CSUSM School of Nursing Created by Natashja Kelly
(Paloma, 2016)
GROWTH & DEVELOPMENT
(Paloma, 2016)
Kyle is a generally happy boy who just turned 4 years old and lives with his family in Oceanside. He loves swimming, trucks, and crafts at pre-school.
Observation of Physical Appearance
Growth and Development
Kyle responds to environmental stimuli, makes brief eye contact, and has soft clear speech. He has good muscle tone and moves extremities well. He is wary of new people and goes to his mother for security. Skin appears normal for race with even color, and no scars or marks visible. Quiet breathing without effort. He appears clean, well nourished, and well developed. He is appropriately dressed. Eyes clear. Enthusiastic affect. Open posture and an easy/even gait.
Developmental stage: Preschooler Growth: Kyle currently weights 33 lbs (25%) and is 40 inches (50%) tall. This is an increase of change of 3 lbs and 2.5 inches from his well child visit last year. He is steadily growing along the 25 percentile for weight and 50th percentile for height. His weight and height gains are within normal range for a preschooler.
Kyle’s Family
Kyle’s Social Life
Kyle lives with his immediate family in a townhouse. He has a little brother who is 9 months old. His parents are in early adulthood. His mother is 30 years and his father is 34 years. When observed, his mother exhibited an attentive authoritative parenting style. His mother works part time as a photographer and a blogger and his father works full time in finance. His paternal grandparents life 20 minutes away in San Diego and his maternal grandparents live in Dublin, Ireland and Skype about twice a month.
Kyle’s mother reports that she grew up catholic; she says that the family is not religious but that they celebrate American holidays. Kyle is seen here on a playdate with his mother’s friend, Candice. Candice has a 5-year-old daughter, Ally, and a 11-month old son. Kyle loves to play with Ally and says that he has other friends from his neighborhood and school that he also likes. Kyle started preschool 2 months ago and his mother reports that he has adjusted to school and has starting to looking forward to going. Kyle does not play any extracurricular sports but loves to swim and take pictures like his mother.
(Paloma, 2016)
Kyle’s growth in height and weight are within normal ranges for annual gains and consistent with an acceptable growth curve/percentile. He is starting to develop a more slender build. Upon examination his physical features are developing without deformity and as expected for his age.
Growth & Development Milestones ___________ Motor Skills (Paloma, 2016)
Expected Gross Motor Skills “Dresses self, throws and catches ball, can pedal a tricycle, kicks ball forward, stands on one foot for 5-10 seconds, skips and hops on one foot, walks down steps with alternate feet, jumps from the bottom of a step, balances on alternate feet with eyes closed.” (Ward, 2014) Mother reports that he can dress himself but still needs help with buttons and snaps. He can kick and throw a ball forward and can catch a ball some of the time. He loves riding his scooter and his mom is going to get him a bike with training wheels for Christmas. He goes down steps with alternate feet and jumps off the bottom step.
(Paloma, 2016)
Expected Fine Motor Skills “Builds tower of 9-10 cubes, draws stick figure with 6 parts, uses scissors to cut outline of a picture, copies and traces geometric patterns, ties shoelaces, uses fork, spoon, and knife (with supervision), colors, prints letters, mostly independent toileting and dressing.” (Ward, 2014). Can draw a circle, a square and a Triangle, Can cut with scissors along a line relatively well. Is interested in tying his shoelaces and mother is teaching him. Can use a fork and spoon. He is learning to write his alphabet in pre-school. He is toileting well but some times wets the bed on weekends.
Cognitive Development with Piaget Typical cognitive and language development for a preschooler includes: A focus on themselves and the use of language to convey concepts. They experience concrete thinking and ask many ‘why’ questions. They enjoy silly rhymes and singing songs. They can learn their address and phone number and start to speak in complete sentences (Ward, 2014) Major characteristics of the Preoperational stage (2-7 years): thought using words as symbols and logic that is not well developed yet. (Ball, Binder, & Cowen, 2015) ____________________________________________________________ Major characteristics of the Preconceptual sub stage (2-4 years): A big increase in vocabulary and comprehension. The child is unable to see things from a perspective other than their own (egocentric). (Ball et al., 2015)
Being 4 years old Kyle is in between the preconceptual sub stage and the Intuitive sub stage and exhibits characteristics from both sub stages.
Major Characteristics of the Intuitive sub stage (4-7 years): Transductive reasoning, or the drawing of conclusions about cause and effect between two facts that may not be related realistically. Magical thinking, the belief that events can happen due solely to thoughts. Centration, the ability to see only one perspective at a time. And animism, the mistaken belief that things that are not a live really are, because they move on their own or make noises. (Ball et al., 2015)
Psychosocial Development with Erikson Kyle is in Erikson’s Initiative vs. Guilt stage (3-6 years). In this stage the challenge for the family is to encourage the child while they explore new activities/roles and ideas. The child will have the initiative to push the boundaries of what they can do and what concepts they understand. Too much criticism of their abilities in this stage leads to feelings of guilt in the child and a sense of uselessness (Ball et al., 2015)
Moral Development with Kohlberg Kyle is at the beginning of Kohlberg’s Preconventional stage (4-7 years). Moral decisions are made in order to please others, avoid punishment, or both. (Ball et al., 2015) An example of this would be if Kyle was trying to please his older friend Ally by stealing his little brother’s cookie to give to her but then decides to hide the wrapper in his pocket to hide the evidence so that he does not get caught.
(Paloma, 2016)
Kyle is seen here participating in associative play, he now interacts with children during play and is able to follow simple rules. They are also showcasing fantasy & dramatic play, which is common for this age, pretending to be super-heroes who have to protect the world from evil birds.
Nutrition Status Kyle seems to be well nourished and his general growth, weight and height, reflect that he has a good nutritional status. As assessed at the beginning of this report he is in the 25th percentile for weight and 50th percentile for height. His trend of growth has been along a consistent upward curve. The USDA recommends that 4 years old boys who are active for at least 60 minutes a day should consume a 1,600 Calorie diet a day (2016). The table below shows how a balanced1,600 Calorie diet looks like in servings.
(USDA, 2016)
A history was taken from the mother regarding Kyle’s typical diet. She says that she tries to incorporate veggies into smoothies and main course dishes and add cheese to them to get Kyle to eat them. She reports that he is a big meat eater so she serves him chicken, turkey and an occasional homemade hamburger. She mixes juice with herbal teas to decrease the amount of sugar that the kids consume. She says that in reality he probably eats more protein and less vegetables than the 1,600 Calorie diet pictured.
(Paloma, 2016)
Orem Self-care requisites: - Sleep habits- Now that Kyle has transitioned into preschool he does not take naps during the day. After his mother picks him up from school at 12:15 she takes him home as has ‘quiet time’ so that the baby can take a nap. The mother usually rests too if she doesn't have a project to work on and this is when Kyle gets his 1-1.5 hour of TV a day. He has been going to bed sooner at night in lieu of a nap. He will go to sleep at 7pm and wake up at 6am most days. - Self-care habits- Kyle is able to brush his hair and his teeth (his mother still supervises). He is able to put on his clothes excluding buttons and shoe laces. He is able to clean himself with a washcloth when he takes a bath with his brother. He is able to use a fork and spoon and wash his hands. - Toilet training- Kyle is able to wipe himself and is consistent about stopping play to use the toilet. He still occasionally wets his bed when he doesn’t get up to use the restroom at night or the family sleeps in on the weekend.
QSEN Collaborative Care & Teamwork: Pediatric nutrition is a great area to showcase the collaborative care competency. The team that needs to work together to provide Kyle proper nutrition includes the doctor, mother, father, grandparents, staff at his preschool, nurse, nutritionist, and Kyle himself. The nutritionist can be a great resource for tools, techniques, and information to chose and implement a healthy diet. The mother knows her son the best and is the one buying and preparing the food. The father is a role model for his son’s diet. The grandparents and staff at the preschool need to help keep consistency in Kyle’s diet and make sure that he is eating well when they are watching him. The doctor can assess and order labs to monitor Kyle’s nutritional status. The nurse provides support and education for the mother regarding an adequate diet for her son at his current age. The nurse should also talk with the boy about what his goals are for his diet. Kyle said that he wants to be as tall as his dad and that he wants to grow up to be as strong as a firefighter.
Interventions Nutrition
Physical Development
Educate Kyle’s mother about food jags. Food jags are periods of days or weeks when a child eats only a few types of foods (Ball et al., 2015). Teach her to continue to provide other food choices in addition to the child’s preferred food. She can give Kyle a gummy vitamin or nutrition shake if she wants to but that kids grow out of these phases and that she should look at his diet on the scale of weeks rather than days. Advise her not to offer other foods between meal/snack time. That the child will eat the nutritious options that are offered when they develop an appetite.
As the child develops more independence and fine motor skills it is important to educate about dental hygiene. Advise the parents to supervise the child while they brush their teeth and to help them floss. The nurse should endorse regular dental check-ups for the child and can suggest getting disclosing tablets from their dentist. The tablets can be made into a game to get all of the color off of the child’s teeth in order to teach them effective brushing techniques. Fluoride should be in the toothpaste if it is not in water (Ball et al., 2015).
Interventions Social Development
Safety
Educate the mother and father about actions they can take to encourage the development of their son, Kyle. Expressing feelings and learning to recognize feelings in others is an important area of growth at this age. The parents can talk about feelings with him and encourage him to play in small groups. Play in small groups will also help Kyle learn rules and how to conduct conversations with others. The parents can role model polite conversational skills and how to follow society’s rules. Encourage him to dress, clean, and care for his own belongings. Provide positive reinforcement for good behavior (Ward, 2014)
Boys between 0-4 years are at highest risk of drowning (Ball et al., 2015). Kyle loves to swim and is either at the ocean or at a friend’s pool at least once a week. The nurse can talk to the parents about always having an adult actively watching the kids and the use of floatation devices. Encourage the parents to put Kyle in swimming lessons and to take CPR classes themselves. The nurse can also talk to Kyle directly and teach him good habits such as never going into the water without an adult watching.
References Ball, J., Binder, R., & Cowen, K. (2015). Caring for children principles of pediatric nursing (6th ed.). Hoboken, NJ: Pearson. Paloma, L. (Photographer) (2016, May 2). Tiny travels: La Jolla [Web log album]. Retrieved from http://www.chrissypowers.com/?tag=motherhood United States Department of Agriculture, USDA (2016, June 7). Myplate daily checklist for preschoolers. Retrieved from http://www.choosemyplate.gov/myplate-daily-checklist preschoolers Ward, S. L. (2014). Pediatric nursing care: Best evidence-based practices. Philadelphia, PA: F.A. Davis Company.