Toddlers may come to know that being sick means feeling bad or having to stay in bed, but they have little, if any, understanding of the meaning of health. They depend on their parents for health management. A normal assessment finding for the toddler is being current on their immunizations. Because their immune system is still maturing, a normal assessment finding would be frequent minor upper respiratory and gastrointestinal infections. Their passive immunity to communicable diseases acquired from breast milk has disappeared and active immunity through the initial immunization series is usually completed by 18 months.
An abnormal assessment finding is not having been immunized or being behind in their scheduled immunizations. A potential problem for the toddler can occur when their parents don’t model healthy behaviors such as eating a balanced diet. The toddler may end up having nutritional deficiencies or become overweight. Nutritional-Metabolic Pattern Toddlers are usually weaned from the breast or bottle before or during toddlerhood. A potential problem with that can be inadequate iron intake since regular cow’s milk is low in iron and can interfere with iron absorption from other food sources.
A normal assessment finding in toddlers is a decrease in growth rate and appetite and can becoming picky eaters. A potential problem is nutritional deficiency if the parents offer empty calories from unhealthy snacks just to get them to eat something. Pattern of Elimination A normal assessment finding for the toddler is increased development of voluntary control over their bladder and urinating less frequently. Their average urine volume for the day will be between 500-750 ml. Their emotional and physical readiness for toilet training rarely develops before 18 months of age.
A potential problem is frustration for both the parents and toddler if toilet training is attempted before the child is ready. The toddler’s gastrointestinal tract reaches functional maturity and most will develop sufficient voluntary control of the internal and external anal sphincters for bowel control. This usually happens before urinary control. Pattern of Activity and Exercise Toddlers are increasingly becoming more mobile and are able to coordinate their large muscle groups better. The toddler generally does not show complete dominance of one-sided body function and may still switch hands when eating or throwing a ball.
They are always busy and will advance from taking their first step to running, climbing stairs, and pedaling a tricycle. Because of their exploratory nature and limited skills they are vulnerable to injury. They will want to play with other children in parallel play. A potential problem is the over use of television to entertain the child. Recent research demonstrates that for every hour they watch television they know 6 to 8 fewer words than toddlers who didn’t. Pattern of Sleep and Rest The toddler’s need for sleep is 12 hours a day which includes 1 or 2 naps.
They need to have a bedtime ritual to help them sleep. A potential problem with the active toddler is that they may not be aware of their fatigue and become overtired and unable to relax enough to sleep. The toddler may suffer from night terrors where they don’t awaken completely for several minutes and look terrified. Cognitive-Perceptual Pattern The toddler’s receptive language skills outweigh their expressive language ability and they often use gestures until they can find the right words to express themselves. They may become frustrated and will default to using “no” to gain control and express themselves.
The toddler’s play can be repetitive and ritualistic. That is how they learn skills and decrease anxiety. A potential problem with the toddler’s endless energy and curiosity is frustration of the parents or caregiver which may lead to child abuse. Hearing loss is one of the most common conditions at birth and if not detected speech, language, cognitive, and emotional development can be impeded. Self-Perception-Self-Concept Pattern The toddler is ready to develop a sense of self separate from parents. They are delighted in their emerging independence and achievements.
Their task of exerting autonomy means they have to give up their dependence on others that was enjoyed in infancy. If they continue to be dependent, they may get a sense of doubt about their ability to take control of their actions. To develop a sense of autonomy they must explore the physical world and the interpersonal aspects of relationships. A potential problem is their safety as they investigate their environment and they are susceptible to accidents. Temper tantrums are a response to frustration when the toddler’s need for autonomy conflicts with parental expectations, safety limits, or the rights of other people.
This can result in child abuse from the parent who is not equipped to deal with it. Roles-Relationships Patterns The toddler understands his parents and siblings’ roles in terms of how their roles relate to him. Their most important relationships are their family. The desire to be like or have what a sibling does can lead to sibling rivalry. If a new baby comes along and gets too much attention and becomes a nuisance, they may revert to infantile behaviors such as wanting to be fed or dressed and losing their toilet skills. The toddler’s behavior can be trying for the parents and abuse can occur.
Sexuality-Reproductive Pattern The toilet training process may precipitate curiosity about the genital area. The parents might name the parts a cute name rather than the correct anatomical terms. This can create problems of learning about sexuality and communicating effectively if sexually abused. Coping-Stress Tolerance Pattern Temperament is the style of behaviors that a child uses to cope with demands and expectations of the environment. The three common temperament patterns are the easy child, the difficult child, and the slow to warm up child.
The difficult child is less adaptable, more intense and active, and has more negative attitudes which can be distressing and frustrating to parents and caregivers and make them feel inadequate in their roles because they don’t know how to deal with them. Toddlers often imitate their parent’s methods of dealing with stress. This can be a problem if the behavior modeled is inappropriate and counter-productive. Values-Beliefs Pattern Toddlers believe rules are absolute and behave out of fear of punishment. Most of their developing values and beliefs depend on their interactions with their parents.
Parents often attend to the toddler only when they are misbehaving and leaving them alone when they are good. This is a potential problem because the toddler’s negative behavior is reinforced because they only get attention when misbehaving. Preschooler Pattern of Health Perception and Health Promotion By age 4 or 5 the preschooler begins to understand that they play a role in their own health. They may become upset over minor injuries and they may view pain or illness as a punishment. They contribute to their own health management by brushing their teeth, taking medication, and wearing appropriate clothes for the weather.
Since the immune system is not fully developed they will continue get contagious illnesses. Nutritional-Metabolic Pattern A normal assessment finding for the preschooler’s food consumption is that about half of their diet consists of carbohydrates and the other half consists of protein 5% and fat 30-40%. They will develop food preferences because of their increased ability to react to the taste and textures of food and their realization that expressing an opinion about food is a way to have control. If offered too many sweets and processed foods along with little physical activity it can lead to obesity and diabetes.
Conflict can arise when the preschooler and families have extreme differences over food preferences. Pain from dental caries, infection, and poorly cared for teeth affects the appetite and chewing ability that impacts their nutritional status. Children from low income households are mostly affected. The prevalence of food allergies in children that develop before the age of two in the United States is increasing. Elimination Pattern Older preschoolers are capable of and responsible for independent toileting. By the end of preschool their daily urine amounts total from 650 to 1000 ml. Children achieve full voluntary bowel control.
Acquired lactose deficiency often appears and is more common in Black, Asian American, and Native American children. Activity-Exercise Pattern Play continues to be the primary activity for preschoolers and they demonstrate increased coordination and confidence with motor activities. They play simple interactive games and dress themselves. The preschooler can regulate body activity better than toddlers. Many preschoolers spend a lot of time watching television. Sometimes parents may use the television to entertain the child and a significant amount of the shows focus on adult themes and violence.
Many experts agree that television disengages the child’s mind and supports less learning. Watching too much television can mean missed opportunities for interacting with other children. Sleep-Rest Pattern Most preschoolers sleep from 8 to 12 hours a night and for older children a nap may not be needed. They usually need a bedtime ritual to move from playing and being with others to being alone and falling asleep. They prolong bedtime routines more often than the toddler. They challenge the parents with their resistance to bedtime and learn to use behaviors that meet their needs and control the family and cause disruption.
The preschooler can experience night terrors and nightmares. Cognitive-Perceptual Pattern Many children are starting formalized education during their preschool years. Their facility with language resembles that of an adult. The preschooler’s vision continues to undergo refinement and by age 6 the child should approach 20/20 visual acuity level. Depth perception and color vision become fully established. The child may develop myopic vision which will require glasses. Hearing develops to the level of an adult’s. The hearing ability can be hindered by recurrent ear infections and may cause language delays.
Pattern of Self-Perception and Self-Concept The preschooler is developing a mastery of self as an independent person, with a willingness to extend experiences beyond those of the family. Social acceptance helps them feel successful in their role as a child, sibling, and friend. They investigate roles through imagination. When they perceive their value in the world they demonstrate improved mental and physical health. Preschoolers remain sensitive to criticism and when ridiculed for ideas or behavior they may develop feelings of guilt and inadequacy. Role-Relationship Pattern
They use play to explore while experimenting with who they are, who they might become, and how they relate to others socially. The drama of play allows them to view themselves from another perspective. Peers are becoming more significant. Ideas about gender differences in work roles and other activities are based on models in the home, at child care or preschool centers, and on television. Preschoolers use play to experiment with new roles and to understand others’ roles better. Younger children may admire and imitate an older sibling which can be a source of irritation and frustration for them.
Divorce commonly creates disruption in the family and may cause regression, confusion, and irritability in the preschooler. Sexuality-Reproductive Pattern Preschoolers know that there are two genders and identify with their own gender. They see representations of both genders in role models and on television to interpret and they can define their own roles. They are curious about the bodies and sexual function of others. When they are teased about this interest or it is implied that sexual information is unacceptable or naughty it will promote negative self-esteem. Being a victim of sexual abuse will cause many emotional problems.
Pattern of Coping and Stress Tolerance Play is an important strategy for the preschooler to use to reduce stress. They are able to verbalize their frustration and show more patience in dealing with difficulties. They also use the coping mechanisms of separation anxiety, regression, fantasy, denial, repression, and projection. Sometimes projection can lead a parent to consider the child as dishonest when they blame somebody or something else for something they did. Temper tantrums normally disappear as a response to stress in the older preschooler. Temper tantrums that persist through the fifth year indicate a lack of matured coping responses.
Pattern of Value and Beliefs Preschoolers lack fully developed consciences. At the age of 4 or 5 years old they do demonstrate some internal control of their actions. Preschoolers control their behavior to retain their parent’s love and approval. Moral actions are demonstrated in simple activities such as standing in line. Life and death fascinates the preschooler. Because of their limited emotional experience with death they may become upset with the idea of dying, assuming that when someone becomes angry and wishes them dead that they will cease to exist.
Children who lose a loved one can have sleep disturbances and other behavioral changes as part of the grieving process. School-Aged Child Pattern of Health Perception and Health Management Most children are relatively health during this time. They learn to accept personal responsibility and participate in self-care such as personal hygiene, nutrition, physical activity, sleep, and safety. Due to a child’s cultural obligation to obey authority figures, children can become passive health care consumers, asking few questions, doing as they are told, and perpetuating poor choices.
Some school-aged children may choose unhealthy behaviors such as smoking or illicit drugs. Leukemia is the most common form of childhood cancer. Nutritional-Metabolic Pattern School-age children often eat foods low in iron, calcium, and vitamin C, and foods that have higher fat and sodium content than their parents did at their age. There is a discrepancy between current dietary intake and recommended dietary intake of these children placing them at risk for poor nutritional habits, iron deficiency, diabetes, obesity, and hypertension. A child’s nutritional pattern usually reflects their family patterns.
This could be a problem when a child doesn’t want to eat breakfast because their parents don’t. Pattern of Elimination Most children will have full bowel and bladder control by age 5. Their elimination patterns are similar to an adult’s, urinating 6 to 8 times a day and 1 or 2 bowel movements a day. Children with primary enuresis have never achieved bladder control. Some may have nocturnal enuresis. This can cause disruption in the family and self-esteem issues and have profound effects socially, emotionally, and behaviorally. Children with encopresis face similar issues.
Pattern of Activity and Exercise The school-age child is generally naturally active. Those children who don’t live in a safe neighborhood or don’t have a parent who exercises are less likely to exercise themselves. The school aged child has the potential to perform more complex fine motor and gross motor functions. Physically active boys are slightly stronger than girls. Many children get their exercise through group activities and organized sports. Concerns exist that children have had too much physical and psychological pressure to perform in sports.
Children can also get injured from playing in sports. Pattern of Sleep and Rest Most school-age children have no problems with sleeping and their requirements of sleep are similar to an adult’s. They sleep 8 to 12 hours a night without naps during the day. The most common sleep problems are night terrors, sleepwalking, sleep talking, and enuresis. Cognitive-Perceptual Pattern The school-aged child’s vision should reach optimal function by age 6 or 7 years of age. Peripheral vision and the ability to discriminate fine color distinctions should be fully developed.
They should have a visual acuity in each eye of at least 20/30. Many children need glasses to prevent academic difficulties, headaches and dizziness when reading or doing close work. Many children may have myopia or astigmatism. The child’s hearing ability is nearly complete by the age of 7 years. Chronic serous otitis media is the common cause of hearing deficits. Attention deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. Pattern of Self-Perception and Self-Concept The school-age child’s concept of the body and its functions is changing.
Changes or differences in their body may frighten the school-age child if they don’t understand their normal developmental process. Physical differences can provoke ridicule and isolation. Children with chronic illness worry that their peer relationships will suffer if they know about their illness. Role-Relationship Pattern Parents and caregivers serve as authority figures that establish rules needed for the functioning of the family and the safety of the child. The school-aged child’s increasing independence and responsibility begin to reduce the amount of parental authority and structure needed.
They prioritize school and peer group relationships. They broaden their interests outside the home. Some may become involved in gangs or behavior that is stressful for both them and their family. Relationships between children and adults are not always positive and sexual abuse has become a more common but hidden problem. Sexuality-Reproductive Pattern The child enters the school-age years identifying with the parent of the same sex and continues to learn the concepts and behavior of the gender role. This is a significant challenge, especially for homosexual children.
Stereotypes continue to influence the child’s ideas of male and female roles. When physical changes of puberty have begun, concern and curiosity about sexual issues grow. A lot of parents are uncomfortable or unsure of what sexual information to give to their children. Pattern of Coping and Stress Tolerance A threat to the child’s security causes feelings of helplessness and anxiety that may affect their ability to function successfully. Grief over the death of a loved one, divorce, or loss of acceptance from a peer group may cause behavior problems.
The family environment provides a sense of security that allows the school-age child to cope with stress. In uncontrollable situations children may become depressed or somaticize. Pattern of Value and Beliefs Cultural, religious, and parental values influence a child’s moral development, concept of right and wrong, and consequences of not demonstrating moral behavior. Some moral behavior problems are common during school-age years such as lying, stealing, or cheating. These actions can be very upsetting for the parents. Compare and contrast identified similarities as well as differences in expected assessment across the childhood age groups.
Mostly similarities were found within all three age groups for the Gordon’s Functional Health Pattern Assessment categories. All of them looked to their parents as role models and for guidance in every category and could either be positively or negatively influenced by them. By example from their parents or by what they are offered to eat from them, they could either learn to be healthy eaters or end up with nutritional deficiencies, obese, or have health problems. All three age groups learn from their parents how to cope with stress and look to them for comfort.
They are all affected by their parents and their culture. The three age groups are each exploring themselves regarding their roles and relationships in life and their sexuality. They are all susceptible to the negative influences of the television. They all need a structured bedtime and adequate sleep. All of them showed an increased desire for and sense of independence. As they each grow older they are able to express themselves and communicate better. The biggest difference was that the toddler and preschooler get more contagious illnesses than the school-age child.
Summarize how a nurse would handle physical assessments, examinations, education, and communication differently with children versus adults. Consider spirituality and cultural differences in your answer To assess a child’s growth, the nurse uses the CDC growth chart to compare the child’s weight to national averages of which there are ethnic differences. The assessment and examination of the child is different than that of an adult. The head to toe sequence for adults is varied in children according to their response and developmental level. The nurse uses play techniques and the child is allowed to play with the instruments.
The child may need to sit on the parent’s lap during the exam. Education and communication is different towards children. The child’s health perception and management is greatly influenced by the parent and their culture so the nurse has to work in partnership with the parent. Most of the history is obtained from the parent although an older child may be able to provide some of their own history. Because the child may not be able to say what hurts or articulate their fears and needs, the nurse needs to be able to interpret behaviors and reactions and be intuitive and reassuring to both the child and parents.
The nurse needs to identify and overcome any barriers to understanding the child and parents whether because of language, culture, or stage of development (Nursing and Midwife Council [NMC], 2008). Reference Nursing and Midwife Council (2008). Advice for nurses working with children and young people. Retrieved April 20, 2012, from www. nmc-uk. org/nurses-and-midwives/advice-by-topic/a/advice/advice-on-working-with-children-and-young-people/
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Topic: Asessment of children, toddler, pre-school using Gorden’s functional health pattern assessment
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