Assessment on Toddler

In Partial Fulfillment of the

Requirements in NCM 204 – RLE

SCHOOL NURSING ROTATION

Submitted To:

Nympha Fernando, RN

Vianah Eve Escobido. StN

Submitted By:

Egcao, Ashlea M.

BSN 2G – Group 3

October 03, 2021

Introduction

Physical Development

Toddlers are children between the ages of one and three. According to some, once your
child reaches the age of one, they are automatically promoted to toddlerhood. They are called
toddlers because of their uncoordinated movements, the way they learn to walk looks like
“toddling”. During the toddler years, the child's physical, cognitive, emotional, and social
development, language development, and sensory and motor skills development will all evolve
rapidly. Between the ages of one and two, children gain roughly three to five pounds and grow
three to five inches; however, between the ages of two and five, this rapid growth slows down.
The child's strength and coordination will improve throughout this time. Children between the
ages of 12 and 24 months continue to form deep ties with their loved ones while also wishing to
be more independent. By the age of two, children's vocabularies can range from 50 to 100
words, and they begin to combine two or more words. Toddlers will also engage in more
advanced gross motor activities such as jumping, climbing, squatting, and throwing a ball. They
learn to wave, clap, and point to things as a way of communicating to people.

Erik Erikson’s eight-stage theory of psychosocial development emphasizes how people

grow and change throughout their lives, with a focus on social interaction and conflicts that arise
at certain stages. Erikson's second stage of Psychosocial development is Autonomy versus
Shame and Doubt. This stage occurs between 18 months to 3 years old. Children at this stage
focuses on developing self-control. It is important for toddlers to establish a sense of personal
autonomy and independence. They get a sense of control over themselves as they learn to
accomplish things for themselves, as well as some basic confidence in their own capabilities.
Toddlers don't have much freedom: we tell them where to go, what to do, what to eat and wear,
and when to sleep, all of which contradicts their growing independence. Toddlers will fight about
anything and everything, no matter how little, in order to achieve even a small bit of authority.
Between the ages of 22 and 30 months, most toddlers are ready to start toilet training. Toddler
must be able to control his or her urine and bowels before starting toilet training. Dry diapers
after sleep and for at least two hours at a time are signs of this control. Toddlers also require
one or two daily naps because their overall sleep time should be between 11 and 14 hours per
day.

Discuss in brief MMDST

 Metro Manila Developmental Screening Test (MMDST) is a screening test to determine
early serious developmental delays in children from 6 ½ years old and below and it was
developed by Dr. William K. Frankenburg. It is not an intelligence test rather it is a screening
instrument to determine if a child’s development is within normal. The purpose of this test is to
evaluate the four (4) sectors of development. These are the following: Personal-Social in which
is a task that will allow the child to take care of himself/herself and interact with people. Fine
motor adaptive, tasks that will show how a child will use his/her hands to draw and pick up
things. Language, tasks that will show the ability of the child to hear, follow directions and to
speak. Lastly is the Gross-Motor, tasks which will show the ability of a child to sit, walk, and
jump. The tests are scored as either Passed (P), Failed (F), Refused (R), or No Opportunity
(NO). if failed, the item which is completely to the left of the child’s age will be considered as a
developmental delay. Though, failure of an item which is completely to the right of the child’s
age line is acceptable and will not be considered as delay.

Introduce your client

Client is patient A.C., 1 year, 1 month, and 7 days old and was born on August 24, 2020
at Buluan District Hospital with the weight of 3kgs. He is the only child of their family. The
patient was scared at first and was not happy, but eventually, with the help of the mother, he
cooperated and felt comfortable throughout the assessment.

I chose my nephew as my patient because we had no toddler in our home and he was
the closest toddler I could assess. Due to the current pandemic, I had limited access on who I
will assess and fortunately, the parents agreed and allowed me to assess their child. I believe
that he is fit for the assessment since he is already a toddler and is capable of doing the Metro
Manila Developmental Screening Test. I was able to perform the assessment with the
cooperation of the mother and the child.

OBJECTIVES

General Objective

- To be able to determine the child’s developments and delays using the Metro Manila
Developmental Screening Test (MMDST)
Specific Objectives
 - To choose a client within the range of toddler
- Collect necessary information about the client
- Determine if the development of the child is appropriate with its normal range
- Interpret the child’s performance and behavior
- Help the parents learn what behaviors and skills to expect with the child’s age

PERSONAL DATA

Name of Client: A.C.

Birthday: August 24, 2020

Ordinal Rank: 1 (only child)

Address: Brgy. Malala, Datu Paglas, Maguindanao

Nationality: Filipino

Religion: Islam

Name of Father: M.C.

Age: 26 years’ old

Educational Attainment: College Graduate

Occupation: Farmer

Name of Mother: H.C.

Age: 25 years’ old

Educational Attainment: College Graduate

Occupation: Government Employee

COMPUTATION OF AGE
 Year Month Day
Date of Test 2021 10 (9) 01 (+30 = 31)
Birthdate 2020 08 24
Age of Child 1 1 7

Therefore, the age of this child is 1 year, 1 month and 7 days.

DESCRIPTION OF TEST ITEMS

PERSONAL SOCIAL

Imitates housework

Administration:

I asked the mother if the child imitates some housework.

“Gumagaya ba siya ng trabahong bahay katulad ng pagwawalis?”

Scoring:

Pass if the child copies any type of housework.

Passed. The child’s mother was sweeping the floor, the child asked for the broom and
imitates the action.

Rationale:

During interactions, kids around the age of 8 months copy simple behaviors and
expressions of others. 1-year-olds learn a wide range of abilities through imitating adults during
this important year of development.

Plays ball with examiner

Administration:
 I gave the child a ball and asked for the ball back.

Scoring:

Pass if the child rolls or tosses the ball back towards the tester.

Passed. The child throws back the ball and did the action three times.

Rationale:

Toddler will start to learn how to throw a ball. Ball activity at this age aids in the
development of grasping abilities, eye-hand coordination, finger muscles, and the capacity to
transfer items from one hand to the other. Balls have features that infants and toddlers learn
about cognitively: they bounce, roll down hills, are easy to move and tough to stay still.

Indicates wants (not cry)

Administration:

I asked the mother how the child lets them know what he wants.

“Ano ginagawa niya o paano niya sinasabi pag may gusto siya gaya ng laruan?”

Scoring:

Pass if the child lets someone know what he wants by pointing, pulling or saying a word.

Passed. The child points at the things he wants to hold and would not stop pointing until
he gets it, according to the mother.

Rationale:

As babies approach one year of age, they begin to communicate using gestures such as
pointing. When a baby points to something, it is a way of communicating with you. At first, you
might not know what the something is. However, if you pay attention, you will notice that a point
might also mean "Look at that!" “I want that!” or “What is that?”.

Drinks from cup

Administration:
 I gave the child a cup with water and told him to drink from the cup.

Scoring:

Pass if the child can do it with a cup that has no spout.

Passed. The child was able to drink from the cup without spilling too much.

Rationale:

Babies will be able to use sippy cup solo by age 1 and an open cup around 18 months of
age. Between 6 and 12 months, start practicing with an open cup - most babies can drink from a
sippy cup by 6 to 9 months, and by the time he is 12, he'll be ready to put up the bottle.

FINE MOTOR ADAPTIVE

Neat Pincer Grasp

Administration:

The child was placed on the mother’s lap so that he can place his hands on the table. I
dropped a small ball directly in front of the child within easy reach. I pointed and touched the ball
and observed how the child picked the ball.

Scoring:

Pass if the child picks up the ball using the ends of thumb and index finger with an
overhand approach.

Passed. The child picked the ball with his thumb and index finger and eventually held the
ball using his hand.

Rationale:

Around the age of 9 to 10 months, children begin to learn the pincer grasp. Learning to
slam two items together and clapping their hands are other milestones that occur around this
time.
Scribbles Spontaneously

Administration:

I placed a piece of paper in front of the child and placed a pencil on his hand. I showed
the child how to scribble.

Scoring:

Pass if the child makes two or more purposeful marking on the paper. If this cannot be
seen, ask the parent if the child scribbles without help.

Passed. At first, the child was throwing the pencil every time I gave him the pencil but
when I showed him what to do, he understood and scribbles on the paper.

Rationale:

Between the ages of 12 and 15 months, most toddlers are ready to begin coloring and
scribbling. When the toddler has achieved the pincer grasp, he'll be ready to hold a crayon in his
hand and make marks with it.

LANGUAGE

Dada or mama specific

Administration:

I asked the mother if the child says “dada” to his father or “mama” to her.

“Tinatawag ka ba niyang mama o papa sa tatay niya?”

Scoring:

Pass if the child uses either “mama” or “dada” correctly for his mother or father.

Failed. The child does not use “dada” or “mama” to call for his parents. He uses “dada”
randomly and even during the test.

Rationale:
 Most babies will properly say "mama" and "dada" by the age of a one. The baby may
say "mama" at the age of eight months, but she will not be referring to her mother.

GROSS MOTOR

Stands momentarily

Administration:

We placed the child standing on the floor and let him balance on his own.

Scoring:

Pass if the child stands alone 2 or more seconds.

Passed. The child was able to stand and balance without assistance for more than 2
seconds.

Rationale:

Infants can normally begin to stand for around 2 seconds between 9 and 11 1/2 months
and stand unassisted between 10 ½ to 14 months, according to the Denver II Developmental
Assessment milestone chart.

Stands alone well

Administration:

We placed the child standing on the floor and let him balance on his own. I asked the
mother if the child can stand without assistance for more than 10 seconds.

“Nakakatayo na ba siya ng mag-isa ng matagal?”

Scoring:

Pass if the child stands alone 10 seconds or more. If cannot be seen, ask the parent if
the child can do this.
 Passed. The child was able to stand with assistance for about 5 seconds but according
to the mother, the child can stand on his own for more than 20 seconds.

Rationale:

They'll be able to stand and use their hands by the time they're 11 to 14 months old.
They will next progress to other difficult tasks, such as bending and sitting down in a controlled
manner from a standing position.

Stoops and recovers

Administration:

I placed a toy on the floor in front of the child while he is standing but he would not pick
the toy so I asked the mother if the child can bend over and pick a thing from the floor.

“Kaya niya bang magpulot ng gamit sa sahig at nakakatayo ba siya ng hindi humahawak
sa sahig o sa ano mang bagay?”

Scoring:

Pass if the child is able to bend over, pick up toy and return to standing without holding
on or touching floor. If this cannot be seen, ask the parent if child can do this.

Failed. The child would fall down when asked to pick something from the ground and
cannot stand back alone, according to the mother.

Rationale:

Between the first and second years of childhood, a lot of things will change. As the
toddler's brain develops, you will notice that their coordination, balance, and motor control
improve. The toddler should be able to bend to pick up a toy and stand up without falling down
at this point.

Walks well

Administration:
 We let the child walk without assistance and observed if he can walk well with good
balance.

Scoring:

Pass if the child does not have any difficulty walking and does not tip.

Passed. The child was able to walk without assistance with good balance but would walk
fast after his 4 steps.

Rationale:

Baby walks well by 12 to 15 months. They learn to walk well in the months after they turn
one. They begin to walk at an age of between 8.5 months and 20 months.

Walks backwards

Administration:

I asked the child to walk backwards but would not do it so I asked the mother if he can
walk backwards.

“Nakakalakad ba siya ng paatras?”

Scoring:

Pass if the child walks backwards 2 or more steps. If this cannot be seen, ask parent if
the child walks backwards at home, possibly when pulling away.

Failed. The child is still not able to walk backwards, according to the mother.

Rationale:

Baby learns to walk backwards and up steps with help at about 16 to 18 months.
Walking backwards is a gross motor milestone that occurs between the ages of 1.5 and 2 years.
It's a difficult task that takes time to master because it's not a typical movement pattern that
children are used to.
INTERPRETATION

Upon performing the tests, the child passed and performed some of it properly. He was
not able to do some tests but basing from his age, it is still normal not to develop the test. He
may perform the failed test after some months.

ASSESS/INTERVIEW

A. Maternal/Obstetrics/Pre-natal History

The mother had two pre-natal check-ups to a midwife for t1 and t2. She had no
complications during pregnancy and experienced dizziness which is a normal thing for a
pregnant woman.

B. Birth History

The labor and delivery happened at Buluan District Hospital. The labor lasted for four (4)
hours and the mother had a Normal Spontaneous Vaginal Delivery at what time. The baby was
delivered on August 24, 2020 at what time with 3kgs of weight.

C. Neonatal

The baby was healthy and had normal vital signs. His Newborn Screening test was
normal. They were discharged on the third day at hospital. The baby showed no complications
upon delivery.

D. Childhood

The baby had LBM and was admitted to Eros Medical Clinic and Hospital for 3 days from
September 11 - 14 and was injected with intravenous fluid. The child has no disease such as
asthma, hepatitis, pneumonia. He had no history of mumps, chicken pox, measles and has no
allergies. He was immunized with complete vaccine of Bacillus-Calmette Guerin (BCG),
Hepatitis B Vaccine, OPV, Diphtheria Pertussis Tetanus Vaccine (DPT), but had not taken
Measles Vaccine. He had no history of serious injuries.

E. Elimination
 The child defecates once a day but also does not defecate in a day sometimes. He
defecates either in the morning or afternoon in yellow color with a little high amount of solid
waste. The child uses a total of three (3) diapers in a day.

F. Nutrition

The child is on bottle-fed and drinks milk three (3) times with a formula of bear brand in
1:1 ratio. He has a meal pattern of 3 meals a day with biscuit or porridge as his meal. The
mother sometimes feed the baby with rice but vomits the rice after fifth intake. The child takes
what vitamin and had his first two teeth on the lower front area. The first tooth erupted last
August 14, 2021 and the second tooth was last September 10, when he had fever and LBM.

G. Activity and Sleep

The sleeping pattern of the child is 9-10 hours at night and sleeps twice a day. He sleeps
at 7pm-4am and also in 12pm. He always sleeps with his “malong” and without it, he cannot
sleep. He should be swayed on his “duyan” so he can sleep easily. The mother lets the child
walk with and without assistance every day.

H. Growth and Development

The client’s current anthropometric measurements are the following: his body weight is
10kgs with the height of 76cm, head circumference of 45cm, chest circumference of 43cm, and
abdominal circumference of 41cm. He has good personal hygiene. The mother bathe the child 8
in the morning and changes his diaper twice in a day. Upon observing in language development
and according to his mother, the child already knows how to say “dada” and “tata”. The child
can be taken care of others aside from his mother, like his grandparents and aunts. If a person
taking care of him is not familiar to him, he first feels the person and make the person familiar to
him and he would get close to that person. According to the mother, the child can be taken care
of easily. The child tends to cry when he is sleepy, wants to defecate, and if he wants to do
something else or change the activity he is doing. Tantrums are very common in children aged
1-3 years. This is because children's social and emotional skills are only just starting to develop
at this age. Children often don't have the words to express big emotions.

CONCLUSION
The child was 1 year, 1 month, and 7 days’ old which is in toddlerhood age. According to
the normal growth and development, a toddler tends to get sense of self-control. They will
engage in more difficult activities such as jumping and climbing, and throwing a ball. I observed
that the child was starting to throw a ball properly but I have not observed more than that. I also
did not observe the sense of self-control of the toddler. He was still thirteen (13) month old,
maybe that is why the child did not show it because according to Erik Erikson, developing the
sense of self-control is from 18 months to 3 years old. Toddlers are ready to start toilet training
but the child does not show readiness because he does not show bowel control Wet diapers are
still present after he wakes up from sleep.
This assessment would be a guide for health teachings as to understand which is normal
and in delays for development in toddlers. Based on my observations and findings, a child
performing the Metro Manila Developmental Screening Test can possibly not pass all the test
items. Maybe because of their age or they have actually delays in development. Upon doing the
assessment, I realized that there are things that a child can do without us knowing it. The
mother of my patient did not know that her child can scribble until performing the test. The
MMDST can show things that a child can do. I also felt happy with the mother when the child
passed the test. I was also amazed when the child passed the other tests because I did not
expect that the child could do the test at the age of one.
WERE YOU ABLE TO MEET YOUR OBJECTIVES?
As a student nurse, this assessment helped me understand the things that a child can do at
their age. This would be a guide for me for future assessments on children and this can be a
tool for understanding toddlers.

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