Which observation in a kindergarten child is most concerning for the school nurse?

The observation that a child walks down stairs by placing both feet on one step is the most concerning for the school nurse as it suggests a delay in gross motor skills development. By the age of 5, most children are expected to descend stairs with alternating feet, indicating a level of coordination and balance that is typically achieved around this age. Using both feet on one step may suggest difficulties with coordination, strength, or confidence while navigating stairs, which could have implications for the child's overall physical development and safety.

In contrast, throwing and catching a ball and tying shoelaces are skills that, while they do demonstrate fine and gross motor abilities, are not as critical for basic safety and mobility as stair navigation. Eating with fingers is common at this age; many children still prefer using their hands for certain foods, and it may not necessarily indicate a developmental concern. Therefore, the inability to descend stairs properly is a more prominent red flag for the school nurse to investigate further regarding the child's physical development.