Growth & Development: Visual Paper Mila
{ Ryan Biancardi California State University San Marcos
Meet Her Family and Friends! Mila (4 years old) lives with her parents and baby brother, Jack. She also has lots of friends and extended family with who she spends time: •Family - Mom, Dad, Jack (baby brother), Mr. Mittens •Friends - Camden, Max, Kenzie, Will, Ben •Others - Donita (nanny), Aunts/Uncles, grandparents Mila just started preschool, and attends ballet class. Her other hobbies include going to the beach, trips to the zoo, watching cartoons, listening to music, playing with bubbles and bouncy-balls, and playing house. She loves wearing dresses and floral headbands. She has long brown hair and brown eyes like her dad. Mila’s parents describe their parenting style as “permissive” because of their allowance of Mila to choose what she eats, and allowing her to sleep in their bed.
Growth & Development: Preschool Mila just turned 4 years old. She is currently in the middle of the preschool stage of growth and development. During this stage, the physical growth continues to be steady, but begins to slow. The average weight gain for a preschooler is 4.5-6.5 pounds per year, while the average increase in height is 2.5-3.5 inches per year (Ward, 2014). Preschoolers tend to be slender, but sturdy, as well as graceful and posturally erect (Perry, Hockenberry, Lowdermilk, & Wilson, 2014). Mila is currently 36 inches tall, and weighs 39 lbs. Her weight is in about the 60th percentile, while her height is about the 50th percentile (CDC, 2010). Although she is sturdy and graceful, she continues to have a “pot-belly.�
Gross Motor Skills Age specific Gross Motor Skills (Preschool):
Mila’s Gross Motor Skills (Preschool; 4 years old):
•Ability to dress self •Throws/Catches ball •Kicks ball forward •Stands on one foot for 5-10 seconds •Balances on feet with eyes closed
•Puts on her own dress and jewelry (needs assistance with bathing suits and tight fitted clothes) •Ability to catch a big ball •Kicks balls around backyard •Learning to hoola-hoop (unable to keep it going for more than 3 seconds) •Participates in ballet
Ward, S. L. (2014). Pediatric nursing care: Best evidence-based practices. Philadelphia, PA: F.A. Davis.
Fine Motor Skills Age specific Fine Motor Skills (Preschool):
Mila’s Fine Motor Skills (Preschool; 4 years old):
•Moves with more balance •Ability to build tower blocks •Draws stick figures •Ties shoes •Uses silverware •Independent toileting
•Colors in Princess coloring books •Uses fork and spoon (but no knives) •Feeds baby Jack with supervision •Can put on own shoes with Velcro straps •Potty trained (needs assistance wiping)
Ward, S. L. (2014). Pediatric nursing care: Best evidence-based practices. Philadelphia, PA: F.A. Davis.
Erikson, Piaget, and Kohlberg Stages Erikson: Initiative vs. Guilt
Children need to begin asserting there power and control, but not too much power. Success in this stage can lead to a sense of purpose. However, if too much power is exerted, disapproval may be experienced and may result in a sense of guilt. Mila enjoys making pancakes , holding the baby, decorating her own room, and choosing what she is going to wear. However, at times she exerts too much power. She recently was a flower girl at a wedding and threw a “tantrum” because she didn’t like the dress she had to wear. She also threw a tantrum when she wasn’t allowed to have cupcakes for breakfast.
Piaget: Preoperational
At the age of 4, preschoolers are in between the preconceptual phase and the intuitive phase. She still likes to make decisions that please her, but she is beginning to see the perspective of others. Mila understands that her friend, Max is only 2 years old and requires more time to do things. She also understands that Mom and Dad are also busy with baby Jack. However, if adequate time is not given to her, she has a tendency to throw a tantrum, and slam her door. She knows that baby Jack is sleeping in the room next door.
Erikson, Piaget, and Kohlberg Stages Kohlberg: Preconventional
During this developmental level, children go through the “na ïve instrumental orientation.” This stage is occupied by actions that are directed towards the self-satisfying needs of the child. These actions are generally geared towards the child, and less about the needs of others. They also begin to have a better understanding of fairness and justice (Perry, Hockenberry, Lowdermilk, & Wilson, 2014). Mila is just beginning this stage of moral development, and demonstrates signs of fairness as as well actions that are self-satisfying. She understands that when she is playing with a toy and others are with her, she has to take turns. She also likes to take turns of feeding her baby brother. She does however, become too aggressive with the bottle at times. When she is told that she has to be more gentle, she has a difficult time understanding why her way is incorrect.
Nutrition •
Preschoolers should eat a variety of foods to promote optimal growth. This will also decrease the chance of obesity. The recommended daily calories is 1400 to 1600 for a child with Mila’s activity level (moderately active). The guidelines also emphasize a reduction in sweet juices, with an increase in fruits, veggies, and whole grains (Perry, Hockenberry, Lowdermilk, & Wilson, 2014).
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Mila enjoys some fruit and whole grains, but she tends to eat these foods when paired with a sweet or fatty condiment. She likes to put honey in her fruit and yogurt, as well as syrup on her waffles and pancakes. She will eat wholesome food, such as eggs and toast, but tends to ask for candy shortly after. She also likes to eat whole grains when they are turned into grilled cheese sandwiches.
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It is not uncommon for children like Mila to be pickyeaters. It is important to understand the habits that these children demonstrate because a clearer understanding of why children are being picky will help guide healthier eating habits for the future (USDA, 2015).
Orem’s Self Care Requisites Sleep habits
Unmet- Parents should avoid allowing preschoolers to sleep with them. It is common for preschoolers to occasionally become frightened at night, however this should be addressed through reassurance and night lights. Mila goes to bed around 8pm each night, but joins her parents around 11pmmidnight.
Self-care habits
Partially met- Mila is beginning to dress her self, brush her teeth, put on her shoes, and properly use silverware. Because Mila is 4 years old, she is at the beginning of the preschool stage. Therefore she is just learning to become more independent with these skills. Although she uses forks and spoons, she is too young to use a knife. She also is able to put on her shoes with Velcro straps,but she is still unable to tie shoe laces.
Toilet training
Partially met- Mila is able to hold it in until she can make it to the bathroom. She is able to get on the toilet independently. She isn’t able to wipe properly when she is finished. She also needs assistance in proper hand-washing.
Concern’s and Interventions Nutrition
Mila is a “picky-eater” who enjoys her sweets. She is introduced to new foods by her parents, but sometimes leaves it on the plate and doesn’t touch it. Intervention: “Be a good role model.” In order for the child to be introduced to new foods, it is sometimes helpful for the parent’s to eat the food as well. They can offer their child small bites and allow time for the child to accept the food. If the child sees that others are enjoying the food, they may be more likely to like it as well (USDA, 2015).
Physical development
Mila is around the 50% percentile for her height, and continues to have a “pot-belly” when preschoolers begin to thin out at this level. Mila is not overweight, but may be at a higher risk of being overweight due to her loves for sweets. Intervention: Always provide positive reinforcement for Mila when she made advances in her gross motor skills (kicking a ball, doing the hoola-hoop). This will encourage Mila to continue to want to participate in physical activities. In combination with healthy food choices and physical exercise, Mila will be at a decreased risk of being overweight or obese.
Concerns and Interventions Social development
Mila is developing well for her age in large part to her friends, family and her participation in preschool and ballet class. She is beginning to say sentences that are greater than 3-4 words. She is also able to follow more than one command at a time (“Can you put your clothes away, and get ready for bed?�) Intervention: As Mila begins her preschool days, she must be encouraged to share with others, and follow instructions set forth by her teachers. Parents should also teach their children the importance of recognizing the feelings of others.
Safety teaching
Mila is beginning to explore outside her once limited environment. Her friends and I like to play on the playground at the beach, as well as go down to the water. Intervention: Mila must be educated on the importance of dangerous areas (streets, talking to strangers, riding a bike without a helmet). Education regarding these dangerous activities does not limit the supervision required. Because Mila is only 4 years old, she should still be supervised, but during these activities is a great opportunity to educate her regarding the importance of safety.
QSEN Safety As Mila begins to gain her own autonomy in life and explores the world beyond her family, anticipatory guidance is a very important aspect of parent education (Ward, 2014). Although it may seem that children have the ability to bathe themselves, buckle themselves into a car seat, or look both ways before crossing the street, they still lack the cognitive development to make rational decisions. Preschool children should still continue to play in fenced areas, swim and bathe under adult supervision, and ask permission before participating in certain activities. This will allow the children to understand the meaning for set limits, as well as avoid injuries and accidents before they become severe.
References Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal child nursing care (5th ed.). St. Louis, Missouri : Elsevier. United States Department of Agriculture. (2015, July). Behavioral milestones. www.ChooseMyPlate.gov. Retrieved from https://choosemyplateprod.azureedge.net/sites/default/files/audiences/behavioral-milestones.pdf U.S. Department of Health & Human Services. (2016, June 8). Preschoolers (3-5 years of age): Developmental milestones. CDC. Retrieved from http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/preschoolers.html Ward, S. L. (2014). Pediatric nursing care: Best evidence-based practices . Philadelphia, PA: F.A. Davis.
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