A HEALTH ASSESSMENT ON

INFANT, TODDLER, PRESCHOOL AND SCHOOL-AGE

In Partial Fulfillment of the

Requirements in NCM 207 - RLE

SCHOOL NURSING ROTATION

Submitted to:

Emilia Escovilla, RN
Clinical Instructor

Kezia Lumsod, St.N

Practicing Clinical Instructor

Submitted by:

Alo, Keana Bless, St.N

Basquez, Paula Andrea St.N
Campos, Eulla Ellah St.N
Silverio, Mary Lianne St.N
Suelan, Erika Lois St.N
Tolentino, Angelique Maye St.N
Viernes, Kristelle Johniene St.N
Villarin, Dustin Pierre Paolo St.N

BSN 2G & 2H - Group 3 - Subgroup 2

October 2, 2023
 INFANCY
INTRODUCTION

Infancy, which typically lasts from birth to 12 months of age, is characterized

by an extraordinary journey of growth, development, and discovery. Our most
fundamental physical, cognitive, and emotional foundations are laid during childhood,
laying the groundwork for the intricate patterns of life that will unfold in later years of life.
Infants rely entirely on their caregivers for their protection, nourishment, and emotional
bonding, forging the bonds of attachment that will influence their relationships
throughout their lives. Although they may lack words to express themselves, infants
commonly communicate their needs and emotions through crying, cooing, and even
showing various gestures, which allows caregivers to decode their signals and respond
with love and care. Children in their first year of life are completely dependent on their
caregivers and form close bonds with them as they develop personalities and attempt
their first steps and words.

According to research, these are the happiest days of a person's life, as well
as the stage of life when humans make the greatest cognitive leaps. The early years of
a child’s life are very important for their health and development. According to (CDC,
2023), healthy development means that children of all abilities, including those with
special health needs, are able to grow up where their social, emotional, and educational
needs are met. During their initial year, infants undergo remarkable advancements,
achieving significant milestones such as acquiring the capability to independently
assume a seated posture, pulling themselves up to stand, leveraging support to take
steps, and potentially taking those very first unassisted strides. As per guidelines
provided by the Centers for Disease Control and Prevention and the American
Academy of Pediatrics, infants typically demonstrate a range of social and cognitive
abilities. It's important to note that every child's developmental trajectory is unique, and
while some may reach these milestones earlier or later than others, such variations are
considered part of healthy development.

The infancy period represents the peak of rapid growth and development,
marked not only by a series of remarkable physical milestones but also by the
emergence of social and cognitive prowess. Infancy unfolds as an infant gradually gains
the ability to express their needs and desires, initially through gestures such as pointing
and crying, laying the groundwork for their subsequent social interactions and cognitive
evolution.

Physically, the head is large in proportion to the rest of the body. Average birth
weight varies from about 2.5 to 4.5 kg (5.5 to 10 pounds), and length varies from
45.7-53.3 cm (18 to 21 inches). After losing 5 to 7 percent of birth weight, infants begin
to gain an average of 142 to 170 grams (5 to 6 ounces) a week. Over the next few
days, infants develop their own sleep patterns, alternating from sleep to crying to
alertness and returning to sleep. Young infants sleep in the fetal position; when placed
on their backs, the chance of “sudden infant death syndrome (SIDS)” is reduced. Many
infants sleep from three to four hours between feedings, initially requiring 6 to 10
feedings per day.
 As normal infants grow, the head and chest circumference become relatively
equal. Infants learn to flip from one side to the other in a prone position. They progress
to sitting alone and crawling. Pulling up on someone’s hands or furniture is followed by
standing alone. By the end of the first year, many babies have taken their first steps.
Following the cooing of early infancy, older infants vocalize simple sounds and begin to
say words such as “dada”, “mama”, and “bye-bye”. The infant can now pick up small
pieces of food and manipulate a spoon and baby cup. Infants try to brush their own hair
and turn the pages of books. They enjoy songs and rhymes and may try to dance and
sing. Babies are highly social at this stage and want to be included in family life. They
understand approval and will join in clapping. Some infants also exhibit independence
by resisting, kicking, or screaming. In some cultures, this independence is strictly
discouraged, whereas others see it as normal.

Sigmund Freud’s psychosexual development theory includes stages of

development in early childhood. One of the earliest stages, the oral stage, typically
occurs from infancy from 1 month to 12 months. Freud emphasized that during this
stage, infants’ primary source of gratification is derived from their mouths. They engage
in oral activities such as sucking, biting, breastfeeding, and chewing various objects to
experience profound satisfaction (Mcleod, 2023).

According to Erik Erikson's psychosocial theory, infants undergo a critical

developmental stage known as "Trust versus Mistrust." It is characterized by the infant’s
dependence on their primary caregivers. Additionally, this stage revolves around the
infants' uncertainty about the world and the way they perceive their caregivers for
stability and consistency of care (Mcleod, 2023). If caregivers can respond consistently
and effectively to the cries of the infant, it indicates that a sense of trust is built. Hence,
infants can come to believe that the world around them is safe, secure, and
dependable, as well as foster feelings of confidence toward their caregivers.
Conversely, when primary caregivers neglect the infant's needs, mistrust would most
likely develop, leading to difficulties forming healthy relationships throughout life. Failure
to build trust also results in fear and a belief that the world is inconsistent and unreliable
(Cherry, 2022). Furthermore, children initially communicate through basic reflex actions
such as sucking and shaking their heads. As Jean Piaget proposed the theory of
cognitive development, he posited that children's cognitive development transpires in
stages. The sensorimotor stage, focusing on children from birth to 2 years of age,
highlights how children rely on their senses and motor action in order to explore and
develop an understanding of the environment. Through these experiences, infants learn
to tell the difference between people, objects, textures, and sights. Also, they begin to
remember that certain actions lead to specific outcomes and use this knowledge to plan
their activities ahead of time, thus understanding the concept of cause and effect. At
around six months, children will start to develop a sense of object permanence wherein
they become aware that objects do still exist even when they cannot see, hear, or feel
them. Children with object permanence signify their capacity to form a mental
representation of an object (Sherrell, 2023).

THE METRO MANILA DEVELOPMENTAL SCREENING TEST

The Metro Manila Developmental Screening Test (MMDST) is a specialized

assessment tool designed for the purpose of evaluating the developmental progress
and potential development delays in children aged 6 ½ years and below. This
instrument underwent substantial modification and standardization in 1981 under the
direction of Dr. Phoebe Williams, who adapted the MMDST from the original Denver
Developmental Screening Test (DDST), which was originally formulated by Dr. William
K. Frankenburg in 1967.

This special protocol carries significant weight for nurses and other medical
experts, as it empowers them with the capability to immediately recognize potential
developmental concerns. Early identification through the MMDST equips healthcare
professionals with the means to provide timely guidance and support to parents or
caregivers, thereby ensuring that children receive the necessary interventions essential
for their optimal developmental progression.

The MMDST comprises four distinct components that comprehensively

encapsulate a child’s development during the critical period spanning from birth to six
years old:

1. Personal-Social Development: pertains to the child’s ability to interact with

others and their capacity for self-care. It assesses the child’s socialization skills
and independence in personal activities.
2. Fine Motor Adaptive Development: focuses on the child’s manual dexterity and
hand-eye coordination. It evaluates their proficiency in tasks requiring precision,
such as grasping objects and engaging in activities like drawing or writing.
3. Language Development: This assesses the child’s auditory comprehension,
ability to follow instructions, and verbal communication skills. It also examines the
child’s capacity to both comprehend and effectively express themselves through
speech.
4. Gross-Motor Development: This encompasses a child’s physical abilities,
including sitting, walking, jumping, and other fundamental physical activities, This
aspect of the assessment identifies potential developmental delays or concerns
related to the child’s gross motor skills

INTRODUCTION TO CLIENT

The client, who is identified as L.B.C.Y., a Filipino child who is currently 11

months and 8 days old, born on October 12, 2022. L.B.C.Y. is the second child among
two siblings. The assessment took place at their residence at Mintal, Davao City. Proper
permission was obtained from the client's parents to proceed with the assessment. The
student nurses chose client L.B.C.Y. since she presents a multifaceted case with a mix
of developmental strengths and areas for further exploration. Her unique developmental
profile makes her an interesting subject for a case study, allowing for an in-depth
investigation into communication, motor skills, language development, and even social
learning during the infancy period.

GENERAL OBJECTIVES

By the end of the school nursing rotation, the BSN 2G & 2H student nurses will be
able to evaluate infant development comprehensively by utilizing various aspects and
domains that provide a fundamental understanding of the client's current health
condition in order to construct a comprehensive case study.

SPECIFIC OBJECTIVES

Upon conducting the assessment, the student nurse will be able to:
a. Establish rapport and build trust with the client and the individuals
participating in the assessment.
b. Collect relevant data and findings pertaining to the assessment
c. Conduct a thorough interview with the participants involved in the
assessment to gather information about the client.
d. Perform assessment and administer MMDST to the client.
e. Analyze and assess the result to normal growth and development of an
infant.

PERSONAL DATA

Name of the Patient: L.B.C.Y Educational Attainment: College

Age: 11 months and 8 days Graduate
Birthday: October 12, 2022 Occupation: Government Employee
Ordinal Rank: 2 of 2 siblings Name of the Mother: A.C.Y.
Address: Mintal, Davao City Age: 40
Nationality: Filipino Educational Attainment: College
Religion: Roman Catholic Graduate
Name of the Father: G.Y. Occupation: Bank Manager
Age: 41

Client L.B.C.Y was 11 months and 8 days old on the day of the assessment on
September 20, 2023. The child was born on October 12, 2022, as the second of two
siblings. He is now residing in Mintal, Davao City. His religion is Roman Catholic, and he
is of pure Filipino descent. The client's father, G.Y, is 41 years old, a college graduate,
and currently works as a government employee. A.C.Y., the client's mother, is 40 years
old, a college graduate, and works as a bank manager.

COMPUTATION OF AGE

Year Month Day

Date of Assessment 2023 09 20

12+9 = 21
Date of Birth 2022 10 12

Age 11 8 = 11 months, 8 days

The test was administered to a client who was 11 months and 8 days of age during the
assessment.

DESCRIPTION OF TEST ITEMS

PERSONAL SOCIAL

Plays Ball with Examiners

Administration: The tester rolls the ball to the client trying to let the client roll the ball
back or toss it back.
Scoring: Passed
Rationale: Playing with balls will improve the child’s motor skills, hand-eye coordination,
and timing. This will also help balance their skills and allow them to practice transferring
objects from one hand to another (Brown, 2022).

Indicates Wants (not cry)

Administration: the tester asked the parent how the child asks if she wants water.
Scoring: Passed by report. The parent said that their child asks for water by pointing it
and not by crying.
Rationale: Pointing can be cute, funny, and sometimes a bit mysterious. But pointing is
also a development milestone for your baby as they continue to build their
communication skills and engage with the world around them. (Larson, 2021)

Drinks from Cup

Administration: The tester asked the client’s parent if she could drink water from the
cup without spilling too much.
Scoring: Passed by report. The parent said that the client can hold adn drink from the
cup without too much spills
Rationale: By the time infants turn 6 months, they begin to show interest in cups,
especially the ones their parents are drinking from. Infants can begin to drink from an
open cup held by an adult as early as 6 months and exploration of the cup should be
encouraged. (ABC Admin, 2020)

Imitates Housework
Administration: The tester asked the parents if the client imitates them doing
housework.
Scoring: Failed
Rationale: One theory, which falls in the "infants don't know that much" camp, assumes
that imitation is based mostly on the way that infants represent movements. This theory
suggests that the way that people understand the movements of other people is based
in part on using the parts of the brain that are associated with making movements.
(Infants and Imitation, 2019)

Helps in House Simple Task

Administration: The tester asked the parent if their child helps with simple household
tasks.
Scoring: Failed
Rationale: In experimental contexts, where infants are provided with opportunities to
assist adults feigning distress, children often fail to help others. In structured problem
situations, infants often display wariness, turn to their parents for security, or just
continue to play (Hammond & Brownell, 2018).

Uses Spoon Spilling Little

Administration: the tester asked the parent if the client used a spoon or fork to eat
without too much mess.
Scoring: Passed by report
Rationale: When children learn to feed themselves and become more independent with
self-feeding tools like finger foods, utensils, or cups, the development of bilateral
coordination is one aspect that is necessary (Beck, 2022).

FINE MOTOR ADAPTIVE

Neat Pincer Grasp

Administration: The tester dropped a cheese curl in front of the client, trying to catch
her attention.
Scoring: Passed. The client catches the attention of the cheese curls and picks them
up using her thumb and index finger.
Rationale: This grasp begins to develop around 9 months of age and after a crude
pincer grasp has developed. You will often see a baby start using this grasp when they
are self-feeding and exploring smaller toys that they can pick up with one hand
(DeYoung, 2020).

Tower of 2 Cubes
Administration: The tester placed blocks on the table in front of the client. The tester
asked the client if she could stack blocks one after another as high/many blocks as she
could.
Scoring: Failed
Rationale: Stacking is a hallmark of fine motor skill development and requires skilled
hand use. One mechanism for children to gain manual proficiency involves establishing
a hand preference that creates practice differences between the hands as the preferred
hand is used more often and in different ways than the other (Marcinowski et al., 2023).

Scribbles Spontaneously
Administration: The tester placed a piece of blank paper and a pencil in front of the
client on the table that can be easily reached.
Scoring: Passed.
Rationale: The application of lines and marks to a rectangular surface is a typical
method of pictorial construction. Picture-making occurs early in human development
when infants begin to scribble, usually on rectangular sheets of paper. Studies of the
early developmental stages of children’s drawings have identified basic kinds of scribble
patterns that evolve into more well-defined graphic forms (Parsons, 2023).

Tower of 4 Cubes
Administration: The tester placed blocks on the table in front of the client and asked
her to stack the blocks upon the other as high as she could.
Scoring: Failed
Rationale: Stacking is a hallmark of fine motor skill development and requires skilled
hand use. One mechanism for children to gain manual proficiency involves establishing
a hand preference that creates practice differences between the hands as the preferred
hand is used more often and in different ways than the other (Marcinowski et al., 2023).

LANGUAGE

Da-da or Ma-ma, specific

Administration: The tester asked the mother if the child correctly says “ma-ma” or
“da-da” to refer to her and to the father.
Scoring: Passed by report. As evidenced by the verbalization of the client's mother, the
client will say “Mama” or “Dada” when she is looking at either of her parents.
Rationale: Infants become better at pronouncing consonant sounds as their speech
abilities improve and their orofacial muscles strengthen. As a result, most babies can
understand the meaning of the words and correctly ascribe "Mama" and "Dada" to the
correct parent by 12 months or earlier (Garoo, 2023).

3 words other than ma-ma, da-da

Administration: The tester asked the parent what words the child uses regularly for
specific objects, persons, or actions.
Scoring: Failed. The mother stated that the client cannot speak words beside s “Mama”
and “Dada.”
Rationale: According to the CDC, an 18-month-old should be attempting to say more
than three (3) words, but by 15 months old, your child should only be expected to try to
say one or two words other than 'mama' or 'dada’ (Robinson, 2023).

Points to one named body part

Administration: The tester asked the child to point where her eyes are.
Scoring: Failed.
Rationale: Most children can point to at least one body part when named by 18 months
(Geddes, 2021).

Combines 2 Words
Administration: The tester observed that the child cannot combine 2 words since she
couldn't speak other words aside from “Mama” and “Dada.”
Scoring: Failed
Rationale: As far as developmental milestones go, according to the American Academy
of Pediatrics (AAP), a child should say his first word by 15 months of age. Another
milestone that gets less attention, but is also important, is when children start to string
word combinations together (Bennett, 2022).

GROSS-MOTOR ADAPTIVE

Stands momentarily

Administration: The tester asked the parent to place the child standing on the floor and
remove support when the child seems to have her balance.
Scoring: Passed by report. The child is able to stand alone for two (2) seconds.
Rationale: Standing independently usually begins at 9-12 months. Baby will only stand
for a few seconds at first while they gain strength. They may not stand unassisted for
more than a few seconds until 13-15 months (Nick, 2021).

Stands Alone Well

Administration: The tester asked the parent to place the child standing on the floor and
remove support when the child seems to have her balance.
Scoring: Failed. The child can stand alone no more than three (3) seconds and cannot
stand for ten (10) seconds or more.
Rationale: Between 11 to 14 months, babies will be able to stand for 10 seconds or
more with a normal posture and balance (Olson, 2020).

Stoops and recovers

Administration: The tester asked the parent if the child can stand alone without any
support after bending and picking up a toy from the floor.
Scoring: Failed.
Rationale: By the age of about 11 to 14 months, they'll be able to stand fully and use
their hands. From there, they will start learning how to do more complicated things,
including bending and sitting down in a controlled way from a standing position (Tantry,
2019).

Walks Well
Administration: The tester asked the parent if the client could walk well on her own.
Scoring: Failed.
Rationale: A few 11-month-old babies will be able to walk independently, though most
babies don't take their first steps until around 13½ months (Masters, 2023).

Walks Backwards
Administration: The tester asked the parent if the child could walk backwards.
Scoring: Failed.
Rationale: 25% of children can walk backwards at 12 months, 75% on 15 months, and
90% at 16 months. Once the toddler knows how to walk forward, the toddler will be able
to take steps backward (Sturkey, 2014).

Walks Holding on to Furniture

Administration: The tester asked the parent if the child can walk while holding on to
furniture such as a chair or sofa.
Scoring: Passed by report.
Rationale: Although crawling gives babies a new perspective on the world around
them, they observe people walking and strive to do the same. In preparation for this
important milestone, babies begin pulling themselves up to a standing position (Walks
Holding Onto Furniture (9-11 Months) – Parenting Counts, n.d.).

Gets to Sitting
Administration: The tester asked the parent if the child is able to sit on her own from
lying down.
Scoring: Passed by report.
Rationale: A baby may begin sitting up with some help by 4–6 months of age, and at 6
months, they may not need assistance. By 9 months, a baby should be able to get into
a sitting position without any support (Fletcher, 2020).

Pulls Self to Stand

Administration: The tester asked the parent if the child could stand by just holding onto
a chair or table without the mother's assistance.
Scoring: Passed by report.
Rationale: Usually around 7-12 months babies will start pulling themselves up to stand.
The object they pull on and use for support can be anything at their height that helps
them feel steady (Nick, 2023).

INTERPRETATION

Segments No. of Tests Passed Fail No Refusal

Administered Opportunity

Personal-So 6 4 2 0 0
cial

Fine Motor 4 2 2 0 0

Language 4 1 3 0 0

Gross Motor 8 5 3 0 0

After doing the Metro Manila Developmental Screening Test (MMDST), the result
shows that client L.B.C.Y turned out to be NORMAL. The infant was able to pass
the tests according to her age.

GENERAL OBSERVATION

A. Maternal/ Obstetric/Prenatal History

The mother of client L.B.C.Y. completed her monthly schedule of prenatal

check-ups for nine (9) months. She reported experiencing a high-risk pregnancy.
As for medications and vaccines, the mother completed two (2) doses of Tetanus
Toxoid (TT) vaccine but was not taking any medicine during pregnancy.
Additionally, the mother couldn't recall the baby's gestational age. However, she
stated that she had three (3) pregnancies, resulting in two (2) live births and one
(1) miscarriage. Lastly, the mother forgot the duration of labor and used
anesthesia upon delivering the baby.

B. Birth History

The mother delivered the client via Normal Spontaneous Vaginal Delivery
(NSVD) in a hospital, specifically Brokenshire Medical Center located in Madapo,
Davao City. The client's head emerged first during the delivery, and she weighs
 2.93 lbs or 1.33 kilograms. The mother wasn't able to provide the client's further
measurements as she had forgotten it.

C. Neonatal

Client L.B.C.Y. underwent newborn screening, wherein the result appears

to be normal. The infant, together with her mother, spent five (5) days in the
hospital. Moreover, the mother stated that there were no medications taken
during her pregnancy, as well as no complications detected in the client.

D. Infancy & Childhood

The client has not experienced any childhood diseases nor received any
immunizations. The client also has no history of previous hospitalization, serious
injuries, and medications.

E. Nutrition

During the early months, the client was breastfed on demand or every two
hours, displaying strong sucking strength. The feeding routine has now
transitioned to S-26 formulated milk, and the client is bottle-fed every two hours.
Additionally, the client has a preference for a diet enriched with fruits, vegetables,
and S-26 formulated milk for breakfast, lunch, and dinner. In terms of nutritional
supplements, the client takes Enfamil Tri-V-Sol Vitamins A, C, & D with a dosage
of 50 mL for supplemental drops. There have been no reported feeding
problems. Dentition began at 8 months of age, marked by the appearance of
drooling, and the client currently has a total of 10 teeth.

F. Elimination

The client, L.B.C.Y., experiences regular bowel movements, typically

eliminating plenty, 2-3 times a day, with yellowish-brown, dry, and solid stool.
Additionally, the client urinates approximately four (4) times a day, and there are
no reported issues or problems with the elimination process.

G. Activity & Sleep

L.B.C.Y. follows a typical sleeping pattern, usually going to bed at around 10

p.m. and enjoying 6-8 hours of sleep. The client takes one (1) nap a day, and
being in duyan aids in promoting restful sleep. Throughout the day, usual
activities include crying, eating, and sleeping, reflecting the natural rhythm of
infant life. When awake and playful, the client engages in interactive play with her
siblings and cousins and prefers to have stuffed toys as her primary choice of
playthings.

H. Growth & Development

Anthropometric Measurements
 The client, who is 11 months and 8 days has a height of 29 inches and a
weight of 22 lbs. The head circumference of the client has a measurement of 45
cm. The chest circumference was measured having 49 cm, while the abdomen
measured at 50 cm.

Cephalocaudal Appearance

The client’s skin color is uniform all throughout and has good skin turgor.
Client’s skin has no signs of lesions or edema, as per observation. The
temperature of the skin is warm and soft to touch. No redness or discoloration
was observed. Head shape is symmetrical, eyes are normal, eyebrows are in
line, nose, and ears are normal and symmetrical as well. The Pinna of the client
returned to its normal position after folding it forward, and no secretions or
discharges were noted. Fingernails were also well-groomed and no hangnails
surrounded the nail.

Personal Hygiene

Upon assessing the client, it was observed that she was clean and
well-groomed. The mother said that they bathe the client twice a day, once in the
morning and once in the evening. Nails are also well-trimmed.

Reflexes

Parachute Reflex

Arms and legs of the client extended immediately after she was quickly
lowered, trying to break the fall. According to Frothingham (2020), when a baby
senses that they are about to fall, their arms reflexively extend to break the fall.
The baby does this before they’ve taken their first step or even experienced a
true fall and learned how to cushion it. The parachute reflex will keep the baby
from getting seriously hurt.

Palmar Grasp Reflex

The tester tried to hand over a rattle, and the client held it immediately.
When the tester tried to pull it away, the client did not easily let go as she had a
strong grip on the rattle. This reflex typically disappears by six months of age,
signifying cortical maturation and the development of cortical motor milestones.
Anekar & Bordoni (2022) stated that the persistence of this reflex beyond six
months is usually present in spastic cerebral palsy.

Blinking Reflex

This reflex was observed when there was a sudden flash of light and the
client blinked her eyes. The reflex activates when a sensory stimulus contacts
either free nerve endings or mechanoreceptors within the epithelium of the
cornea (Peterson & Hamel, 2023).
Language Development

Language/Dialects

During the assessment, the client was not able to talk but only used a babbling
sound.

Words Uttered

Client L.C.B.Y is unable to communicate during the assessment, however, she

was able to utter “mama”, “papa”, and “baba” during the assessment.

CONCLUSION

Infancy, spanning from birth to around 12 months, is a critical phase marked by

rapid growth and development. During this time, infants establish the foundation for
physical, cognitive, and emotional development, forming strong bonds with caregivers
who provide essential support. While they cannot speak, infants communicate through
cries and gestures, and they achieve significant milestones like sitting, crawling, and
taking their first steps. Language development progresses from simple sounds to early
words, and motor skills enable them to handle objects and engage in basic activities.
Cultural influences shape variations in their independence-seeking behaviors. Theories
by Freud, Erikson, and Piaget shed light on aspects of infant development, emphasizing
the importance of oral gratification, building trust, and sensorimotor exploration in this
remarkable phase of early life.

In the assessment, the client’s mother’s early history indicates a pregnancy with
prenatal checkups, a high-risk nature, and completed TT vaccinations. The birth was via
NSVD, with a healthy neonatal period and no reported complications. Infancy and
childhood were marked by good health, no diseases, hospitalizations, or serious
injuries. Nutrition transitioned from breastfeeding to S-26 formulated milk, supplemented
with vitamins. The client’s elimination patterns are regular, and sleep and play routines
are typical. Growth and development measures fall within expected ranges, and
reflexes display normal motor and sensory responses. Overall, the assessment
suggests a child with a healthy developmental trajectory and maternal care support.
Additionally, the client performed normally for his age group in MMDST.

The child’s development is determined using the data collected by the student
nurses. This assessment serves as a valuable learning experience that provides
insights into the proper techniques for conducting such assessments. It contributes to
the expansion of our knowledge and skills, allowing us to better comprehend and
manage infant characteristics and their common developmental pattern. Through this
evaluation, student nurses can refine their techniques and enhance their readiness for
professional career growth. It also equips us with the knowledge to identify
age-appropriate interventions and health education methods tailored to our client’s
needs.

APPENDICES
A. MMDST
B. ASSESSMENT FORM
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TODDLER
I. INTRODUCTION
 A. TODDLER
A toddler is a child who is between the ages of one and three. Several
physical and biological developments take place during this stage. A toddler
typically puts on 5 to 6 pounds (2.5 kg) and 5 inches (or 12 cm) each year. As a
result, the child's once-plump body now has more muscle and is slimmer. The
toddler's head circumference grows by roughly 2 cm in the second year. It results in
physical changes like a pouchy belly, lordosis, or a forward curve of the spine at the
sacral area, and a waddle or broad stance when walking.

Basically the body system keeps developing, Blood vessel lumens gradually
widen as a result of changes in the respiratory system, which reduces the risk of
developing lower respiratory infections. Gastrointestinal infection is caused by acidic
stomach fluids. They can eat three meals a day because they can eat more food in
their stomach. The spinal cord's complete myelination allows for regulation of the
urethral and anal sphincters as well. Additionally, at the point where IgG and IgM
antibody production reaches its peak, passive immunity from intrauterine life is no
longer active. The blood pressure rises to 99/64 mmHg, the heart rate drops from
110 to 90 beats per minute, the respiration somewhat slows down, and the brain
grows to roughly 90% of its adult size. Eight new teeth, including canines and first
molars, erupt during the second year of development for the deciduous teeth.

Furthermore, the child's appetite alters. It starts to sluggish down and won't
eat unless you personally spoon-feed them. Parents are nevertheless urged to do
their best and keep giving their children the necessary nutrients they require in an
acceptable amount. Language development includes things like often using "no" as
an expression of autonomy and speaking in two-word sentences. This is a
challenging time because toddlers turn aggressive and pessimistic. They also begin
to move about, act lively, and show curiosity. Additionally, they start acting in
ritualistic, inflexible, and repetitious ways.

In Erik Erickson’s theory of psychosocial development, trust vs. mistrust

stage, the first stage, was identified as the most crucial time in a child's life it since it
affects both their entire personality and how they interpret the world. Erikson held
the view that a child's social and emotional development is influenced by early
patterns of trust. A child will feel safe and secure in the world if they are able to
properly create trust. His study holds that a parent fundamentally molds their child's
perspective and potential relationships. The crucial factor is that an infant's
trustworthy encounters and associations surpass their untrustworthy ones, for the
most part. This will improve their understanding of how to trust themselves and the
outside world, claims Erikson. (Cherry, 2022)

The second stage of psychosexual development, the anal stage, according to

Freud, takes place between the ages of 18 months and three years. When a person
is in the anal stage of psychosexual development, their libido becomes
concentrated on the anal area, which causes them to derive great pleasure from
defecating. A child who enjoys exercising control over the act of defecation might be
used as an example of this developmental stage. When a youngster is learning to
use the potty, this particular type of conflict usually reaches its peak as adults place
restrictions on the frequency and location of a child's feces. The first time a
youngster interacts with authority has the ability to influence how they deal with
different forms of authority in the future. (Mcleod, 2023)

According to Jean Piaget's Theory of Cognitive Development, the acquisition

of language between the ages of two and seven marks an important turning point in
the preoperational stage of human development. At this age, children begin the
cognitive process of symbolic thinking and develop the capacity to represent
physical objects with words and pictures. People frequently have egocentric
inclinations and struggle to acquire a perspective that is compatible with that of
others. My linguistic proficiency and critical thinking skills have improved, but I still
have a propensity to think in overly specific terms. (Cherry, 2022)

According to Robert Havighurst, a toddler's developmental tasks include

learning to walk, talk, control bodily waste elimination, get along with other kids,
follow simple rules, develop self-confidence, learn to express emotions in socially
acceptable ways, develop a sense of independence, play cooperatively, and learn to
take care of themselves. According to the theory, people must effectively complete
each phase of growth in order before moving on to the next. Peers and supportive
communities help people grow personally and boost their sense of accomplishment.
(Abrina, 2020)

According to Kohlberg's phases of Moral Development, a toddler is in the first

level, which consists of two separate phases. In this level, reasoning is based on the
expected results or consequences that an individual would experience as a direct
result of their acts. Moral reasoning begins with the idea of punishment as its
foundation. The youngster has the opinion that behavior is immoral if it leads to
 punishment as a result. In Stage 2, a child's reasoning is motivated by self-interest
and rewards. (Koblin, 2021)

B. MMDST
The Metro Manila Developmental Screening Test is a clinical tool for
determining if a child's developmental condition is typical and for identifying delays
through the use of different tests that can be given in accordance with the child's
age. The initial Denver Developmental Screening Test (DDST), designed by Dr.
William K. Frankenburg, was updated and standardized by a pediatrician by the
name of Dr. Phoebe D. Williams.

The MMDST test kit, which contains all the materials needed for this test
based on the things chosen, is used to conduct it. The line contains the age. To plot
the age line on the MMDST form, the age line is computed in advance to determine
the child's actual age. It consists of four developmental stages that occur in children
between the ages of 0 and 6 1/2. Personal-Social, Language, Gross Motor, and
Fine Motor Adaptation. Each item will be scored after the developing parts are
finished. Depending on the outcomes, you can get a pass, fail, decline, or have no
chance at all.

C. INTRODUCTION OF THE CLIENT

The client is identified by his credentials V.B.B., born on July 6, 2022,
Filipino. The client's family resides in Israel St., Dumanlas, Buhangin, Davao City.
He is the youngest among the 3 children of the family. I chose this client, because
he is my cousin and I can evaluate him quickly knowing that he is an active
participant, and confident with talking to other people. Prior to the evaluation, an
informed consent was obtained, and the mother of the client willingly and
unequivocally provided their cooperation and authorization for the assessment to be
conducted. Since the client was already a member of my family, I, the test
administrator, had already established a rapport with him. Before and after the
examination, preventive actions including hand hygiene were performed. The client
is sitting on his mother’s lap during the assessment.

II. OBJECTIVES

a. General Objectives
 The BSN 2G and 2H student nurses will be able to assess the chosen
toddler's development at the conclusion of the school nursing rotation by moving
through the child's four developmental maturity domains while using the MMDST and
assessment guide.

b. Specific Objectives

1. Establish a relationship with the client's mother;

2. Describe why you are visiting
3. Obtain data from the client's mother or other legal caregiver
4. Determine the client's precise age
5. Plot the MMDST evaluation form's age line precisely; summarize
the findings of the evaluation
6. Determine the client's growth and development's delays and
progress; and
7. Give the client health education based on the results of the
evaluation.

III. PERSONAL DATA

Name: V. B. B. Name of Father: V.B

Birthday: July 6, 2022 Age: 40
Age: 1 year & 2 months Educational Attainment: Vocational
Ordinal Rank: Third Occupation: Electrician
Address: Israel St., Dumanlas, Name of Mother: K.B
Buhangin, Davao City Age: 36
Religion: Roman Catholic Educational Attainment: Vocational
Occupation: Housewife

IV. COMPUTATION OF AGE

In order to identify which test items should be administered correctly, the age of
the child will be used as the reference point for drawing the age line on the MMDST
form. This consists of the date the test was conducted and the child's birthdate.

Year Month Day

 Date of test: 2023 09 21

Date of birth: 2022 07 6

Age of child: 1 year 2 months

15 days

V. DESCRIPTION OF TEST ITEMS

a. PERSONAL SOCIAL

Plays ball with the examiners

Administration: The tester asked the mother to let the child stand and then the
tester rolled the ball towards the child trying to get him to roll the ball back

Scoring: Passed. Everytime the tester rolls the ball, the client always picks it up
and tosses it back to the tester.

Rationale: Playing with balls will improve the child’s motor skills, hand-eye
coordination, and timing. This will also help balance their skills and allow them to
practice transferring objects from one hand to another (Brown, 2022).

Indicates wants (Not Cry)

Administration: The tester asked the mother how does the child let her know
what he wants. “Kabalo na siya na mag ingon ma’am kung unsa iyang gusto?
Halimbawa kanang mauhaw or gusto mag dede, unsa iyang ginabuhat ma’am?

Scoring: Failed. The mother verbalized that “di mani siya kabalo pa muingon
unsa iyang gusto, muhilak ra jud ni iya.

Rationale: Children will let you know what their needs and wants are in
something by staring, pointing, touching and grabbing after they are 9 months old
( Communication and talking: babies and toddlers, 2022)

Drinks from cup

 Administration: The tester asked the mother if the child can hold up and drink
from the cup without spilling that much

Scoring: Passed by report. The mother verbalized that “Oo makainomm na na

siya ug tubig gikas sa baso”

Rationale: at 12 months, most children can use cups correctly. The children can
take sips and hold an open cup (Geddes, 2023)

b. FINE MOTOR ADAPTIVE

Scribbles spontaneously

Administration: The tester placed a piece of blank paper and a pencil on a table
in from of the child

Scoring: Passed, the child picks up the pencil and scribbles on the blank paper.

Rationale: Scribbling is one way for a child to write her thoughts. Drawing and
scribbling are the child's first step to use their skills that will be needed for writing
later.(Scribbles have meaning (Early Learning Professionals), n.d.)

Neat pincer grasp

Administration: The tester made sure that the child is comfortably sitting on his
mother lap and can reach the table, after that, the tester dropped a piece of
cheese curl on top of the table and points it to the child.

Scoring: Passed. The child immediately picked up the cheese curl using his
thumb and index finger.

Rationale: Neat pincer grasp is an important aspect of a child’s developmental

and growth. As a child grows, the child can have a control over their movements
as they develop their ability to grasp objects with precision (Beck, 2023)

c. LANGUAGE

Dada or mama specific

Administration: The tester observed if the child says dada or mama, after that
the tester asked the mother if the client knows how to specifically call his father
dada or his mother mama.
Scoring: Failed. The client wasn’t observed to speak mama and dada, and the
mother’s response was “ Di pa jud ni sya kabalo muingon ug mama ug papa”

Rationale: Many infants reach new language milestones by the age of 8 months.
These frequently resemble other consonant and vowel combinations, such as
"baba," or other sounds. Many infants start recognizing the names and labels of
their family members at this time as well. Early on, babies start using
recognizable syllables like "ma" and "da." Babies start using words to
communicate at this period. Babies can see their parents' excitement when they
play with noises using language. When parents call their children "Mama" or
"Dada," many babies may sense the joy in their parents' voices, which can
encourage them to link the sounds to the names. (Gabrielle, 2023)

Dada or mama non specific

Administration: The tester asked the mother if the client can say mama or dada
even not in specific.

Scoring: Passed by report: The mother stated “Gaingon siya pero mama lang
jud”

Rationale: The'm,' 'p,' and 'b' sounds, quickly followed by 'd,' 'g,' and 'h,' are
usually the first sounds babies babble; however, a first word is when the child
assigns meaning to their babble, for example, vocalizing'mama' for mom or
'dada' for dad. first words typically arise around 12 months. (Seigel, 2021)

Turns to voice

Administration: The tester whispered the client’s name from behind making
sure that no breathing air will touch the child

Scoring: Passed. The client turned his head to the back after hearing his name.

Rationale: Your child should actively respond to common noises, particularly

speech sounds, by the time they are a year old. They can locate sounds made
above and below their ear level and will turn to faint sounds on either side.
(Dawson, 2022)

Imitates speech sounds

 Administration: The tester asked the parent “Kaya na niya mag copy ug mga
sounds or like words na ginaingon ninyo pag madunggan niya?”

Scoring: Passed by report. The mother verbalized “kabalo man pero kanang
mga dali ra pud na words”

Rationale: Between 12 and 24 months, the toddler should be able to repeat

words they hear from their parents or the environment (DiProperzio, 2023)

d. GROSS MOTOR

Stands Momentarily

Administration: The tester asked the mother to put the child standing on the
floor, and remove support as the child gains his balance

Scoring: Passed. The client immediately gained his balance, and he stood
without any problems.

Rationale: at the age of around 8-12 months, the toddler would be able to stand
alone momentarily on their own and could be able to take two or three steps at a
time (Shroff, 2022)

Stands alone well

Administration: The tester once asked the mother to put the child standing on
the floor, and remove support as the child gains his balance

Scoring: Passed, the client was standing more than 10 seconds.

Rationale: Generally, children can stand up for a brief period of time without
support. At first, it will last for seconds, but it will gradually increase as the
toddlers practices moving around. (Tantry, 2019)

Stoops and recovers

Administration: The tester asked the mother, “If naa stay ginapunit sa floor
ma’am, halimbawa nakatinddog na sya no, nya naa syay dulaan na puniton,
makabalik syag tindog nga wala gagunit sa salog or miski sa unsa paman for
support?”
Scoring: Passed by report. The mother verbalized “Oo kaya na nya”

Rationale: At the ages of 11 to 14 months, a toddler will be able to stoop down

and get an object on the floor and stand back again without falling. The toddler
would be able to maintain the balance as they inspect an object (Pediatric
Neurologic Examination Videos & Descriptions: 12 Month Old, n.d.)

Walks Well

Administration: The tester asked the mother “Makalakaw na ni sya ma’am?”

The tester also asked the mother to let the client walk.

Scoring: Passed. The client can walk well without any problems.

Rationale: A few 11-month-old babies will be able to walk on their own, though
the majority of babies don't take their first steps until around 13½ months
(Masters, 2023).

Walks backwards

Administration: The tester demonstrated to the client how to walk backwards

and let the child do it himself

Scoring: Passed. The client was able to execute it without any problems

Rationale: 25% of children can walk backwards at 12 months, 75% on 15

months, and 90% at 16 months. Once the toddler knows how to walk forward, the
toddler will be able to take steps backward (Sturkey, 2014)

Walks up steps

Administration: The tester asked the mother “Kaya na po niya magsaka ug

hagdanan ma’am? Paunsa sya magsaka ma’am”

Scoring: Passed by report. The mother verbalized “Makasaka man mugunit lang
nuon sya sa grills sa rails.
 Rationale: Between the ages of 17-20 months, the toddlers would be able to
slowly walk up the stairs with support and lead with the same foot (BabySparks,
2020)

Kicks ball forward

Administration: Standing 6 inches infront of the ball the tester demonstrated to

the client how to kick the ball and asked him to do it.

Scoring: Passed. The client was able to kick the ball 6 inches infront of hi with
any problems.

Rationale: Toddlers can practice kicking a ball with assistance at around 15

months old. At around 19 months, the toddler will be able to kick precisely.
(BabySparks, 2020)

Throwing the ball overhead

Administration: The tester demonstrated how to do an overhead throw passing

the ball to the mother, after that the tester asked the client to do it.

Scoring: Passed. The Client was able to throw the ball overhead towards the
tester.

Rationale: Toddlers will experiment throwing at the age of 12 months. Toddlers

can throw over their head at 14 months and could throw an object at least 3 feet
in the air on their second birthday (BabySparks, 2018)

Jumps in place

Administration: The tester asked the client to jump and demonstrated to him
how to do it.

Scoring: Passed. The client was able to jump in place without falling of tripping.

Rationale: Toddlers typically start to jump at age between 16-18 months and will
begin jumping in place. Jumps support the important areas of muscle strength
and bone strength (BabySparks, 2018).

VI. INTERPRETATION
Segments No. of test Passed Failed No Refusal
administered Opportunity
Personal-
Social 3 2 1 0 0

Fine Motor 2 2 0 0 0
Language 4 2 2 0 0
Gross 9 9 0 0 0
motor
The result shows that client V. B. B in four sectors, has no delays. Thus, the
client’s MMDST is Normal.

VII. GENERAL OBSERVATION

Assessment
a. Maternal/Obstetrics/Prenatal History
The mother claims that she underwent a prenatal checkup throughout her
pregnancy. She said that she did not go through labor and that she is at high risk
throughout pregnancy even without the use of anesthetic (Epidural anesthetic).
She did not have any difficulties during her pregnancy. She finished the Tetanus
Toxoid Vaccine as well. The mother's medical history includes three pregnancies,
three terms, three preterms, one abortion, and three live births.
b. Birth History
The mother reported that the newborn boy was delivered by cesarean at SPMC
(Southern Philippines Medical Center) without incident. The infant was born
weighing 2.7 kg and measuring 19 cm in height. His head circumference
measures 35 cm, chest measures 33 cm, and his abdomen measures 32 cm.
c. Neonatal History
After the mother gave birth, the newborn infant reportedly underwent a newborn
screening right away. The baby had no difficulties, and no medicine was
administered to him. They spent three days in the hospital.

d. Infancy and Childhood

According to the mother, the infant has had all recommended vaccinations for
diphtheria, acellular pertussis, bacillus Calmette-Guérin (BCG), measles, and
oral polio (OPV). The newborn was transported to the emergency department
owing to a laceration even though it has no allergies, congenital issues, or history
of hospital admission.
 e. Elimination
The mother claims that at the age of one, the kid is aware of morning bowel
control but has not yet established nighttime bladder control. Additionally, the
mother stated that the youngster will urinate five times each day. The mother said
that there were no issues with urine or excrement. The mother also said that their
bowels were dark brown in color and had a dry substance.
f. Nutrition
According to the mother, she was able to breastfeed her infant 4- 5 hours, every
30 minutes to 1 hour. The toddler usually eats 4 times a day, breakfast, lunch, a
snack in the afternoon and dinner. His food preferences are blended vegetables,
specifically squash and string beans, fruits and biscuits. The mother stated that
the toddler has no food allergies. The toddler is currently taking vitamins named
Celine plus, Ferlin and Iron. In the dentition, the toddler’s first tooth appeared at
the age of 7 months, and has the symptoms of fever during teething. And now he
has 6 primary teeth (2 central (up), 2 central (down), and 2 lateral (up) ), all of
which are little in size, milky white in color and no obscuration was seen in his
teeth.
g. Activity and Sleep
According to the mother, the toddler usually sleeps at 8 in the evening and wakes
up by 6 in the morning with 10 hours of sleep everyday. The toddler starts his day
by playing with his toys, and goes to their sibling’s school.
h. Growth and Development
Cephalocaudal Assessment

1. Skin
The toddler's skin is consistently light in color, smooth, dry, warm to the touch,
and free of any ulcerations. There are also no signs of bronzing, cyanosis,
flushing, jaundice, or pallor. His skin has a strong turgor, and when pinched for
two seconds, it instantly returns to its former shape. The patient had well
manicured nails with a capillary blanch time of two seconds and no
abnormalities.
2. Head
The toddler's head is normocephalic, and his or her skull is symmetrical and free
of any lumps, depressions, or other abnormalities. Black hair on the client is
typically dispersed. There are no visible infestations on the scalp, which is clean.
3. Eyes
The client's brows were discovered to be evenly spaced and symmetrically
placed during the inspection of the toddler's eyes. The eyelashes were curled
inward and were evenly spaced apart. The child's eyelids shut symmetrically and
have an undamaged surface free of discharges, discolouration, or lesions. The
lacrimal ducts and glands are not swollen, painful, or torn. Her bulbar conjunctiva
is clear, and she has a bright, glossy, and smooth cornea. The palpebral
conjunctiva is bright, smooth, and pink, while the sclera is white. Her pupils are
brown, rounded, quickly light sensitive, and easily accommodated.
4. Ears
The child's ears were clean and smooth; they lacked any lesions, discharges, or
dry spots. The outer canthus of the eye corresponds with both symmetrical
 auricles, which are the same color as the skin on her face. The auricles felt
powerful and lively. The pinna retches when folded.
5. Nose
The nasal septum of the child is visible at the midline and has a reddish mucosa.
There were no discharges and no impediments were discovered. The patient's
sinuses are not sensitive, and no lesions were seen. The patient is not
experiencing any respiratory discomfort and is breathing well.
6. Mouth
The child's lips are symmetrical, rosy in color, moist, and free of any lesions. With
an incomplete set of teeth and a midline position, the tongue is free of lesions.
With a total of 6 teeth, the client's teeth are healthy and typical for a child.
Additionally, there are no visible symptoms of dental decay.
7. Pharynx
Due to the patient's unwillingness to cooperate, the student nurses were unable
to do a physical examination of the throat.
8. Neck
The trachea of the patient is situated midline. The patient's neck's range of
motion is normal, it was also noted.
9. Thorax
The student nurses were unable to perform a physical assessment of the thorax
due to the patient's lack of cooperation.
10. Heart
Upon inspection, there were no discernible pulsations over the heart's
precordium. At the PMI, the heartbeat was clearly audible during palpation. Given
that the youngster had been seen running and jumping prior to the evaluation,
the heart rate was recorded during auscultation at the PMI and was found to be
113 bpm. At the PMI, S1 and S2 were the loudest, and S3 was very faint.
Auscultation of the aortic, tricuspid, pulmonic, and apical pulses revealed no
murmurs. Additionally, a healthy peripheral blood flow is seen over the body's
pulse sites.
11. Abdomen
The patient’s abdomen has intact and unblemished skin with no scars or lesions
noted and was normal in shape.
12. Genito- Urinary System
-
13. Musco-skeletal System
The color of the limbs is uniformly brown, with equal sides of joints and bones,
and the toddler's resistance to muscular strength was noted in both the left and
right muscles, with no anomalies, contractures, tremors, or lesions observed.

Personal Hygiene
According to the mother, the toddler's daily routine involves a bath in the morning,
before bed and also putting on lotion.

Language Development
Language/Dialects
According to the mother, the toddler understands and speaks a few words of
English and Bisaya.
Psychosocial Development
Words Uttered
The child can say a few words like "mama," but he is still unable to form whole
sentences.
Negativism
The toddler's independence and self-interest are noted by the parents during the
evaluation. Even though he hasn't experienced it yet, this serves as an example
of how children commonly respond to changes in their lives with a resounding
"no."
Curiosity
According to the mother, she stated that the toddler immediately became curious
about the object especially when it's new to his eyes.
Possessiveness
According to the mother, the toddler showed signs of possessiveness every time
the mom gave attention to his brother.
Temper Tantrums
According to the mother, the toddler cries when he doesn't get what he wants
and when it gets grumpy.
Imitation
As the mother stated, the toddler tends to imitate when the family is singing,
combing and putting on lotion.

VIII. CONCLUSION

During the toddler years, children's physical development slows down as they
learn to control the growth of their motor, cognitive, and linguistic abilities. This
transformation is exhibited through imitation, which commonly takes the form of
pretend play as children act out roles as princesses, houses, or heroes. Furthermore, it
is noteworthy that toddlers begin to push for independence and autonomy as they
learn impulse control, begin to develop complex thought, and begin to interact with
their caregivers. According to Sigmund Freud, toddlers are in the "anal" stage of
development. According to Freud, the child needs to acquire these skills in order to
feel accomplished and independent.

The client's age was assessed to be 1 year, 2 months and 15 days during the
assessment's general observation. In general, it was noted that the client's growth was
normal. Additionally, the client's development was consistent with his age. In the Metro
Manila Developmental Screening Test (MMDST), he was able to pass most of the tests
that were in accordance with her age.

Overall the general and specific objectives were met. The student nurses
were able to assess the 4 aspects of the MMDST and were able to interpret them.
Assessment of the client’s overall health was done in a cephalocaudal order, and
proper health teachings were given to the caregiver of the client.

IX. APPENDICES
A. MMDST FORM
B. ASSESSMENT FORM
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 PRE-SCHOOL
INTRODUCTION

A child who is in preschool age is between the ages of three to five and is not yet
enrolled in a kindergarten program, whether it be public or private. When a child turns
five years old but has not yet started kindergarten in a public or private setting, they are
still considered to be preschoolers until they start kindergarten or first grade, whichever
comes first. Preschoolers are experimenting with their emotions and learning how to do
so at this age. They accomplish this in a variety of ways, including talking, gesturing,
creating noise, and playing. Preschool-age children are in a crucial phase of motor
development. They are refining basic motor skills, such as crawling, walking, running,
jumping, and climbing. These fundamental movements lay the foundation for more
complex physical activities later in life. Children aged 4-5 are increasingly seeking
independence. They want to perform various tasks on their own, such as dressing
themselves, brushing their teeth, and eating independently. Preschool education
encourages and supports this growing independence. Lastly, By the time they are three
years old, most children have 20 deciduous teeth, which are referred to as the primary
teeth, baby teeth, or milk teeth. These teeth begin to come out one by one when a
youngster is around age 5 or 6.

According to Miles (2022), Most kids grow 4.4 pounds annually between the ages
of 2 and adolescence. Additionally, between the ages of 2 and 3, they gain 3 inches (8
cm) in height, and between the ages of 3 and 4, they gain 2 3/4 inches (7 cm). Children
attain half their adult height by the time they are 24 to 30 months old, which may be
difficult for you to imagine. The primary determinant of a child's eventual height and
weight are their genes. There are, however, several variables that might have an impact
on the child's weight and height. Start with gestation. If the kid was born early, they will
likely be smaller, and if they were born after their due date, they may be larger than
typical. The second is maternal health. A smaller baby is more likely to be born if the
mother smokes, uses drugs, or eats poorly during pregnancy. You're more likely to
deliver a larger baby if the mother gained a lot of weight during pregnancy or had
gestational diabetes. Third, sex. At birth, newborn girls typically weigh and measure a
bit less than newborn boys. Next, hormones. A hormonal imbalance in the child, such
as low levels of growth hormone or thyroid, may be a hindrance of their development.
Another factor is Drugs. The growth of a child may be hindered by certain medications,
such as regular usage if the child has a chronic condition (such as cancer, kidney
disease, or cystic fibrosis), or any disorder limiting their capacity to consume or absorb
nutrients (like gastrointestinal issues). Then, Genetic disorders. If the child's growth is
impacted by their genetic makeup in general. Additionally, having a genetic disorder like
Down syndrome, Noonan syndrome, or Turner syndrome could be a factor. Lastly,
sleep. Babies' increases in sleep are associated with growth spurts. According to one
study, obtaining more sleep directly increases the likelihood that a baby will grow longer.
In actuality, growth surges happened 48 hours after more sleep was provided.

Erik Erikson, a renowned developmental psychologist, proposed a theory of

psychosocial development, which consists of eight stages that span from infancy to old
age. Each stage represents a unique psychosocial crisis or conflict that individuals must
successfully navigate to achieve healthy personality development and a sense of
well-being. For Preschool years, the Initiative vs. Guilt, children explore their
surroundings and develop a sense of initiative. Supportive environments encourage
initiative, while discouragement can result in guilt. For Sigmund Freud developmental
theory, also known as psychosexual development theory, is one of the foundational
theories in psychology. It posits that human development occurs in distinct stages, each
characterized by a primary source of pleasure and conflict. The Psychosexual Theory of
the preschool age is the Phallic Stage, which is marked by the emergence of the
Oedipus complex in boys and the Electra complex in girls. Children become aware of
their genitals and develop attraction to the opposite-sex parent while viewing the
same-sex parent as a rival. The resolution of these complexes is critical to healthy
development. Piaget, on the other hand, proposed that cognitive development occurs in
distinct stages, each characterized by specific cognitive processes and abilities.
Additionally, it describes how children gradually acquire knowledge, develop reasoning
abilities, and make sense of the world around them. The cognitive development of a
Preschool child is the Preoperational stage. In this stage, children become more
proficient in language and symbolic thinking. However, they tend to exhibit egocentrism,
where they struggle to see situations from others' perspectives. They also engage in
animistic thinking, attributing human qualities to inanimate objects. Moreover, another
theory that was implemented for the development of a preschool child was Lawrence
Kohlberg's theory of moral development, which proposes six stages that individuals
progress through as they develop their moral reasoning and decision-making abilities.
These stages are typically divided into three levels, each with two stages. Preschool
age was included in the Pre-Conventional Morality, which has two stages: Obedience
and Punishment Orientation and Individualism and Exchange. For Obedience and
Punishment Orientation, At this stage, individuals, typically children, focus on avoiding
punishment. They make moral decisions based on the fear of consequences and
authority figures' rules. The primary concern is self-interest and avoiding harm.
Likewise, in the Individualism and Exchange stage, individuals recognize that there are
different perspectives and interests. Moral decisions are guided by self-interest, but
there is an understanding of reciprocity. People follow rules to gain rewards or favors in
return.

The Metro Manila Developmental Screening Test (MMDST) is a screening test

for children aged 6 ½ years and below that looks for developmental deficits as well as
normal development. The Denver Developmental Screening Test (DDST), developed by
Dr. William K. Frankenburg, was modified and standardized by Dr. Phoebe Williams.
The MMDST assesses four areas of development: Personal-Social, Fine-Motor
Adaptive, Language, and Gross-Motor. In the MMDST, The child's parent or carer is
given an explanation of the procedure by the nurse. It must be emphasized that this test
is merely a screening and not a diagnostic one. The parents or guardians of the child
being studied should be notified that the test is not an IQ test so that they do not
interpret it incorrectly. To ensure collaboration, the nurse should get to know the parent
and the child well. Additionally, to continue with the test administration, the student
nurse must determine the child's actual age, which is defined as their age on the day of
the test. The age of the subject affects whether test items will apply to or be given to the
child, making it the most important factor. Furthermore, The MMDST has 105 test items,
but not all of them are used. The examiner gives items that cross the age line priority.
However, it is crucial to make clear to the parent or carer that not every duty must be
completed correctly by the youngster. If the order were to be kept, the examiner should
start with the personal-social sector before moving on to the others. Items with an "R" in
the footnote can be passed by report. Lastly, The test items are given a pass, fail,
refused, or no opportunity (NO) score. Developmental delay is seen as the failure of a
task that is fully to the left of the child's age. In contrast, it is permissible and not a delay
when something totally to the right of the child's age line fails.

Presently, Z.S., a female preschooler who is 4 years, 11 months, and 16 days on

the day of testing, was the client chosen due to her active personality and participation
in class. Her enthusiastic personality made her stand out, which attracted the student
nurses' attention and made her their client. Additionally, she willingly accepted the
student nurses' permission when they decided to make her their client and cooperated
with them well throughout the test. Lastly, the test was successful, and the student
nurses were able to determine what was the development of the child.
 I. OBJECTIVES

GENERAL OBJECTIVES

At the end of the 4-week School Nursing Rotation, the student nurses of San Pedro
College, BSN-2G, Group 3 - Subgroup 2, will be able to assess and evaluate the growth
and development of the preschooler using different assessment tools and techniques.

SPECIFIC OBJECTIVES

A. Gather all essential data about the client through an interview with the client's
care
B. Compute the actual age of the client day of the assessment
C. Administer the Metro Manila Developmental Screening Test (MMDST) and
assess the client's personal-social, fine motor adaptive, language, and gross
motor development
D. Interpret and discuss the client’s development based on the MMDST results
E. Examine the cephalocaudal condition of the toddler to check for any
abnormalities
F. Assess the client’s physical growth and cognitive development
G. Discuss the overall assessment to come up with a conclusion
II. PERSONAL DATA

Name of Patient: Z.S.

Birthday: October 4, 2018

Age: 4 years, 11 months, and 16 days

Ordinal Rank: 3 out of 3 siblings

Address: Boulevard, Davao City

Nationality: Filipino

Religion: Roman Catholic

Name of Father: A.S

Age: No response

Educational Attainment: No response

Occupation: CTTMO

Name of Mother: M.S.

Age: No response

Educational Attainment: No response

Occupation: Housewife

III. COMPUTATION OF AGE

Year Month Day
Date of Test 2023 09 20
Date of Birth 2018 10 04
Age 4 11 16 = 4 years, 11 months, 16 days
The test was administered to a 4 years, 11 months, and 16 days-old client during the
assessment.

IV. DESCRIPTION OF TEST ITEMS

Using the Metro Manila Developmental Screening Test (MMDST) form, the student
nurses assessed the preschooler to identify if there were any presence of
developmental delays.

The form contains four sectors of the child's development: personal-social, fine motor
adaptive, language, and sector.

PERSONAL- SOCIAL
Buttons Up ( Passed)
The student nurses asked the child if she could button any piece of clothing. The
client passed this test as she stated that she knows when she needs to button her
clothes.
Rationale: The majority of kids reach the stage in their natural development at age
three where they are able to perform the most fundamental caregiving tasks on their
own (Self-help skills: Concept & milestones: Denomme, D. 2021, March 21).

Dresses with supervision ( Passed)

The examiner asked the client if she could dress without any help but with
supervision, and she stated that she dresses on her own without any supervision but
does not know how to tie shoelaces, thus client stated that she can put on slip-on
shoes.
Rationale: Children between the ages of three and five are typically able to move onto
more sophisticated self-care tasks and grow current talents to an even more useful
state (Self-help skills: Concept & milestones: Denomme, D. 2021, March 21).

Separates from mother easily (Passed)

Upon observing the child in their classroom, it looks like she does not cry or look
for her mother since the child is participative during class. Thus, the child passed this
test.
Rationale: Separation anxiety decreases with age, but identical sensations may
resurface for brief periods for various causes (Separation Anxiety in Toddlers: A
Parent's Guide, 2022).

Dresses without supervision (Passed)

The child stated that she was able to clothe herself without the supervision of the
mother, resulting the preschooler passed this test.
Rationale: Having your child dress themselves helps them learn to be more
independent. They may get frustrated by part of the process, and you may need to help,
especially with younger children and shirts, shirts are tricky to put on and take off, but
they can do a lot of it on their own. They also feel a sense of pride in doing something,
“all by myself.” (Lindteigen, 2020).

FINE MOTOR ADAPTIVE

Copies + (Passed)
The child was shown a picture of a cross (+) on the test form's back by the
examiners without being instructed on how to draw one. The client was then told to
draw one just like the illustration by the student nurses. The child succeeded in the test
since she was able to draw two intersecting lines.
Rationale: Preschoolers are improving their drawing skills as they get closer to turning
four. They must be able to reproduce a cross (Logsdon, 2021).

Copies O (Passed)
The examiners presented the child with a picture of a circle (O) on the back of
the test form without showing her how to draw it. The student nurses then instructed the
client to draw one like the picture. The child passed the test as she could draw a picture
of a circle (O).
Rationale: Children were creative in drawing pictures of a person using lines, dots, and
circles and storytelling. This implies that play and creativity are inseparable activities for
children. Preschool teachers need to allow children to engage in pretend play to promote
creativity (Bitew & Sewagegn, 2023).

Copies ▢ (Passed)
The examiners presented the child with a picture of a square (▢) on the back of
the test form without showing her how to draw it. The student nurses then instructed the
client to draw one like the picture. The child then draw a square with straight lines,
therefore she passed the test.
Rationale: Children ages 4-5 years able to copy squares (Kid Sense, 2019).

Imitates demonstrated square (Passed)

The student nurses demonstrated to the child how to draw a square by drawing
first its two opposite sides and then the other two opposite sides. The child then
illustrated what the student nurses demonstrated, which includes as a result the client
passed the test.
Rationale: Preschoolers are able to draw figures and shapes that are recognizable (Kid
Sense, 2019).

Draws man in 3 parts (Passed)

The student nurse told the child to draw a picture of a man or woman, without
telling her to add other body parts. The child then started to draw a smiley face,
therefore the client passed the test
Rationale: As eye contact is significant to children under the age of 4, their drawings of
adults gradually expand from a head and legs to include features like eyes. They don't
sketch what they see but rather what they know, and they will add details when those
aspects become significant to them (Mcilroy, 2022).

Picks longer lines (Passed)

The student nurses showed the child two parallel lines on the back of the test
paper and gently asked, "Can you tell me which line is longer?" The child confidently
identified the longer line both before and after flipping over the paper.
Rationale: The little children will learn how to fasten their buttons, tie their shoes, and
identify whether options are longer or shorter lines (Logsdon, 2021).
LANGUAGE

Comprehends Cold, Tired, Hungry (Failed)

The student nurses posed these questions to the child: "What do you do when
you're tired?" "What do you do when you're cold?" and "What do you do when you're
hungry?" The child responded by saying that she would eat an egg when she's hungry.
In contrast, the client mentioned that she would touch ice when she's cold and yawn
when she feels tired. Consequently, the child did not pass the test, as she was only able
to answer one question accurately in a straightforward manner.
Rationale: Many children begin to use the word "hungry" to represent other emotions
such as boredom, loneliness, grief, or other emotions around preschool age (Gavin,
2021).

Comprehends 3 prepositions (Passed)

The student nurses showed the child a block and directed her to do the following:
“Place the block on the table”, “Place the block under the table”, The preschooler was
able to carry out all instructions effectively. Thus, the child passes the test.
Rationale: Following instructions is a part of everyday life. It is the child’s ability to act
on requests by others. Following instructions requires the child to attend to detail in
spoken language, to sequence the information in the appropriate steps and to seek
clarification if they have trouble remembering or recalling the information (Following
instructions - Kid Sense Child Development, Admin 2023).

Recognizes 3 colors (Passed)

The student nurses asked the child to identify and name the color of the crayon
we showed to her, the client immediately knew what color the student nurses were
showing in front of her. Therefore she passed this test.
Rationale: At the beginning of the preschool years, children can usually identify and
name basic colors such as red, blue, green, yellow, and orange. They often learn these
colors through exposure to toys, books, and educational activities (Pavlenko, G. V., et
al., 2021)

Opposite analogies (Passed)

The client was asked to listen carefully to the instructions from the student
nurses. They were told to say the opposite of what the nurses said, like "Fire is hot, ice
is?”, "If the mother is a woman, dad is a?”, "If a horse is big, a mouse is?". The client
answered correctly with "Cold, Boy, Small" for two of the questions. So, the child passed
the test.
Rationale: Around the age of 3, many children start to recognize basic opposites, such
as "big" and "small," "hot" and "cold," or "happy" and "sad." They may not fully grasp the
abstract nature of opposites but can identify specific pairs (Phillips & Pexman, 2015).

Defines 6 words (Failed)

The student nurses asked the client “what is a ball?, … a
river?...desk?...house?...banana?...curtain?..roof?..fence?...street. The child answered
that a ball is a toy, a banana is a fruit, therefore the client failed the test because she
can only identify 2 out of 9 words that the student nurses asked.
Rationale: Limited vocabulary or difficulty forming words and sentences (Hartnett,
2017).

Gives first and last name (Passed)

The preschooler was asked to give her full name, and she did so correctly. Thus, the
child successfully passed the test.
Rationale: Between the ages of 4 and 6 months, babies frequently comprehend and
even respond to their names, but they usually won't utter them until they are between 18
and 24 months old. Between the ages of 2 and 3, we would want a typically-developing
child to be able to speak their full name clearly and consistently (How To Help Your
Child Say Their Name | Wee Talkers — Wee Talkers, 2020)

GROSS MOTOR
Balanced on 1 foot for 10 seconds (Passed)
The student nurses initially showed how to balance on one foot to the child. The student
nurse asked “Do you know how to do this?”, while standing on one foot. The child
successfully followed what the student nurse instructed and can maintain the position
for 10 seconds.
Rationale: By five-years-old, children should be able to stand on one foot for 10
seconds (Pediaprogress, 2021).

Hops on 1 foot (Passed)

The student nurses demonstrated to the child how to hop on one foot and instructed her
to do the same thing. The child successfully imitated the examiner, which indicates that
she passed the test.
Rationale: Hopping on one foot is usually seen in developing children between the
ages of 3 and 4 years. This skill, which normally comes after jumping, demands
strength, balance, and coordination (Menz, 2021).
Catches bounced ball (Passed)
The examiner stood about 3 feet away from the child and instructed her to catch the ball
with her hands and not with her arms. The examiner then bounced the ball to the child
and was able to catch it. Therefore, the client passed the test.
Rationale: The capability to catch, throw, and kick a ball frequently reflects a child's
ability to balance their body in space, interact with their surroundings, and coordinate
opposing sides of the body. A child should be able to catch a ball thrown from 5 feet
away with their hands only and their arms outstretched at the age of three (Ball Skills,
2015).

Heel to toe walk (Passed)

The student nurses first show the child how to perform the heel-to-toe walk before
instructing the child to do the demonstration. After one trial, the student nurses
observed that the client can perform the heel-to-toe walk, therefore the client passed the
test.
Rationale: Normal adult heel-to-toe gait should prevail by age 3 (Johnston et al., 2014).

Balance on 1 foot for 5 seconds (Passed)

The student nurses asked the child to stand on 1 foot for 5 seconds and she
successfully performed it.
Rationale: By 3.5-years-old, children should be able to stand on 1 foot for 5 seconds
(Pediaprogress, 2021).

INTERPRETATION

Client Z.S was able to pass most of the tests that were part of her age line. In the
personal-social sector, the client passed all the 4 tests. In the fine motor adaptive sector,
she also passed all the 6 tests. The child also passed 5 tests and 2 failed tests in the
Language sector. Lastly, in the gross motor sector, she was able to passed all the 5
tests.
The examiners also performed tests found on the left side of the failed items in her age
line. As the client could pass all those tests, no delays were recorded. Thus, the client's
development is considered normal according to the standard or criteria of the Metro
Manila Developmental Screening Test (MMDST). Aside from the items in the age line of
the client, more tests were conducted to achieve the criterion of three passes and three
fails in each sector. Failed items on the right side of the age line are normal because the
tests were designed for older ages. Furthermore, parents should know that each child is
 unique as they develop at their own pace and most of their capabilities do not arise
concurrently.

V. GENERAL OBSERVATION

PARAMETERS ACTUAL OBSERVATION RATIONALE SOURCE

A. PHYSICAL
DESCRIPTION - Body is ectomorphic Nickerson, C.
● Body build - Fair smooth skin, with well - The ectomorph (2022).
trimmed nails. No masses, body type is Sheldon's
● Cephalocaudal
with round and symmetrical distinguished by Constitutional
description face. long, thin Theory:
● Dentition & gums - with complete set of baby muscles, limited Somatotyping
teeth fat storage, and . Simply
limbs. Psychology.

- A head-to-toe Belleza, M.,

examination is a RN. (2023).
thorough Head-to-Toe
physical assessment:
examination Complete
used to collect physical
patient assessment
information and guide.
assess the Nurseslabs.
patient's health.
In order to
determine any
potential health
problems the
patient may be
suffering, a
systematic and
comprehensive
examination of
the entire body
from head to toe
is required.

B. GROWTH & - Can jump forward and - Early on, children Mcilroy, T.
DEVELOPMEN backwards gain abilities that (2022). What
T - Can skip without enable them to do Are Gross
hesitations both gross and fine Motor Skills
● Describe the
- Runs fast motor tasks For
following: - Can throw ball to successfully, Preschoolers
o Jumping desired direction including muscle ?
o Skipping - R. Dominant, H line strength, core
o Running stroke needs strength, postural
o Throwing ball improvement. control, endurance,
o Writing - Right handed and coordination.
- Can draw basic shapes
o Handedness
 o Drawing - Colors perfectly without
o Coloring going beyond with lines
o Handling toys - Good grasp
- Uses right hand, and
o Holding
can cut papers.
scissors and
pencil

o Self-care
activities - The majority of
▪ Bathing - Bathes with parents kids reach the
- Knows how to wash stage in their
▪ Washing &
her own hands, natural
drying washes before meals. development at
hands - Independently dresses age three
▪ Dressing and undress herself where they are
(dress & - Knows how to button able to perform
undress) and unbutton the most
▪ Button or - Brushes by herself 3x a fundamental
day caregiving
unbutton
- Knows how to comb tasks on their
▪ Brushing her hair own. Children
teeth - Can’t tie but can between the
▪ Combing manage to wear ages of three
hair slip-ons and five are
▪ Tie or lace typically able to
move onto
shoes
more
sophisticated
self-care tasks
and grow
current talents
to an even
more useful
state, however
some skills may
require more
attention on an
individual basis.

C. NUTRITION - Eggs are Rd, A. T.

● Observe if basic - Eats 3x a day. Meals: packed with (2023, April
food intake is Rice, Eggs, Meat, some nutrients, 14). 5
vegetables including Reasons Why
taken
- Breakfast: Puto; Lunch: high-quality Kids Should
● 24-hour dietary Egg; Dinner: Sud.an protein, critical Eat Eggs -
recall - Eats snacks if snack time vitamins and The Family
● Eating habits - Likes egg, and dislikes minerals, and Nutritionist.
● Foods – likes “sabaw or soup” are a great The Family
and dislikes and - H:1.08m W:15kg option for Nutritionist.
reasons behind BMI:13.2 toddlers, https://myfami
preschoolers, lynutritionist.c
● Height and
and definitely om/why-kids-
weight, BMI
 any picky should-eat-eg
eaters. gs/

- By the age of
three or four,
the majority of
kids have
daytime
urination and
bowel control.
After this age,
you should
speak with your
child's
healthcare
practitioner
about leaking
or daytime
wetting.

- Children are
drawn toward
classmates with
similar hobbies
or playing
habits, who by
this time may
become their
first true best
pals.

- Children
between the
ages of five and
seven have
vivid
imaginations,
which causes
them to dread
imaginary
creatures like
monsters. The
"worst case
scenarios" that
could occur are
the focus of
these
overactive
imaginations.

D. TOILET - Can tell beforehand that - By the age of Toilet training.

TRAINING she is to urinate and three or four, (2019,
● Observe bowel defecate the majority of December
- Doesn’t pee on pants kids have 26). Johns
and bladder
while sleeping daytime Hopkins
integrity urination and Medicine.
● Daytime and - Client verbalizes that she bowel control.
night time control needs to defecate or After this age,
● Verbalization of urinate. you should
- Have gentle and positive speak with your
need to void and
toilet training child's
defecate healthcare
● Accidents and practitioner
regression about leaking
● Attitudes or daytime
wetting.

E. ACTIVITIES, - Morning person - Children are Emberling, H.

PLAY & SLEEP - Gross: Moderately active drawn toward (2022).
● Daily routines - Fine: can write, draw, and classmates with Preschool
color well similar hobbies Friendships:
● Play activities
- kitchen toys or playing The
o Gross - Classmates and siblings habits, who by “Frenemy”
o Fine - Sleeps early, and wakes this time may and the
● Toys up early for school become their “BFF”.
● Playmates first true best
● Sleep pattern pals.

F. COGNITIVE - can visually describe an - Different Heick, T.

DEVELOPMEN animal thinking in (2019). The
T - believes in fairytales childhood is Assimilation
- wants to be a princess now easily and
● Assimilation
someday assimilated, Accommodati
● Accommodation - Believes that apple is which solves on of
● Magical Thinking healthy the assimilation knowledge.
● Role-fantasy - Ice outside freezer: Melts problem. When
Thinking - pencil is used for writing cause and
● Centering effect situations
● Reversibility occur
concurrently,
● Conservation
the youngster
● Ego-centricism now
● Pre-logical understands
reasoning that they should
● Can state cause anticipate
and effect specific
relationship reactions to
their activities.

G. SPIRITUAL
DEVELOPMEN - Parents educate her
T about God,
- Attends masses every
● Describe the
Sunday with parents and
child’s reaction siblings.
to: - She loves Jesus
 o Parental
behavior and
attitude related
to religion and
spirituality
o Attending
masses / other
religious
activities
o Concept of
God and faith

H. MORAL
DEVELOPMEN - knows what is good and
T bad
- observed to be influenced
● Concept of right
by egocentric and
and wrong narcissistic. needs
● Does the child - feels upset when
react to someone lies
situations based - verbalized that she will
on egocentricity report to her teacher
and narcissistic - verbalized that she will
report in such thing is
needs?
witnessed
● Child’s reaction
on:
o Telling lies
o Stealing
o Bullying

VI. CONCLUSION

Client Z.S. physical physical growth was based on the observation of the student
nurses during the day of the assessment. As expected, the preschooler has an
ectomorphic and energetic body. According to the World Health Organization,
preschoolers with the age of 4.5 years should have an average weight of 16.9kg and
should have an average height of 3 feet and 5 inches. Additionally, 4 years and 11
months old children should lie within the range between greater than 14.3 in the 5th
percentile and less than 21.1 cm-kgs in the 85th percentile. However, the body weight of
client Z.S. didn’t match the normal weight since she has the weight of 15kg, but has the
average height of a preschool child with the height of 3 ft and 5 in. Upon calculating the
Body Mass Index of the child, she has a BMI of 13.2 and can be considered as
underweight. In addition, there were no issues with the physical appearance of the child,
and was properly groomed. Based on the general observations of the student nurses on
the preschooler, the client was able to do and answer different developmental tasks
properly and only had a few complications when answering some questions. Lastly, the
preschooler was able to perform physical-social, fine motor-adaptive, language, and
gross motor sectors. Upon doing the Metro Manila Developmental Screening Test, the
majority of the tasks in each sector were passed and only a few failed. The
Physical-Social, Fine Motor-Adaptive, and Gross Motor are all passed. However, in the
Language sector, there were 2 failures. Furthermore, all of the tasks in the gross motor
sector were passed. Regardless of the failed results, it was reasonable if the
preschooler wasn’t able to pass the task since it was out of his age range.

To conclude this paper, as student nurses, it is important to assure the client and
provide praise when conducting the assessment and performing the tasks in the
MMDST to gain confidence and build rapport. As for client Z.S., she was able to carry
out the instructions well provided by the student nurses and gave them enough
information about herself despite her young age. Moreover, the student nurses gave
health teachings in simple terms to make them understandable for the preschool child. It
is significant to promote health teachings since according to Lamanauskas et al., 2021,
early childhood is a critical period for developing healthy habits and behaviors. Health
education in preschools plays a vital role in promoting physical, mental, and emotional
well-being among young children. Lastly, parental guidance during the preschool years
is indispensable for a child's holistic development. It influences cognitive growth,
emotional well-being, social competence, values, safety, language skills,
self-confidence, and preparedness for school. Parents are the primary educators and
role models for their preschoolers, and their active involvement in guiding and nurturing
their children can shape their future success and happiness. Therefore, parents should
recognize the profound impact they have on their preschoolers' lives and embrace the
responsibilities and joys of parenthood with dedication and enthusiasm.
VII. APPENDICES

ASSESSMENT FORM
MMDST
VIII. REFERENCES

Bergqvist-Norén, L., Hagman, E., Xiu, L., Marcus, C., & Hagströmer, M. (2022).
Physical activity in early childhood: a five-year longitudinal analysis of patterns and
correlates. International Journal of Behavioral Nutrition and Physical Activity, 19(1), 47.

Bitew, W. B., & Sewagegn, A. A. (2023). Exploring pretend play and creativity
development among preschool children in Northern Ethiopia: a collective case study.
Education 3-13, 1–11.

Dathe, A. K., Jaekel, J., Franzel, J., Hoehn, T., Felderhoff-Mueser, U., & Huening, B. M.
(2020). Visual perception, fine motor, and visual-motor skills in very preterm and
term-born children before school entry–observational cohort study. Children, 7(12), 276.

Golubović, Š., Đorđević, M., Ilić, S., & Nikolašević, Ž. (2022). Engagement of
Preschool-Aged Children in Daily Routines. International Journal of Environmental
Research and Public Health, 19(22), 14741.

Gross, Y. (2020). Erikson's stages of psychosocial development. The Wiley

Encyclopedia of Personality and Individual Differences: Models and Theories, 179-184.

Johnston, L., Eastwood, D., & Jacobs, B. (2014). Variations in normal gait development.
Paediatrics and Child Health, 24(5), 204–207.

Kid Sense. (2019). Fine Motor Development Chart - Kid Sense Child Development. Kid
Sense Child Development.

Lantz, S. E., & Ray, S. (2020). Freud Developmental Theory.

Lindteigen, R. (2020). Montessori at Home: How allowing a child to dress themselves

promotes independence. Klein-Spring Montessori School.

Miles, K. (2022, February 15). Average weight and growth chart for babies, toddlers,
and beyond | BabyCenter. BabyCenter

Pavlenko, G. V., Pavlenko, A. I., & Shklyar, I. A. (2021). Middle preschool age children’s
color comprehension development within the concept of color presentation in culture.
Ilkogretim Online, 20(5).

Pediaprogress. (2021). Does My Child Struggle with Balance? Pediaprogress.

Phillips, C. I., & Pexman, P. M. (2015). When Do Children Understand “Opposite”?.

Journal of Speech, Language, and Hearing Research, 58(4), 1233–1244.

Raising Children Network. (2017, November 16). 4-5 years: preschooler development.
Raising Children Network.
Samaiya, A. (2022). Jean Piaget’s Cognitive Development. International Journal of
Indian Psychȯlogy, 10(1).
 SCHOOL-AGE

INTRODUCTION TO SCHOOL AGE

The school age period encompasses ages 6 - 12 years old. While physical
growth tends to progress slower during this time in comparison to infancy and
toddlerhood, the changes the child will undergo are significant especially as they
transition into adolescence. (Silbert-Flagg & Pilliteri, 2018) School aged children are
sensitive and it is critical that they develop self-confidence during this period. They also
tend to strive for independence in performing various tasks as they become increasingly
exposed to their environment. (CDC, 2021)

Common physiological changes that the child will undergo include the loss of
lordosis and knock-knees present during toddlerhood, the complete growth of the brain,
eruption of permanent teeth, enlargement of the heart, maturation of the respiratory
system, etc. The time these changes manifest may differ per individual. Puberty also
begins around the school age period due to the maturation of the brain which will then
signal the production of gonadotropic hormones which facilitate the appearance of
secondary sex characteristics like breasts and facial hair. Girls tend to be more
conscious about these bodily changes especially with the growth of breasts and the
occurrence of menstruation later on in her life. Boys may also feel self conscious as
prepubertal girls develop faster than boys in terms of height. (Silbert-Flagg & Pilliteri,
2018)

As for emotional development, if a child was able to successfully progress

through the Trust vs. Mistrust stage based on Erik Erikson’s Psychosocial Theory, the
child will enter the school age period with the ability to trust others and develop a sense
of respect for oneself. During the school age period, children are now in the
Psychosocial stage entitled Industry vs. Inferiority. This stage is where the child starts to
develop new sets of skills and honing them. If the child is discouraged during this stage,
they may end up with feelings of inferiority which they may carry on even as they
mature into adults. (Silbert-Flagg & Pilliteri, 2018)

The cognitive development of a school-age child is a transitional period in which

the child starts to adapt a concrete operational thought process from the preoperational
thought process they used as a child. By the time they reach school age, the child
learns Decentering or the ability to see the situation from different viewpoints rather than
one-dimensionally, Acommodation which is the ability to adapt their thinking based on
new information or the ability to understand that there is more than one reason for a
person’s actions, Conservation or the ability to understand that a change in shape
doesn’t necessarily mean that the quantity/size of the object has changed, and Class
inclusion which is their ability to understand that things may be classified into different
groups at the same time. The recurring thought behind these concepts is that the child’s
thinking is becoming more complex as they tackle different ideas at once. (Silbert-Flagg
& Pilliteri, 2018)

Last but not the least, the school aged child enters the moral development stage
called Preconventional Reasoning. (Silbert-Flagg & Pilliteri, 2018) The Preconventional
Reasoning stage has two sub-stages which are Level 1: Punishment/Obedience
Orientation which is where the child follows a rule to avoid being punished and Level 2:
Instrumental Purpose where the child follows a rule in order to recieve rewards or to
satisfy their personal needs. School aged children in particular often do nice/good acts
with the anticipation that they will be rewarded for the act instead of doing the act
because it can help or benefit others. (Sanders, 2023)

THEORIES
Ages 6 to 12 fall under the industry vs. inferiority stage of psychological
development, which is based on Erik Erickson's theory. A youngster picks up a variety
of emotional and social abilities at this age. Their peers and the community can have a
significant impact on their abilities. At this age, individuals also begin to understand the
notion of competence; they aspire to excellence and success. At this time, the struggle
is between industry and inferiority. Since competency is learned at this age, a child's
sense of right and wrong and their willingness to put up the effort necessary to succeed
comes from industry. While inferiority is when a youngster feels unhappy or dissatisfied
when they don't succeed at anything, this produces equilibrium to cultivate a humble
mindset.

Children at this age have the conventional level of moral development, in

accordance with Lawrence Kholberg’s theory of moral development. This is where a
child learns to think about other people’s feelings as well as their own. They also begin
to form their own judgment and are motivated by positive reinforcement.

According to Jean Piaget's cognitive development theory, ages 11–15 fall under
the formal operations phase. This is where children learn rational thinking, and their
reasoning is based on observation and forward thinking.

INTRODUCTION TO CLIENT
The client, who will be referred to as J.D.S., is a 13 year-old, Filipino boy, born on
September 2, 2010. He is the 3rd child out of 5 siblings, and currently lives in
Boulevard, Davao City. He is currently studying at a public school as a 6th grader. His
mother, a 36 year old woman who will be referred to as M.D.S, works as a Sari-sari
store vendor whereas, his father, E.D.S. is deceased at 32 years old. Both of his
parents have finished highschool. As for religion, their family practices Catholicism.

The client was chosen to be assessed among the Grade 6 students due to his
outgoing personality. He is observed to be boisterous and friendly which made building
rapport easier for the interviewers leading to a more successful assessment. The client
was also very engaged and cooperated well during the interview.

GENERAL OBJECTIVES
At the end of this 4-week School Nursing Rotation, student nurses will be able to
identify the school-ager’s developmental status and provide health teachings when
abnormalities are observed.

SPECIFIC OBJECTIVES
A. Identify the client to be assessed.
B. Establish rapport with the client.
 C. Explain the purpose and the procedure that will be conducted.
D. Ask for consent to proceed with the assessment.
E. Gather data required for the study
F. Identify the developmental status of the client.
G. Recognize possible factors of the developmental status of the client.
H. Discuss the assessment results.
I. Provide health teachings regarding the client’s development

PERSONAL DATA
The client, who will be referred to as J.D.S., is a 13 year-old, Filipino boy, born on
September 2, 2010. He is the 3rd child out of 5 siblings, and currently lives in
Boulevard, Davao City. He is currently studying at a public school as a 6th grader. His
mother, a 36 year old woman who will be referred to as M.D.S, works as a Sari-sari
store vendor whereas, his father, E.D.S. is deceased at 32 years old. Both of his
parents have finished highschool. As for religion, their family practices Catholicism.

ASSESSMENT / INTERVIEW

PARAMETERS ACTUAL RATIONALE SOURCE

OBSERVATION

A. PHYSICAL - The student’s As puberty approaches, the Physical developmental

DEVELOPMENT cephalocaudal student becomes more milestones:
● Observe and appearance is aware of his body; body School-Age |
describe the normal. image develops; the Virtual Lab
following: - His body build ectomorph body type is school. (n.d.).
○ Cephaloca is ectomorphic. characterised by long, thin https://www.virtua
udal muscles, limited fat storage, llabschool.org/fcc
appearanc and limbs. /physical-develop
e ment/lesson-4
○ Body built Any presence of Lordosis,
or Knock-knees disappears Silbert-Flagg, J., &
during school age and the Pillitteri, A.
process of puberty begins.
(2018). Maternal
(Silbert-Flagg and Pillitteri,
2018, p. 1874, 1876) & Child Health
Nursing: Care of
the Childbearing
& Childrearing
Family. Wolters
Kluwer.

B. DENTITION AND - His lips is Loss of deciduous teeth Silbert-Flagg, J., &
GUMS smooth and and eruption of permanent Pillitteri, A.
● Observe and pinkish teeth begin during (2018). Maternal
describe the - We asked him school-age. On average a
& Child Health
following: to smile and school-aged child gains 28
○ Color and open his teeth which include the Nursing: Care of
completene mouth, we central and lateral incisors, the Childbearing
ss observed that the 1st, 2nd, 3rd cuspids; & Childrearing
○ Dental he had two and the 1st and 2nd molars. Family. Wolters
caries missing teeth (Silbert-Flagg and Pillitteri, Kluwer.
○ Missing due to tooth 2018, p. 1880)
teeth decay.
C. PERSONAL CARE - He can dress School age children are Silbert-Flagg, J., &
● Observe and and bathe on able to bathe on their own, Pillitteri, A.
describe the his own. but may not be as efficient (2018). Maternal
following: - Only wash his due to not seeing its
& Child Health
○ Dresses hands before importance, or the child is
○ Bathes eating. too busy. (Silbert-Flagg and Nursing: Care of
○ Washes - He can also Pillitteri, 2018, p. 1902) the Childbearing
hands control his & Childrearing
(before and bowel and Family. Wolters
after bladder control Kluwer.
eating) and cleanses
○ Bladder himself after
and bowel defecating.
control
○ Cleans self
after
defecating
or toilet
accident

D. ACTIVITY AND REST - He likes to play School age children tend to Silbert-Flagg, J., &
● Play activities volleyball and be quite active, however it Pillitteri, A.
● Toys he is a varsity often depends on their age. (2018). Maternal
● Sleep and player in the Older children tend to be
& Child Health
relaxation school. more confident and
- He goes to bed outgoing in comparison to Nursing: Care of
by 9-10 pm. younger children. Children the Childbearing
tend to have a close & Childrearing
relationship with a Family. Wolters
same-sex child and actively Kluwer.
seek the company of other
children. (Silbert-Flagg and
Pillitteri, 2018, p. 1884,
1891)

E. NUTRITION - His favorite Increased energy Silbert-Flagg, J., &

● Food – likes and food Lechon requirements often appear Pillitteri, A.
dislikes Baboy. As for in spurts during school age, (2018). Maternal
● 24 hour dietary dislikes, he has so it is important that food
& Child Health
recall no specific food with high nutritional value
● Eating habit: preferences or are given. Boys tend to Nursing: Care of
● Favorite food and aversions. need more energy in the Childbearing
reasons behind - For his 24-hour comparison to girls. Both & Childrearing
● Eating behaviors dietary recall, sexes require more iron Family. Wolters
and actions he ate an egg intake, as well as fluoride Kluwer.
● Height and weight, for his and calcium which ensures
BMI breakfast, proper bone growth.
Harvard Health. (2022,
bihon for lunch, (Silbert-Flagg and Pillitteri,
January 6). The
barbeque for 2018, p. 1898-1899)
sweet danger of
dinner, and
sugar.
popcorn for his The consequences of bad
https://www.healt
snacks. eating on their health, such
h.harvard.edu/he
- He drinks as high sugar consumption
art-health/the-sw
enough water resulting in diabetes,
eet-danger-of-su
and eats regular consumption of
gar
regularly fruits and vegetables
- His favorite preventing old age
food is Lechon diseases, tooth decay as a
Baboy, a result of sweetened food
traditional and sweet consumption,
 Filipino dish and excessive calorie
made of consumption.
roasted pig. He
enjoys its
crispy skin and
tender meat.
- Washes his
hands before
eating.
- Height: 5’2
- Weight: 77lbs
- BMI: 14.1
(underweight)

F. MENTAL DEVELOPMENT

CLASSROOM CHILD’S REACTION RATIONALE SOURCE

ACTIVITY

*At least 5 1. Group activity Group Activity Creative activities

*Oral recitation, a. He performed well Children of school age typically for school-age
group activities, in a roleplay that show a strong interest in group learning and
board work, his group had activities. This is fantastic development. (2022,
etc. prepared for their because it helps school-age March 11). Raising
English class. children: develop imagination Children Network.
and creativity; increase https://raisingchildre
self-confidence; express n.net.au/school-age/
feelings, thoughts, and ideas in development/creativ
verbal and nonverbal ways; e-development/scho
learn about the world from ol-age-creative-activ
another person's point of view; ities
practice decision-making,
problem-solving, and critical
thinking; and practice and
improve social and motor skills.

2. Worksheets and Quizzes Worksheets and Quizzes Lisas, & Lisas.

a. According to the When used in conjunction with (2021b, June 1). 10
client, he dislikes effective teaching strategies, reasons why you
writing long well-designed worksheet should use quizzes
worksheets since questions can hold students' with children.
he prefers to talk attention. Worksheets also Promote Your
instead. serve a variety of purposes in School.
various settings. A quiz is a https://www.promote
useful tool for helping students yourschool.co.uk/blo
see and own their knowledge g/10-reasons-why-y
gaps. It's a terrific method to fill ou-should-use-quizz
in any gaps and give them more es-with-children
confidence before formal
examination.

3. Classroom Performance Classroom Performance

a. He was On communication, cognitive Moss, E., &
bothersome in engagement, and mastery St-Laurent, D.
class and would motivation, secure youngsters (2001). Attachment
interrupt when outperformed their insecure at school age and
someone was classmates. With the worst academic
 speaking, but he performance across all metrics performance.
was also excluding mastery motivation, Developmental
responsive and controlling children were most at Psychology, 37(6),
tried to speak up risk for academic 863–874.
when necessary underperformance. https://doi.org/10.10
37/0012-1649.37.6.
863

G. OBSERVABLE PROBLEMS
● Based on the overall observation of the student nurses, client J.D.S has some
observable problems. He has a good school performance, as evidenced by
participation through recitations, group activities and high scores on
examinations since he is one of the students in section one. He is also sociable
and has no anti-social behavior, however, he shows destructive behavior in a
form of bullying. After thorough observation, the student nurses ruled out that the
client has no physical manifestations of physical illness.

H. MORAL DEVELOPMENT

CHILD’S RATIONALE SOURCE

REACTION/ACTUAL
BEHAVIOR

● Concept of right - He has a good Children begin to doubt the Parenting, W. (2019).
and wrong perception of right infallibility of those in Moral development in
● Actions based and wrong positions of authority, such children – Stages and
on approval of as parents and teachers. role of parenting.
others? - He says that he They might become quite WOW Parenting.
● Child’s reaction will tell the teacher aware of what he ought to https://wowparenting.
on: if he sees or hears and ought not to do. They com/blog/moral-devel
○ Telling one of his would want to take part in opment-children//
lies classmates telling establishing the regulations.
○ Stealing lies, stealing, and They learn to be fair and see
○ Bullying bullying. the value of following the
rules. They are aware that
children have rights as well,
and they apply regulations
that best suit them.

I. SPIRITUAL DEVELOPMENT

CHILD’S RATIONALE SOURCE

REACTION/ACTUAL
BEHAVIOR

● Describe child’s School-agers are still highly Abel, K. (2022).

reaction to: - He says that grounded in the concrete, Children’s
○ Parental they go to church but they are beginning to development of
behavior every Sunday build a stronger sense of spirituality.
and and pray spiritual identity based on FamilyEducation.
 attitude religiously personal experience and https://www.familyedu
related to - He believes in religious practice. cation.com/kids/value
religion God. s/childrens-developm
and ent-spirituality
spirituality
○ Attending
masses/ot
her
religious
activities
○ Concept of
God, faith,
priest

CONCLUSIONS

According to the assessment, the client has a height of 5 feet and 2 inches and a
weight of 77 pounds. The BMI that was calculated is 14.1, which indicates that the client
is underweight. The client’s BMI-for-age is at the <1st percentile, which means that this
child‘s BMI is significantly less than the average BMIs of his age. This brings up the
issue of malnutrition in school aged children as being underweight may affect various
everyday activities because of the lack of physical strength. Depending on the severity,
it can get in the way of the client’s development and skills for his age. It is suggested
that the client consume a staple starchy carbohydrates like potatoes, bread or rice
during every meal, cheese or milk which is a good source of healthy fat, high calorie
drinks i.e. smoothies, milkshakes, etc. Fostering a healthy attitude towards food and
eating may also help in ensuring the child eats well. (NHS, 2023)

In conclusion, this paper is very important for student nurses in helping to better
understand the usual developmental accomplishments an individual may have as well
as common developmental delays and their potential causes. Student nurses learned
and gained knowledge and skills through these experiences, especially when handling
pediatric clients in the future. Intrapersonal skills were honed and the sense of empathy
and compassion towards patients were further realised.

APPENDICES
\]
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