Carley Cain, N232 Growth & Development ISSUU

Zola Grey Shepherd

(“Meredith, Zola, Derek”, n.d.)

Carley Cain N323 Growth & Development ISSUU

Meet the Family Zola was adopted by her mom and dad when she came to the hospital as an orphan who needed treatment for spinal bifida (Rhimes, 2010). She is now 2 ½ years old and healthy. She weighs 25 lbs, and is 35.75 inches tall. From observation, Zola appears to be an active, vocal, and sociable child. She smiles frequently and is engaged with people around her and her environment. (“Zola”, n.d.)

Mother: Dr. Meredith Grey is a general surgeon at Seattle Grace Hospital (Rhimes, 2010). (“Meredith, Zola”, n.d.)

Father: Dr. Derek Shepherd is a neurosurgeon at Seattle Grace Hospital (Rhimes, 2010). (“Derek, Zola”, n.d.)

Baby brother: Bailey is 7 months old, and a biological son of Derek and Meredith (Rhimes, 2010). (“Bailey”, n.d.)

Family Dynamics: Derek and Meredith are happily married and are learning to balance work and family life. Their parenting style is caring and hands-on. They both enjoy taking care of their children, communicate effectively, and equally contribute to family needs. Their parenting style can be categorized as authoritative.

Social Networks: Zola spends time with her family at home, and at various social outings to the park. When both of her parents are working she is in day care at the hospital where she plays with her best friend Sofia. Sometimes she is babysat by people in her parents’ support system such as her Aunt Lexi, or their friend Mark Sloan. Her favorite toys are her rubber duckies, stuffed giraffe, and blocks. She also enjoys playing with her brother, Bailey.

Growth & Development Expected Milestone

Zola

Physical Birth weight quadrupled (Perry et al., 2012).

Zola’s birth weight: 7.5 lbs, current weight: 25 lbs. Milestone not met.

20 teeth (Perry et al., 2012).

Zola has 20 teeth, milestone met.

Daytime continence (Perry et al., 2012).

Zola exhibits daytime bowel and bladder control most days.

Language Says first and last name (Perry et al., 2012).

Zola can say her full name.

Can sing a song (“Bright Futures Exam”, n.d.)

Zola can sing ‘The Itsy Bitsy Spider’.

Knows sounds animal sounds (“Bright Futures Exam”, n.d.)

Zola likes to make lion roars, and cat meows (Rhimes, 2010).

Uses 3-4 word phrases (“Bright Futures Exam”, n.d.)

Zola frequently talks in short phrases.

Is understandable 50% of the time (“Bright Futures Exam”, n.d.)

Zola is understandable 55% of the time.

Socialization Easier separation from parents (Perry et al., 2012).

Parents report Zola being easier to drop off at day care.

Can help clean up after playtime (Perry et al., 2012).

Zola cleans up her toys when asked to.

Knows gender (Perry et al., 2012).

Zola knows that she is a girl, and her brother Bailey is a boy.

Emotional expansion (Perry et al., 2012).

Zola exhibits pride, shame, guilt, and embarrassment.

Plays in imaginary ways with toys (“Bright Futures Exam”, n.d.)

Zola has an active imagination.

Plays with another child and has friends (“Bright Futures Exam”, n.d.)

Zola plays well with others, especially her friends at day care.

Motor Skills Expected Milestone

Zola

Gross Motor Skills Jumps with both feet (Perry et al., 2012).

Zola can jump with both feet.

Jumps off chair or step (Perry et al., 2012).

Zola can jump off a stepping stool.

Stands on one foot momentarily (Perry et al., 2012).

Zola can stand on one foot for 1 second.

Walks a few steps tip-toed (Perry et al., 2012).

Zola can walk 2 steps tip-toed.

Throws ball overhand (“Bright Futures Exam”, n.d.)

Zola can throw a ball overhand.

Fine Motor Skills Builds an 8 cube tower (Perry et al., 2012).

Zola can build a 7 cube tower.

Milestone almost met.

Holds crayon with fingers, not fist (Perry et al., 2012).

Zola no longer hold crayons with her fist, she uses her fingers.

Can imitate a drawing with vertical and horizontal strokes (Perry et al., 2012).

Zola can imitate a drawing with vertical and horizontal lines.

Moves fingers independently (Perry et al., 2012).

Zola can move all of her fingers independently.

Brushes teeth with help (“Bright Futures Exam”, n.d.)

Zola brushes teeth with help most times she is prompted to do so by her parents.

Piaget

Zola is in Piaget’s preconceptual phase, which “is a subdivision of the preoperational phase” (Perry et al., 2012). This is phase is characterized by: egocentrism, transductive reasoning, global organization, centration, animism, irreversibility, magical thinking, and inability to conserve (Perry et al., 2012). Egocentrism is only being able to understand situations from one’s own perspective (Perry et al., 2012). Transductive reasoning involves “reasoning from particular to particular” (Perry et al., 2012). Global organization is the cognitive process that leads children to believe that since one part of something has changed, the whole is also changed (Perry et al., 2012). Centration is only focusing on a singular aspect, rather than multiple possibilities (Perry et al., 2012). Animism is the attribution of life-like characteristics to inanimate objects (Perry et al., 2012). Irreversibility is the cognitive process that involves not being able to undo physical changes (Perry et al., 2012). Magical thinking means that children believe that their thoughts can cause events to occur (Perry et al., 2012). Inability to conserve is the inability of children to understand that mass is constant despite changing appearance (Perry et al., 2012).

Some examples of Zola displaying characteristics of the preconceptual phase include: Zola refused to wear any dresses because one dress was uncomfortable (transductive reasoning).

Zola not wanting to sit on the blue chair in day care, even though it is exactly like the pink chair Sofia is sitting on (centration). Zola talks about cars having faces (Animism). Zola thinks that her mom and dad stayed home on their day off because she wished they would (magical thinking). This shows that she is meeting the 2 ½ year old expectations.

Erikson Zola is in Erickson’s stage of autonomy vs. shame and doubt. According to this, her psychosocial developmental task is to develop autonomy, and if she fails to do so she will acquire a sense of shame instead (Perry et al., 2012). The quest for autonomy develops alongside the toddler’s improving motor skills. As Zola is becoming able to do more things, she wants a sense of independence and self-mastery. Zola exhibits negativism, a characteristic of this stage, when she says “no” or “me” to her parents when they try to do things for her. Another characteristic of this stage is ritualism, which is when children Zola’s age are comforted by sameness and routine (Perry et al., 2012). Because Zola does not have a consistent schedule in her life, this is discussed further in the ‘Recommendations & Interventions’ section.

Kohlberg

Kohlberg’s moral development stage for Zola’s age group is the preconventional level (Perry et al., 2012). During this stage children should be able to use the labels “good/bad” and “right/wrong” to describe things that either resulted in no consequences (good and right) or resulted in consequences (bad and wrong) (Perry et al., 2012). Parents should expect their children to want to avoid punishment by following authority when they expect a consequence (Perry et al., 2012). This results in obedience, but they do not understand the basic moral order behind consequences (Perry et al., 2012). Zola exhibits behavior that is conducive with Kohlberg’s theory when she follows her parents’ instructions in order to avoid punishment. However, because she does not understand the reasoning behind consequences, if Zola is allowed to yell in day care without consequence, she may yell at home because she assumes that behavior is acceptable because she has not been punished for it.

Nutrition Status Birth weight quadruples by age 2 (Holt, 2011).

• Zola weighs 25 lbs, which is not a quadruple of her birth weight of 7.5 lbs.

Toddlers should progress from soft foods to foods with different textures (Holt, 2011).

• Zola now eats a variety of differently textured foods.

Toddlers need adequate iron, calcium, and phosphorus (Perry et al., 2012).

• Zola gets iron from iron-fortified cereals, red meats, and dried fruit.

• Zola gets calcium and phosphorus from milk, yogurt, and sometimes vegetables.

Toddlers usually need 3 meals and 2 snacks per day (Perry et al., 2012).

• Zola often refuses to eat this much, sometimes she only eats 1 meal and 2 snacks.

Healthy eating habits help prevent obesity and anemia (Holt, 2011).

• Derek and Meredith provide Zola with low-fat foods, and foods with iron.

Children over 2 should drink 2 servings of low-fat or fat-free milk a day (Holt, 2011).

• Zola sometimes drinks up to 4 servings of milk a day.

Diet should consist of: whole grains, fruits, veggies, milk, beans, lean meat, poultry, fish, and other protein-rich foods (Holt, 2011).

• Zola is picky and refuses to eat veggies and fish.

Provide vitamin D supplementation, if necessary (Holt, 2011).

• Zola receives supplementation, because her parents were worried about her picky eating.

Limit consumption of fruit juice and soda to promote dental health (Holt, 2011).

• Zola is only given 1 fruit juice a day.

Limit high-sugar foods (Holt, 2011).

• Zola is only given 1 sugary treat a day.

Encourage toddlers to drink water throughout the day (Holt, 2011).

• Zola drinks water from her sippy cup throughout the day.

CDC Growth Charts: • Zola weighs 25 lbs, which puts her in the 10th percentile (“Birth to 36 months: Girls length”, 2000).

• Zola is 35.75 inches tall, which puts her in the 50th percentile for length (“Birth to 36 months: Girls length”, 2000).

• Zola’s head circumference is 19 inches, which puts her in the 50th percentile for head circumference (“Birth to 36 months: Girls head”, 2000).

Orem’s Self-Care Requisites Sleep Habits Zola wakes during the night frequently, and can be difficult to get to bed. She takes an occasional daytime nap, but never more than 1 nap a day. Derek and Meredith have the same nighttime routine, that involves a story before bed, but they only do that the days they are home for bedtime. Because of their work schedule Zola often falls asleep at daycare. Derek and Meredith report her getting at least 11 hours of sleep a day. Lately Zola has been complaining of monsters, and wakes up during the night crying, which has made getting to sleep and staying asleep more difficult.

Self-Care Habits Zola now has the motor skills, and a quest for autonomy that enables her to develop self-care habits with guidance. She is able to brush her teeth. Her parents allow her to do it, then they make sure she does everything. She is also able to dress herself with help. Some other self-care habits she has include washing her hands after going to the bathroom, and when she arrives at day care (that is a day care rule).

Toilet Training Zola has been toilet training for 11 months now. She can make it through some days dry, but still requires a night time diaper.

This may have to do with her immature sleep schedule (Perry et al., 2012). If she has an accident during the day, it is usually because she was playing and forgot to go to the bathroom

(Perry et al., 2012). She wears pull-ups during the day just in case. She has adequate motor skills to use the bathroom, she also has regular bowel movements (Perry et al., 2012). She can recognize the need to go, verbalizes it, and imitates others (Perry et al., 2012). At the beginning of her toilet training she was impatient with her soiled diapers and showed curiosity toward her parents’ bathroom habits (Perry et al., 2012).

Derek and Meredith recognized that she was ready to start training 11 months ago (when Zola was 19 months) and have been attentively toilet training her since, they also communicate her progress and routines to the day care staff.

Recommendations & Interventions Nutrition: Concern: Derek and Meredith are concerned about Zola’s eating habits. They say she is picky, and worry that she is not getting adequate nutrition.

Intervention: Provide them with anticipatory guidance that Zola’s picky eating habits are a phase, that is normal, but may persist for a few months longer. Educate them that growth rates decline in toddlers, resulting in decreased and unpredictable appetites (Holt, 2011).

Some ways they can help Zola are by allowing her to touch, smell, or taste new foods many times before she accepts them (Holt, 2011). Allow her to settle down for 15 minutes before a meal, and try to make it enjoyable (Perry et al., 2012). Offer small portions, because large ones may overwhelm her (Perry et al., 2012). Give her bland foods, and allow her to graze on healthy foods if that’s what she wants (Perry et al., 2012). Also, provide consistency with the same plates, silverware, and mealtimes, which Zola may find comforting (Perry et al., 2012). Encourage Derek and Meredith to limit Zola’s milk intake so she will be hungry for other foods (Perry et al., 2012).

Physical Development: Concern: Zola is in the 10th percentile for weight according to the CDC growth chart (“Birth to 36 months: Girls length”, 2000).

Intervention: Although the CDC considers the upper and lower 5th percentiles to be abnormal, a recommendation to a growth specialist may be useful in order to stay ahead of any potential growth problems (“Use and interpretation”, 2013).

Social Development: Concern: The lack of routine in Zola’s life is a concern, because this may interfere with her developing autonomy. According to Erikson, children Zola’s age are comforted by routine and sameness, or ritualism (Perry et al., 2012). This supports their quest for autonomy by providing them a sense of security which allows them to venture out (Perry et al., 2012).

Derek and Meredith’s hectic and unpredictable work schedules may get in the way of Zola’s sense of security.

Intervention: Teach Derek and Meredith about this phase, and Zola’s need for routine.

Encourage them to take this into consideration when making their schedules.

Safety: Concern: The QSEN core competency of safety for this age group includes the issues of: motor vehicles, drowning, burns, accidental poisoning, falls, chocking/suffocation, and bodily damage (Perry et al., 2012).

Intervention: Each of these risks related to developmental ability should be evaluated, and anticipatory guidance should be given to Derek and Meredith regarding these risks, and what to do about them. For example, because Zola is transitioning from soft foods to foods of different textures, also toddlers tend to put things in their mouths, Derek and Meredith should be aware that chocking is a major safety concern (Perry et al., 2012). They should not offer her large, round pieces of food, and should not allow her to play with toys that have small removable parts (Perry et al., 2012). Also, now that Zola is more mobile, autonomous, and likes to explore, they should expect her to try to get into cabinets and storage areas (Perry et al., 2012). To promote safety they can baby proof the house and put potential poisons locked and high up in the house (Perry et al., 2012).

References [Bailey]. (n.d.). Retrieved June 25, 2017, from https://40.media.tumblr.com/44aebcee1b442c482272c13e4375ec2b/tumblr_n4l1592G6I1q h7khwo1_500.png Birth to 36 months: Girls Head circumference-for-age and weight-for-age percentiles.

(2000.). Retrieved June 26, 2017, from https://www.cdc.gov/growthcharts/data/set1clinical/Cj41cs020c.pdf Birth to 36 months: Girls length-for-age and weight-for-age percentiles. (2000.). Retrieved June 26, 2017, from https://www.cdc.gov/growthcharts/data/set1clinical/Cj41cs018bw.pdf Bright Futures Exam: 2 1/2 Year Old. (n.d.). Retrieved June 25, 2017, from https://mainecare.maine.gov/Provider%20Forms/Bright%20Futures/BF[11]%202%20and%2 0a%20half%20year.Fianl.20100319.gy.pdf [Derek, Zola]. (n.d.). Retrieved June 25, 2017, from http://24.media.tumblr.com/8c096927e93706c596aa8e1772bc499c/tumblr_miip79hkTg1rfi 76go1_500.png Holt, K. (2011). Bright Futures Nutrition Pocket Guide (3rd ed.). Retrieved from https://brightfutures.aap.org/Bright%20Futures%20Documents/BFNutrition3rdEdPocketGui de.pdf [Meredith, Zola, Derek]. (n.d.). Retrieved June 25, 2017, from http://static.tumblr.com/760e9940e1c47c0ff22989c72d72a508/h382wnc/OG9n41a4u/tum blr_static_ccu1jfwxuzkkkswc0wcoo8cg.jpg [Meredith, Zola]. (n.d.). Retrieved June 25, 2017, from https://s-media-cacheak0.pinimg.com/236x/85/45/36/854536319512b84d9654fd684c060b5a.jpg Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2012). Maternal child nursing care (5th ed.). St. Louis, MO: Elsevier.

Rhimes, S. (Writer). (2010.). Grey's Anatomy [Television series]. ABC. Use and interpretation of the WHO and CDC growth charts for children from birth to 20 years in the United States. (2013). Retrieved June 26, 2017, from https://www.cdc.gov/nccdphp/dnpa/growthcharts/resources/growthchart.pdf [Zola]. (n.d.). Retrieved June 25, 2017, from http://s5.favim.com/orig/74/african-actressadorable-baby-Favim.com-756332.jpg