherently cause aggressive behavior toward peers. However, emotional regulation difficulties may arise due to stress or anxiety related to their condition. E. Mental health concerns. Anxiety, depression, and feelings of isolation are common among children with chronic illnesses. They may struggle with self-identity, fear of medical procedures, and social exclusion, increasing the risk of mental health disorders.