Growth and Development Visual Presentation
In this issue:
Tommy, his family, & his social Network……………………........1-3 Growth & Development…………....4
Gross and Fine Motor Skills………..5 Cognitive, Psychosocial, & Moral Development…………..…..6-7 QSEN……………………….…………8
Michael macal N332 California State University San Marco
Nutritional Status …………….……8 Orem Self Care Requisites………..…..9 Family Education…………………….10
Tommy is a precocious, 13 month old toddler who has a very active imagination. He is a fearless baby who seeks out fun and adventure wherever he goes. He is the oldest child of Didi and Stu Pickles. He has a younger brother named Dil. Tommy’s paternal grandpa Lou plays an active role in his life. He lives with Tommy’s family and often babysits Tommy and his friends. Tommy’s family structure is both an Extended Family system; consisting of aunts, uncles , cousins and grandparent and a Multigenerational Family; including grandparents, children and grandchildren (Perry, Hockenberry, Lowdermillk & Wilson, 2014). Tommy appears well developed for his age. He was born with little to no hair and his head circumfrence is large then his chest. Tommy family is Caucasion and they practice both Christianity and Judaism.
Both Didi and Stu Pickles have jobs in order to support their family. Didi works as a Home Economics teacher, although her background is in Child Psychology and Stu is a toy inventor. At times they argue about the right parentying style to enforce. Although Didi is a loving mother she believes in disciplining her children when needed by utilizing an authoritative style in comparison to Stu who is more permissive. The Pickles family are in the Childbearing and Infant stage of the Developmental and Family Life Cycle. According to this theory the family is adjusting to the recent pregnancies and births of their babies as well as the new role of mother and father (Kaakinen, Duff-Gedaly, Hanson, & Coelho, 2015) . There is also a focus on maintaining intimacy and relationship bonding during this stage (Kaakinen et al., 2015). With the birth of their second child, the Pickles are also learning to adjust to the varying temperaments of their children (Kaakinen et al., 2015).
Tommy does not attend daycare and is not old enough for preschool. His social network includes his friends Chuckie Finster, twins Phil and Lil DeVille, Susie Carmichael and his bossy cousin, Angelica Pickles. He regularly interacts with his friends who his grandpa Lou also babysits. As a 13 month old toddler, Tommy does not play sports but enjoys swimming, playing with building blocks, action figures, tossing a ball , finger painting and coloring. Tommy participates in parallel play, in which he plays next to his friends but not directly with them (Perry, et al., 2014).
Tommy is in the Toddler Stage of Growth and Development • Head circumfrence is 47 cm which places him in the 88th percentile for his age (CDC growth charts, 2010).
• He currently weighs 10.2kg or 22.4 pounds which places him in the 41st percentile for his age (CDC growth charts, 2010). • He is 76 cm in length which places him in the 48th percentile for his age (CDC growth charts, 2010).
Tommy is on the right track since his growth and development is between the 5th and 95th percentiles (CDC growth charts, 2010).
• Tommy’s weight to length ratio places him in the 61st percentile (CDC growth charts, 2010). What to expect for Tommy’s in the upcoming months? By 30 months, a toddler’s weight is four times their birth weight (Perry, et al., 2004). The height of a toddler at 24 months is half of the expeected adult height. On average toddlers will gain 7.5 cm per year (Perry, et al., 2004).
Tommy meets or exceed the gross and fine motor skills for his age group. He is able to walk independently and is already building towers with four or more blocks. He is able to climb up and down furniture without assistance. He enjoys playing with his ball and will soon start to climb stairs (Developmental Milestones, 2016).
Based on Tommy’s age he is placed in the Tertiary Circular Reactions stage of the Sensorimotor phase (Perry, et al., 2014). Characteristics of this stage include: • Ability to separate one’s self from objects • Spatial relationships begin to be understood • Object permanence is advanced • Recognition of symbols • The appearance of an object are thought to be related to it’s function (Perry, et al., 2014).
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Psychosocial Development
Tommy’s psychosocial development according to Erikson’s theory involves Autonomy vs Shame and Doubt (Perry, et al., 2014). When toddlers are allowed independence to perform a task autonomy is developed (Perry, et al., 2014). Shame and doubt can occur when the toddler is not permitted to express desired independence. This age group often struggle between the need for independence and dependence on others (Perry, et al., 2014). Negative responses such as “No” are frequently expressed when seeking independence (Perry, et al., 2014). Challenges for a parent include understanding emotions and mood can quickly escalate into a temper tantrum (Perry, et al., 2014). Maintaining consistency as well as appropriate expectations, encouragement and rewards can foster positive behaviors (Perry, et al., 2014). Routines or ritualism, provides comfort to toddlers as their sense of independence increases (Perry, et al., 2014).
• Tommy’s moral development at this age group is classified as Preconventional or Premoral level. Toddlers at this age group have limited awareness or concern if something is right or wrong (Perry, et al., 2004). • Egocentric toddlers have difficulty understanding others perspective or viewpoint (ATI, 2013) • Tommy and toddlers in his age group may begin to act based on punishment or reward. • If Tommy is punished for taking a cookie from his friend Chuckie. Tommy will view this action as wrong or bad (Perry, et al., 2004). • If Tommy is not punished he will view taking the cookie as right or good since its not associated with a punishment (Perry, et al., 2004).
QSEN The American Association of College of Nursing established QSEN, quality and safety education for nurses (American Association of Colleges of Nursing, 2016) This initiative encompasses 6 competencies including: Patient- centered care, Teamwork and Collaboration, Evidence –based practice, Quality Improvement, Safety, and Informatics (American Association of Colleges of Nursing, 2016) Safety is an important topic, especially for toddlers. Parents must be aware of hazards and provide a safe environment to prevent injuries or death. See discussion on toddler drowning under Family Education.
Nutritional Status
Tommy continues to be breast fed by his mother but has now started to be bottle fed due to Didi’s work schedule. Tommy has also started to eat other soft foods including apple sauce, pudding, ice cream and fruit juice. Tommy is a picky eater and refuses vegetables. Tommy should drink 24 to 30 ounces of milk a day and his daily fruit allowance should equal to 1 cup (ATI, 2013). Tommy requires 13 g/day of protein due to his energy requirements and food items high in sugar should be limited to (ATI, 2013). Food items should be cut into small pieces in order to prevent choking (ATI, 2013). Tommy’s parents should follow the U.S. Department of Agriculture’s guidelines for nutrition (ATI, 2013).
Sleep habits Tommy sleeps on average about 11 to 12 hours a night. He also take at least one nap during the day. Tommy’s routine bedtime is 830pm every night and his naptime after lunch is at 1130am. This is consistent with toddlers in his age group (Perry, et al., 2014). Self-care habits Tommy requires assistance with most of his activities of daily living ADLs. He requires his parents to bath and cloth him as well as brushing and flossing his teeth. Tommy is able to communicate when he needs a new diaper but he is dependent on his parents to clean and change him. Toilet training Tommy is not yet toilet trained but wears diapers. Toddlers in his age group typically are not ready to be toilet trained until 18 to 24 months (Perry, et al., 2014). Tommy will be able to learn to toilet train when he has bladder and bowel readiness, cognitive, motor and psychological readiness (Perry, et al., 2014).
Problem/Concern
Intervention
Nutrition : Tommy loves everything and anything sweet including French fries, soft serve ice cream and fruit. Tommy is starting to develop taste preferences and is becoming a picky eater.
Tommy’s parents should adhere to the U.S. Department of Agriculture’s guidelines for when planning meals for Tommy (ATI, 2013). Juice should be limited to 4to 6 ounces per day (ATI, 2013). Finger foods should be offered to promote independence (ATI, 2013).
Physical Development: Tommy’s grandpa Lou has been smoking cigarettes for over 40 years. When ever he babysits he continues to smoke around Tommy.
Smoking cessation programs should be introduced to grandpa Lou in order to decrease second hand smoke and the potential for increased ear infections, cough and colds, tooth decay, asthma, poor lung development as well as lung cancer (American Academy of Pediatrics, 2015). Reducing the number of cigarettes smoked each day and smoking away from Tommy is a starting point to positive health outcomes (American Academy of Pediatrics, 2015).
Development/ Social Development : Tommy is increasingly independent but is experiencing separation anxiety when his mother leaves for work.
Separation anxiety is a common occurrence in this age group. Transitional objects such a blanket or teddy bear provides security. Brief separation is important and necessary for both parents and toddler (Perry, et al., 2014).
Safety Teaching : Tommy and toddlers his age are very curious. Tommy loves water and enjoys taking a bath and swimming in his pool. Tommy does not know how to swim.
Toddlers must always be supervised near water in order to prevent a potential drowning. Ensure pools have a fence and gates are locked. Bathroom doors and toilet lids should be closed (Perry, et al., 2014).
American Academy of Pediatrics. (2015). The dangers of secondhand smoke. Retrieved September 27, 2016 from https://www.healthychildren.org/English/healthissues/conditions/tobacco/Pages/Dangers-of-Secondhand-Smoke.aspx American Association of Colleges of Nursing. (2016) Quality & safety education for nurses (QSEN). Retrieved September 28, 2016 from http://www.aacn.nche.edu/qsen/home Assessment Technologies InstituteÂŽ (ATI) RN Nursing Care of Children Edition 9.0: Content Mastery Series Review Module (9th ed.) [Adobe Digital Editions Version]. (2013). Retrieved from https://www.atitesting.com Developmental Milestones. (2016). Retrieved September 27, 2016, from http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/toddlers.html Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family health Care nursing: Theory, practice and research (5 th ed.). F.A. Davis: Philadelphia. National Center for Health Statistics. (2010). CDC growth charts. Retrieved September 25, 2016, from https://www.cdc.gov/growthcharts/cdc_charts.htm Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal Child Nursing Care (5th ed.). St. Louis, MO: Mosby: Elsevier.
[Untitled image of Tommy Pickles arms stretched out] Retrieved September 19, 2016 from http://rugrats.wikia.com/wiki/Tommy_Pickles/Gallery?file=TommyP.jpg [Untitled image Rugrats Logo] Retrieved September 19, 2016 from http://s682.photobucket.com/user/elliotousley/media/Rugrats.png.html [Untitled image of the Pickles Family] Retrieved September 20, 2016 from http://cartoon-characters.com/wp-content/uploads/2014/04/Stu-Didi-Tommy-Dil.jpg [Untitled image of Grandpa Lou Pickles] Retrieved September 20, 2016 from http://rugrats.wikia.com/wiki/Lou_Pickles?file=Grandpa_Lou_Pickles.png [Untitled image of Didi and Stu Pickles] Retrieved September 21, 2016 from http://rugrats.wikia.com/wiki/Stu_Pickles/Gallery [Untitled image of Lil Deville] Retrieved September 21, 2016 from http://rugrats.wikia.com/wiki/Lil_DeVille/Gallery [Untitled image of Phil Deville] Retrieved September 21, 2016 from http://rugrats.wikia.com/wiki/Phil_DeVille/Gallery [Untitled image of Susie Carmichael] Retrieved September 21, 2016 from http://rugrats.wikia.com/wiki/Susie_Carmichael/Gallery [Untitled image of Angelica Pickles] Retrieved September 21, 2016 from http://rugrats.wikia.com/wiki/Angelica_Pickles/Gallery [Untitled image of Chuckie Finster] Retrieved September 21, 2016 from http://rugrats.wikia.com/wiki/Chuckie_Finster/Gallery [Untitled image of Spike the dog] Retrieved September 21, 2016 from http://rugrats.wikia.com/wiki/Spike