NR 328 Week 2 Toddler Growth and Development Paper Example

Growth and Development Write-Up: A 26-Month-Old Boy Admitted for Pneumonia, and How His Stage Changed Every Step of the Examination

Student Name

College of Nursing, Chamberlain University

NR 328: Pediatric Nursing

Instructor Name

Month Day, Year

Growth and Development Write-Up: A 26-Month-Old Boy Admitted for Pneumonia, and How His Stage Changed Every Step of the Examination

The Child

Leo is 26 months old, admitted to the pediatric unit on his second day of treatment for pneumonia; details have been changed. He lives with his mother and grandmother, who speak Portuguese at home, and he attends an English-speaking daycare three days a week. His weight is 12.6 kilograms, on the 50th percentile, and his length is 88 centimeters, on the 60th, both following the curves his clinic has recorded since birth. His mother stayed with him throughout the assessment.

The first half of this write-up sets out what a child of this age is expected to be doing in four areas. The second half, which carries the assignment, turns each of those into something I did differently when I examined him.

Ranges, Not Birthdays

Each expectation below is given as a range rather than a date. The CDC's revised developmental checklists were built on milestones that most children, 75% or more, would be expected to reach by a given visit age (Zubler et al., 2022). That makes a checklist milestone the late edge of the ordinary spread, not its middle. A child who reaches it at the visit is not ahead, and one who has not yet reached it is a reason to look more closely, not a verdict.

The practical effect for Leo is that every item below is read as a question about where he sits in a spread, not whether he has passed a test. It also means his illness has to be allowed for. A child on the second day of pneumonia, febrile overnight and sleeping badly, will often do less than he can, so where his mother's account of the week before admission differed from what I saw today, both are recorded and her account is labeled as reported.

Four Areas, Kept Apart

Movement. Between about 18 and 30 months, most children run, kick a ball forward and climb stairs holding a rail or a hand, putting both feet on each step. Leo ran across the playroom before admission, according to his mother, and today walked steadily down the corridor holding her hand, though he tired after a minute. That fits his age and his illness.

Hands. Children in this range stack several blocks, turn pages of a board book, feed themselves with a spoon with some spilling and begin to scribble. Leo stacked four blocks on his tray table and fed himself applesauce with a spoon.

Language. By two, most children use at least two words together and point to pictures or body parts when named; the number of words grows quickly through the third year. His mother says he uses about 30 words, mostly Portuguese, some English, and puts two together in Portuguese ("mais água," more water). He did not speak to me in English, but pointed to his nose and his foot when I asked in English. For a child learning two languages, his words across both languages together are what should be counted, so this fits his age.

Social behavior. Toddlers of this age are wary of strangers, especially when unwell, want a familiar adult close, and assert themselves with "no." Leo turned his face into his mother's shoulder when I came in and said "não" when I reached for his arm.

Taken together, the four areas show a child within the ordinary range in each, with his speech the least certain because it was reported more than observed. Keeping the four apart matters: a lag in one area and a lag across all four would call for different plans.

Where I Stood and What I Touched

The conversion is where the stage did its work. Because he was wary of strangers and wanted his mother, I examined him on her lap, not on the bed, with his back against her chest so she could hold him gently in a hug rather than a restraint. I sat down to his eye level instead of standing over him, and I spent the first two minutes talking to his mother, not to him, so he could look at me from a place he felt safe.

The order followed his tolerance, not a head-to-toe sequence. I counted his breathing first, while he was still and before I had touched him, because the count is only valid at rest. I listened to his chest next, from the back, since that is where his pneumonia is and since a toddler tolerates a stethoscope on his back more readily than on his chest where he can see it. His heart, abdomen and skin came next. The things most likely to end his cooperation came last: his ears, his throat and the blood pressure cuff, which squeezes and which many toddlers dislike.

The Words Used With Him

A child of two cannot be prepared hours in advance; he has no way to hold the idea and will only spend the time frightened. So I told him what I was about to do in the moment, in a few words, just before doing it: "Listen to your back now," said while showing him the stethoscope and letting him touch it. His mother repeated each sentence in Portuguese. I avoided asking him questions he could answer with "no" when there was no real choice, such as "Can I look in your ears?" Instead I gave him choices he could actually make: "Which ear first, this one or this one?"

The Child Between Stages

Leo sits between late infancy and the preschool years. In some ways he behaves like an older child: he can follow a one-step request and point to his body parts, and he wanted to hold the stethoscope. In others, particularly while he is ill, he behaves like a younger one: he needed his mother's body between him and me, and he could not be distracted for long. I built the approach for the younger side, because illness moves children backward, and I used the older side where it helped, letting him hold and handle equipment and giving him small choices. The approach worked for all of the examination except his throat, which I did not see, and which I noted as not examined rather than normal.

References

Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics, 149(3), Article e2021052138. https://doi.org/10.1542/peds.2021-052138