Toddler Final
Toddler Final
Toddler Final
Toddlers is the period from 1 to 3 years of age. Toddlers develop from having no
control to being able to walk and speak. They also learn to control their bladder and bowels
and they acquire a wide variety of information about their environment.
Two-year-old children lose the baby look. Toddlers usually chubby with relatively short
legs and large head. The face appears small when compared to the skull, but as the
toddler grows, the face seems to grow from under the skull and appears better
proportioned. Toddlers have a pronounced lumbar lordosis and a protruding abdomen.
The abdominal muscles develop gradually with growth and abdomen flattens. Toddlers
can be expected to weigh approximately four times their birth weight. The weight gain is
about 2 kg between ages 1 and 2 years and about 1 to 2 kg between 2 and 3 years. The
3-year-old should weigh about 13.6 kg. A toddler’s height can be measured as height or
length. Height is measured while the toddler stands, and length is measured while the
toddler is in a recumbent position because the measurement differ slightly. The head
circumference of the toddler increases about 2.5 cm each year. By 24 months, the head
is 80% of the average adult size and the brain is 70% of its adult size
According to Freud, the ages of 2 and 3 years represent anal phase of development,
when the rectum and anus are the especially significant areas of the body. Erikson viewed
the period from 18 months to 3 years as the time when the central developmental task is
autonomy versus shame and doubt. Toddlers begin to develop their sense of autonomy
by asserting themselves with frequent use of the word “no”. They are often frustrated by
restraints to their behavior and between ages 1 and 3 may have temper tantrums.
However, with the guidance of their caregivers they slowly gain control over their emotions.
Parents need to have a great deal of patience coupled with an understanding of the
importance of this developmental milestone. According to Piaget (1966), in the cognitive
development the toddler completes the fifth and sixth stages of the sensorimotor phase
and starts the preconceptual phase at about 2 years of age. In the fifth stage, the toddler
solves problems by a trial and error process. By stage 6, toddlers can solve problems
mentally. According to Kohlberg (1981), the first level of moral development is the
preconventional when children respond to punishment and reward. During the second
year of life, children begin to know that some activities elicit affection and approval.
According to Fowler (1981), the toddler’s stages of spiritual development is
undifferentiated. Toddlers may be aware of some religious practices, but they are primarily
involved in learning knowledge and emotional reactions rather than establishing spiritual
beliefs. A toddler may repeat short prayers at bedtime, conforming to a ritual, because
praise and affection result. This parental or caregiver response enhances the toddler’s
sense of security.
Client’s name is JDS, 2 years of age and was born on April 5, 2017. The son of Journe
Suyman and Ritchell Tello. The student nurses chose him as a client because he was
cooperative, approachable and very active, he responds well on every task that the tester
gave him.
Objectives
After 20-30 minutes of assessment and interview, the tester will be able to collect data
necessary for the overall assessment specifically;
b. Detect if there are delays regarding the growth and development of the client,
e. Compare the client to the normal growth and development according to theories.
Personal Data
JDS, 2 years of age, was born on April 5, 2017, a Filipino Citizen, Roman Catholic
and currently residing at Davao City. Father’s name is Journe, 21 years of age, high school
graduate and the occupation is a staff in Mandaue Homes. Mother’s name is Ritchell Ann,
22 years of age, undergraduate.
Computation of Age
Computation of age will be the basis for drawing the age line in order to determine the test
items to be administered. Date of test was on September 16, 2019 then subtracted to the
client’s birth date on April 5, 2017 to calculate for the child’s exact age. Therefore, the age
of the child is 2 years, t months and 11 days.
As we calculate the age of our client and indicated the age line at 2 years and 5 months,
it was reflected that the test items that will be administered in the conduction of the
MMDST assessment are:
Personal – social
Plays interactive games, uses spoon spilling little, puts on clothing, Washes
hands and dries, separates mother easily, Removes Garment
Language
Combines two words, points to one named body part, names one picture,
follows directions, uses plurals
Gross Motor
Throwing ball overhead, balance on 1 foot 1 second, jumps in place, pedals
tricycle, broad jump
Personal-Social
Activities under this sector are: plays interactive games, uses spoon spilling little, puts
on clothing, washes hands and dries, separates mother easily, and removes garment. The
test under this sector indicates the child’s ability to care for themselves and interact with
others.
To test if the client plays interactive games, we asked his mother if the client plays
with other children and the mother verbalize “Oo, nagadula na siya sa laing bata pareha
anang tagu-anay.” This test was passed by report. According to Jean Piaget, play is
important to a child’s development. Play becomes the primary means by which children
foster their cognitive development and learn about the world. (Potter & Perry, 2013).
To test if the client uses spoon spilling little, we asked again his mother if the client
can use spoon or fork to get food to his mouth without spilling and the mother verbalize
“Oo,kabalo na siya muhungit og pagkaon gamit kutsara og wala kayo mahulog.” This test
was passed by report. According to Bandura, toddlers learns through imitation and
practice such as holding a spoon and put it into the mouth correctly. (Kozier & Erbs, 2018).
To test if the client can now put his own clothing and removes garment, we asked the
mother if she can give him another piece of cloth since the child goes home sweating from
outdoor play. The child obediently puts on his new clothing and removes his soiled cloth.
This indicates that the client passed this test. According to Bandura, practice, self-
regulation and self-efficacy are important to toddlers for their development in activities of
their daily living such as dresses self. (Kozier & Erbs, 2018).
To test if the client can now wash his hands and dries, we asked again his mother if
we can let the client do handwashing on his own. The child obediently washes his hands
and pat dry. This indicates that the client passed this test. According to Erikson, a sense
of autonomy emerges during toddlerhood and strives for their independence allowing them
to do things that do not result in harm to themselves or others such as washing their hands.
(Potter & Perry, 2013).
At the end of our MMDST, the student nurse tests the client by observing him if he
can be separated to his mother easily. We had observed that the toddler is comfortable to
the tester without getting upset even if his mother is cannot be seen. This indicates that
the client passed this test. According to Sigmund Freud, toddlers perform psychosocial
developmental milestones for age such as accepting separation from mother for short
periods of time. (Kozier & Erbs, 2018).
Language
This section assess the child's ability to hear, follow directions and to speak. During
the assessment, there are times when the mother interrupts instead of the interviewers
indicating instructions. As when parents of the child instruct their child to perform the task
will mean of repetition of the task.
Combines two different words. The mother was asked "maam kaya naba sa baga na
mag sturya ug duha ka words o maingon niya iyang gibati sa daghan nga words?" "O kay
pareha anang gutomon siya mag ingon man siya na "gutom ko ma", ug "kaon ko ma".
According to Erikson in psychosocial development theory, by 5 years of age, speaking
skills are well developed. (Kozier & Erbs, 2018). Children use words purposefully and ask
questions to acquire information. According to Sigmund Freud, toddler stage is receptive
and expressive language skills are developing quickly. Children can understand words
and follow directions long before they can actually form them into sentences. (Kozier &
Erbs, 2018).
Point to one body part. The child was asked of what is the name of the body part,
"unsa mani siya(examiner point to the feet)?" "Feet", "kani(points to the head)?" "Ulo",
kani(examiner points to the hand) "kamot". The child was able to pass test. According to
Erikson, during the toddler stage, receptive and expressive language skills are developing
quickly. Children can understand words and follow directions long before they can actually
form them into sentences. (Kozier & Erbs, 2018).
Names 1 picture. The tester points pictures that is in the footnote found on the back of
the test form one at a time and ask the child, “What is this?” The tester points to the picture
of a:
Follows direction. "Jodo sunda akong iingon ha, ibutang ning lapis sa salog" ,"sa
lamesa", "ihatag ka mama". The child passed the task on the third time because this is
where the mother instructs the child instead of the interviewer. According to Erikson,
children can understand words and follow directions long before they can actually form
them into sentences. (Kozier & Erbs, 2018).
Uses plurals. The mother was asked if the child uses plurals, "maam naga ingon na
ba ang bata ug "mga" o "daghan" ug gina gamit ba ni niy para maka ingon sa iyang
makita?" "O muingon siya ug "daghan dulaan" ug "mga dulaan". The child has passed the
task. As for the examiner, the mother may be too possessive for her child to show that the
child is able to answer and perform all the task. According to Piaget, concepts start to form
in late toddlerhood. A concept develops when the child learns word to represent classes
of objects of thoughts. An example of a concrete concept is table, representing a number
of articles or furniture that are all different but all tables. (Kozier & Erbs, 2018).
Imitates Vertical Line. This task is to test if the client could imitate a vertical line that
the testers showed. First, the child should sit comfortably with a proper writing level table.
Place the paper and pencil in front of the child and tell him to draw the same lines as the
demonstrator shows how it's made. The child was not able to imitate the vertical lines but
instead he did a bunch of scribbles. The demonstrators gave another piece of paper and
show the child to do it again and still have no improvement. The demonstrators tried
another task – to make the child grasp a cheese curl which he successfully did it after
dumping the cheese curls out of the bottle. According to Bandura, he believes that learning
happens when imitation occurs. (Ramont & Niedringhaus, 2008)
Dumps Cheese Curl from the Bottle. To test if the client is able to dump the cheese
curls out of the bottle by himself without using his fingers and grabbing it. The testers place
a cheese curl in the bottle and instruct the child to get it out. If the child does not dump the
cheese curls from the bottle on his own, show him how to do it 2 or 3 times. The child
dumps the cheese curls out of the bottle on his own, thus, pass. According to Bandura, he
believes that learning happens when imitation occurs. (Ramont & Niedringhaus, 2008)
Gross motor
In this sector, the client must be able to Balance on one foot for 1 second, Throwing
ball overhand, jumps in place, pedals tricycle and broad jump. This sector shows tasks,
which indicate the child’s ability to sit, walk and jump. According to Bandura, He believes
that learning occurs through imitation and practice. (kozier & erb, 2008).
To test if the client can balance his 1 foot for 1 second, the tester instruct the client to
balance his one foot for 1 second. He was able to stand on one foot for 10 seconds. He
passed as he was able to do it for the first try. According to Piaget, he believes that
individuals move from one stage to the other seeking cognitive equilibrium or a state of
mental balance (Santrock, 2009)
To test if the client can throw the ball overhand, the tester Instruct the child to throw
the ball to the tester using an overhand throw. The child was able to throwthe ball within
the arm’s length of the tester between his knees and face. The tester scored this test as
a pass. According to Bandura, He believes that learning occurs through imitation and
practice. (kozier & erb, 2008).
To test if the client can jump in place, the tester instructs the client on how to do it.
The client was able to jump in place. The tester scored this test as a pass. According to
Piaget, he believes that individuals move from one stage to the other seeking cognitive
equilibrium or a state of mental balance (Santrock, 2009)
To test if the client can pedal a tricycle, the tester saw him pedals his tricycle before
we started our assessment. The child was able to pedal a tricycle. The tester scored this
test as a pass. According to Bandura, He believes that learning occurs through imitation
and practice. (kozier & erb, 2008).
To test if the client can do a broad jump, the tester place a test form on the floor and
show the child how to do a standing broad jump across the width of the paper of the paper,
then the tester told him to do it. The client was able to jump with both feet together over
the 8 ½ inches. The tester scored this test as a pass. According to Piaget, he believes that
individuals move from one stage to the other seeking cognitive equilibrium or a state of
mental balance (Santrock, 2009)
Interpretation
The test result was normal. All sectors starting from personal-social down to gross
motor was able to perform by the child. In the personal-social behavior, he was able plays
interactive games with other children, dress and undress himself without the parent’s
supervision, uses spoon to feed himself with spilling a little, washes hands and pat dry,
and he can be easily separated from his mother. While in the fine motor adaptive sector,
the child was able to perform towering of cubes but was not able to imitates vertical line
on a paper. Through this, testers tried another task – to make the child grasp a cheese
curl which he successfully did it after dumping the cheese curls out of the bottle.
Furthermore, in the language sector the child was able to combine two words, points to
one named body part, names one picture, follows directions and uses plurals. Lastly, in
the gross motor sector the child can throws ball overhead, balance on 1 foot in 1 second,
Jumps in place, pedals tricycle, and did a broad jump.
General Observation
A. Maternal/Obstetric/Pre-natal History
Upon the interview about maternal, obstetric and pre-natal history, the mother stated
that she had her pre-natal check-ups during the 3rd month, 5th month, 7th month, 8th month
and had her ultrasound session during the 9th month of pregnancy. TT vaccine during the
6th month of pregnancy. There were also complications during pregnancy such as fever,
urinary tract infection lasted for 3 days. Follic acid, calcium and biogesic 1 capsule/day
was taken during pregnancy. She had her labor for 15 hours and she did not used
anesthesia during birth.
B. Birth History
Last April 5, 2017 at SPMC Hospital, JDS was born and the manner of delivery was
normal spontaneous vaginal delivery. Birth weight was 2.8 kg. birth height of 54 cm.
C. Neonatal
The child underwent newborn screening, there were no complications. The length of
stay in the hospital was 2 days.
D. Childhood
Fever, cough, colds were some of the childhood disease, the child was immunized
with complete vaccine such as BCG, Hepa B, OPV, DPT, Measles, Hi B, Hepa, meningitis.
There were no allergies
E. Elimination
The child uses diaper for his is elimination and urination every night. He was able to
verbalize the need defecate and urinate but according to her mother, he still cannot fully
control his bladder that’s why he is using a diaper and he sometimes pee on his own pants
especially at night. Urination per day is 2-3 times per day. He defecate once a day with a
soft consistency, brown colored stool. There were not problems regarding the elimination
of the child.
F. Nutrition
The child is still being fed with breastfeeding 4 times a day or by demand, sucking
strength is strong. He was also given with a formula milk every night before he sleeps
which is birch tree, nido 10-15 mL. The child has a good appetite and he eat meal 3 times
a day, he loves to eat chicken and he has vitamins such as tiki tiki and propan TLC
The child sleeps twice a day, afternoon and night. He usually sleeps 9-10 hours and take
naps 2-3 hours every afternoon. He would do some rituals before he sleep, he’ll play and
pray before sleeping, his toys are truck and animal toys.
Client’s height is 34 inches and 10 kg in weight. He would sometimes take a bath and
dress up himself with supervision. The dialect of the child was adapted from the family
which is Bisaya, he usually says “Mama”, “Papa”, “Gutom ako”, “Chicken”.
Conclusion
The growth and development are commonly thought of as having four major
components: physical, psychosocial, cognitive, and moral development. These
components of development include how the body grows and changes. The client
performs the gross and fine motor and psychosocial milestones within the normal range
such as; walk up steps without assistance, balance on one foot, jump in place, ride a
tricycle and accept separation from a mother.
In the thorough assessment, the testers observe the major problem that appears on
the child based on the developmental tasks of a toddler. The testers found out that toilet
training is the major task during this stage and requires health teaching. The client cannot
control his urine and bowel movement since he is still in the stage of learning. As per
health teaching, information about toilet training techniques, accident prevention and
proper hygiene were provided to the client and anticipatory guidance to the parents.
The testers find the assessment fun and comfortable because the client is
participative and positive throughout alI the test that were performed. In this physical
assessment, the testers also concluded that objectives were met at a certain progress of
each test form. The growth and development in the toddler years provide the basis for a
child’s future health and well-being. As a student nurse, demonstrators and testers of this
physical assessment, it is essential that doing an accurate and timely assessments
promote health and detect delays early, and thus allowing for early interventions.
Practicing the physical assessment accurately could lead to an enhanced and improve
skills that is significant on becoming a successful nurse someday.
References:
Berman, A., Snyder, S., Kozier, B., Erb, G., (2018). Kozier & Erb’s Fundamentals of
Pilitteri, A. (2010). Maternal & child health nursing: care of the childbearing &
James, RJ., Ashwill, JW., et al. (2002). Nursing care of children. Principles & practice.
Second edition.
Ramont, R., Niedringhaus, D., (2008). Fundamentals Nursing Care. Second Edition.