ASSESSMENT OF THE

TODDLER

SUBMITTED TO, SUBMITTED BY,

Mr. Ram Holambe Mr. Abhishek Raut
M.Sc. Pediatrics 3rd Year B.B.Sc Nursing
V.I.O.N., Parli-V V.I.O.N., Parli-V
SUBMITTED ON
 ASSESSMENT OF THE TODDLER
TODDLER PERIOD: 1 to 3 year of age.

DEFINITION OF TODDLER ASSESSMENT:

A toddler assessment is a systematic review of the body systems, structures and growth and development of a toddler or between 1 to 3
year of age to identify normal or deviation from normal.

OBJECTIVES TODDLER ASSESSMENT:

GENERAL OBJECTIVE:

At the end of assessment students will acquire knowledge regarding systematic review of the body systems, structures and growth and
development of the toddler, they will develop considerable attitude towards identification of normal or deviation from normal of toddler and they
will also develop the required skill in the accurate assessment of toddler in the clinical practice.

SPECIFIC OBJECTIVES:

1. Assess the normal growth and development of the normal healthy toddler.
2. Detect in early period any abnormal condition like delayed milestones, mental retardation etc.
3. Evaluate toddler with developmental, chromosomal and neurological disorders.
4. Identify deformity and treatable diagnosis.
5. Formulate screening tool for early primary prevention.
6. Plan nursing care
7. Provide health education to mother
DEMOGRAPHIC DATA:

1. Name of the Informant : Mr. Mahesh Munde

2. Relation with the Child : Father
3. Name of Child : Master Yash Munde
4. Age : 2.5 years
5. Date of Admission :
6. Sex : Male
7. Reg No.
8. Birth Weight : 3500 gm
9. Date of Birth : 19/11/2019
10. Hospital/Ward :
11. Diagnosis :
12. Religion : Hindu
13. Name of Mother : Mrs. Shital Munde
14. Antenatal History : - Mother had taken vaccination and attended 9 antenatal visits during the antenatal period.
- She has taken adequate nutrition and folic acid, multivitamin supplements and calcium supplements
15. Birth History : Mother has delivered a full term baby by vaginal delivery on 19/11/2019 at 5 pm, a male child of
birth weight 3500 gm.
16. Any Problem : no any problem.
17. Socio-economic Background: The child and his family belong to middle class. They have annual income of rs 5 lakh and well prestige in
society
18. Chief Complaints : no any chief complaint .
 PHYSICAL EXAMINATION:

SR CHARACTE- NORMAL ABNORMAL PATIENT FINDINGS REMARK

NO RISTIC
1 Overall health Looks healthy Looks ill acutely/ chronically Looks healthy
2 Nourishment Well nourished Under/over nourished Well nourished
3 Body build Normal Thin/ obese Normal
4 Consciousness Conscious unconscious Conscious
5 Alertness Alert Inattentive/drowsy/anxious/ Alert
worried/depressed
6 Orientation Oriented to time, place, person Disoriented/confused Oriented to time, place, person N
O
7 Speech Use of jargons, adjectives, Difficult/unusual voice/pitch-faster or Use of jargons, adjectives, R
pronouns slow/slurred/ paces/pauses pronouns M
8 Dress Dressed properly and neatly Improperly dressed/untidy Dressed properly and neatly A
9 Personal hygiene Well maintained & clean Not maintained & unclean Well maintained & clean L
10 Posture, gait, Upright, smooth rhythmic gait Gait stooped Upright, smooth rhythmic gait
position
11 Body curves Normal Lordosis/ kyphosis/scoliosis Normal
12 Vital signs
Body temperature Euthermia (98.60F) Hypo/hyperthermia 97.70F Hyperther
mia
Pulse As per age & sex Deviation from normal 104 beats/min
Respiration As per age & sex Deviation from normal 24 breath/min
B.P As per age & sex Deviation from normal
13 Skin
Color Pink Pallor/jaundice/cyanosis/flushing Pink Normal
Vascularity Visible vein Varicose vein Visible vein
Pigmentation No pigmentation Scar/edema/birth marks No pigmentation
Moisture Dry Moist/clammy Dry
Temperature Warm Hot, cool Hot Increased
 Texture Soft , regular Rough Soft , regular
Turger Elastic and mobile Loss of elasticity Elastic and mobile
Lesions Absent Present Absent
Edema Absent Present Absent
Hair Appropriate as per age Inappropriate as per age Appropriate
distribution
14 Nails
Condition Smooth Brittle/ soft/rough Smooth Normal
Color Pink Blue/white Pink
Capillary Within 3 sec More than 3 sec Within 3 sec
Refilling
Clubbing No clubbing Clubbing No clubbing
15 Head
Skull Appropriate to body shape & size Disproportionate to body size and Appropriate to body shape & Normal
shape size
Scalp No lesions/tenderness Lesions/ tenderness No lesions
Hair Clean, black in color Pediculosis /unclean/ Clean brown in color
dandruff/infections
16 Face Pink Pale/flushed/puffiness/fatigue/pain/fear Face having fear , burn skin
/
Anxiety
Facial movement Mobile & easy movements Asymmetric & difficult Mobile & easy movements
17 Eyes
Eye brow Present normal Present normal Normal
Eye position Straight Intrusion/extrusion/squint Straight
Eye lashes Normal Infection/sty Normal
Eye ball Normal Sunken /protruded Normal
Conjunctiva Clear, pink Redness, hemorrhage, yellowish Clear, pink
Cornea Clear/smooth/shiny/transparent Cloudy Clear/smooth/shiny/transparent
Eye movements Paired eye movements Uncoordinated eye movements Paired eye movements
Pupils PERRLA (Pupil equal, regular in Pupil unequal, irregular in shape, non PERRLA (Pupil equal, regular
 shape, reactive to light, and reactive to light, do not accommodate in shape, reactive to light, and
accommodate) accommodate)
18 Ears
Auricle Normally situated Absent Normally situated Normal
Outer pinna Symmetric Deformity/tenderness/swelling Symmetric
Canal Yellow brown earwax, no lesion Impacted cerumen/discharge/ foreign Yellow brown earwax, no lesion
bodies/ mass /redness/swelling
Tympanic Intact Perforation/ abnormal color Intact
Membrane
19 Nose
External nose Straight Deviation in shape, size Straight
Nasal septum Straight Deviation Straight
Nostrils Not tender/swollen Tender/swollen Not tender/swollen
Frontal Not tender/swollen Tender/swollen Not tender/swollen
Maxillary sinuses
20 Mouth
Lips Moist, pink without crusts Asymmetrical/dry/fissures/scar/ crusts/ Dry Normal
blue/ angular stomatitis
Tongue Moist/pink/midline/symmetric/ Abnormal Dry
mobile/without lesions color/coating/swelling/lesions/deviatio
n from midline/enlargement/ulceration/
protrusion/paralysis
Mouth No odor Foul smelling No odor
Gums Pink, no lesion Bleeding/ swelling/pus/ inflammation/ Pink, no lesion
discoloration/ lesions/ ulcer
Buccal mucosa Discoloration/ulcer/masses
Teeth (Number, Disease free, firmly placed, 18-20 Discoloration/ dental caries/ Disease free, firmly placed, 18
Arrangement, temporary teeth’s, symmetric malocclusion/plague/missing or loose temporary teeth’s, symmetric
general condition) teeth/deformities
Uvula (look for Symmetric, visible but not Enlarged, white spots/appears swollen Symmetric, visible but not
Symmetry when enlarged enlarged
 patient says, Ah )
Pharynx Smooth/ moist/pink/gag reflex Dry, red, grayish membrane, absent moist/pink/gag reflex present
present gag reflex
Voice Effortless speech Abnormal voice- hoarse, extremely Effortless speech
high or low pitched/speaking requires
effort
Sense of taste Able to identify taste Unable to identify taste Able to identify taste by
observing facial expression not
able to tell
21 Neck
Movements Flexion, extension, rotation Movements restricted/painful Flexion, extension, rotation Normal
Lymph nodes Not palpable Palpable/enlarged Not palpable
Thyroid Not observable except in thin Enlarged, observable nodules, Not observable except in thin
person tenderness person
External jugular Not distended-in sitting position Marked distension with bulging Not distended-in sitting position
Vein Distended-in supine position Distended-in supine position
Carotid arteries Present ,equal, normal regular Diminished, absent ,abnormally Present ,equal, normal regular
pulsation forceful pulsations pulsation
22 Chest Normal breath sound Normal
Respiratory system Normal Pneumonia Use of accessory muscles
Chest movement No effort, or use of accessory Abnormal sounds- wheezing, crackles,
Effort muscles strider etc.
Chest retraction Not present Chest retraction present
Breath sounds Normal breath sound Murmurs congenital heart disease etc.
Heart sounds S1 & S2 heard,
23 Abdomen Normal no any palpable mass Normal
Distension: No Abdominal distention
Abdominal girth Normal Ascitis
Palpable mass: No mass palpable Organomagaly
Bowel sounds: Normal peristaltic movements Liver palpable (hepatomegaly)
Enlargement or
tenderness of
 organs
24 Back (spine) Normal curvature. Spinal curvature deformity, tenderness, Normal curvature Normal
stiffness over spinous process
25 Male genitals
External Normal distribution of pubic hair Abnormal distribution of pubic hair; Normal
unclean, masses, scar, lesions, erosion,
odor, tenderness, swelling
Penis Uncircumcised, retractable if Hypospadiasis ,discharge Uncircumcised
penis circumcised
Scrotum Symmetric, size varies, lose Unsymmetrical, swelling Symmetric, size varies, lose
wrinkled skin, no swelling wrinkled skin, no swelling
Testes Descended in each side of Undescended testes, hydrocele, etc. Descended in each side of
scrotum, firm, egg shaped, not scrotum, firm, egg shaped, not
tender tender
 ASSESSMENT OF GROWTH AND DEVELOPMENT OF THE TODDLER :

SR AGE IN CHARACTEI PARTICULARS NORMAL ABNORMAL PATIENT REMARK

NO MONTH STICS FINDING
I 18 PHYSICAL
months OR
BIOLOGICAL
 Steady growth in height & weight 13 kg Normal
 Head circumference 44
 Height 77 cm
 Weight Formula for wt calculation
Wt = (Age in Years X 2) + 8
 Legs appear bow
 Anterior fontanel closed Closed
 Height
 Respiration 26-28 /min.
 Probably ready for daytime bladder & 24 months Bladder & bowel
bowel control control at day time

II 18 GROSS
months MOTOR
 Runs clumsily; falls often Falls often Normal
 Walks upstairs with 1 hand held. Walks upstairs
 Pulls & pushes toys  Pulls & pushes
toys
 Jumps in place with both feet  Jumps in place
with both feet
 Seats self on chair  Seats self on chair
 Throw ball overhead without falling  Throw ball
overhead without
 falling
 Walks sideways and backwards  Walks sideways
and backwards
 Gets everything, explore drawer, dustbins
etc
III FINE MOTOR
18  Builds a tower of 3-4 cubes Builds a tower of 3-4 Normal
months cubes
 Scribbles vigorously
 Imitates a vertical stroke with crayon Some line draw on
paper
 Turn pages in books- 2-3 pages at a time
 Dumps pellet from bottle
 Puts block into hole
 Transfers objects hand to hand at will  Transfers pencil
hand to hand at
will
IV 18 SENSORY
months MILESTONE
 Can see better, thus has intense interest in Interest in cartoons Normal
pictures
 Identifies various shapes Doesn’t identify
shapes
 Convergence well established
 Some depth perception Do not depth of
perception
V 18 PSYCHOSOCI ERIK ERIKSON 1963
months AL
DEVELOPME
NT
 Sense of autonomy 1-3 years
  Egocentric Not want help from Normal
to others
 Autonomous behavior increasing Wants to do self
care activities by
own
 Autonomy is tested with “no”.
 Negativism is predominant
 Begins to have temper tantrums Temper tantrum is
present
 Awareness of strangers but less fearful of
them
 Seeks help from others when in trouble Seeks help from
mother when in
trouble
 Bedtime rituals begin
 Thumb sucking is peak, especially before or Thumb sucking
during sleep for comfort continuously
 Imitate parents doing household work Yes
 Beginning awareness of ownership Yes
 Awareness of gender identity No
 Knows own sex No
VI 15, 18, PSYCHO-  Anal stage: Sigmund Freud (The greatest 1-3 years Child control over Normal
24, 30 SEXUAL amount of sensual pleasure for the toddler is bladder and bowel
months MILESTONE obtained from the anal and urethral areas. activity during day
of age As increased myelination of the nervous time , at night some
system occurs, toddler begins to obtain times bed wet
sensuous pleasure from the feeling of
distended bladder, from masses of feces in
the rectum, and from the release of the
contents of these organs)
VII COGNITIVE JEAN PIAGET
MILESTONE
1 12-18 the child seems to Normal
months  Sensorimotor Stage: try to find new
Sub stage V Tertiary Circular Reaction:- solutions to old
(Instead of reproducing the accidental events, problems e.g. child
the child chooses to vary them. E.g. Instead of want to open tiffin
pulling the same toy the child varies the play but not open then he
by pulling larger or smaller toys shorter or throw the tiffin
longer distances. By experimenting in this
way, the child seems to try to find new
solutions to old problems.)

2 18- 24 Sensorimotor stage (sub stage VI): The Normal

months toddler shows evidence of the beginning of
mental representations of events.
 Invention of new thing through mental
combination
 Can differentiate self from objective short differentiate self
attention span from objective short
attention span
 Beginning sense of time & and anticipation
of events
VIII MORAL LAWRENCE KOHLBERG
MILESTONES
1 15 0-2 years of age  Pre-conventional morality stage, 0-2year He likes more breast Normal
months Stage 0: (The good is what I like and I feeding than diet, if
want,’’ thus egocentric judgment about what breast milk not
a child likes or dislikes occurs.) given he was
excessive cry

2 18  Pre-conventional morality stage, 0-2year

 months Stage 0:
IX 15, 18, SPIRITUAL  Intuitive – projective: James W. Fowler 1-3 Years Normal
24, 30 DEVELOPME  (The child forming long lasting images and
months NT feelings.Imigination, perceptions, and
of age feelings are the mechanisms by which the
child explores and learns about the world at
large.)

X LANGUAGE,
SPEECH
18 Receptive  Identifies pictures of familiar objects when Identified the name Normal
months named of hen, toys.
 Identifies one or more parts of body when Able to show his
named head, nose and leg

18 Expressive  Speaks 10 real words besides jargon Speaks words Normal

months
 Names pictures Told name of food
picture
 Uses words more than gestures to express Uses word for
desires express desired e.g.
food is good
 One word used to communicate Call lady as aunty
 Uses phrases composed of adjectives & Sometime
nouns
 About 25% of vocalizations are intelligible
XI SELF CARE
ACTIVITIES
 18  Holds a cup with both hands Hold glass by both Normal
months hand
 Finger feeds proficiently Try to feed with his
figure
 Eats with spoon in mouth, spills frequently Present
 May play with food Play with buistkits
 Negativism & high activity Don’t want to help
from other
 Removes simple garments & unzip the Remove shirt by
garments own
 May complain when wet or soiled Yes
 Increased readiness for bowel & bladder Yes
control
 May smear feces No

 Adequate attempts to wash hand No

XII 1-3 years DEVELOPME

NTAL TASK
FOR  Setting into healthy daily routines. Daily routine of Normal
TODDLER eating & sleeping
 Mastering of good eating habits. Only want Jung’s
food
 Mastering the basics of toilet training. Had toilet training
 Developing the physical skills appropriate to Yes
his stage of motor development.
 Becoming a family member. Yes
 Learning to communicate effectively with Yes
others.
 Setting into healthy daily routines.
FOR FAMILY
  Meeting the spiraling costs of family Family members Normal
member. knows his needs
 Providing the home that is safe, Yes
comfortable, and has adequate space
 Developing a satisfactory division of labor.
 Promoting understanding between the Yes
toddler and his family.
 Rededicating themselves, among many Adequate
dilemmas, to their decision to be a child
bearing family.
XIII PLAY
STIMULATIO
N
18  Enjoys solitary play or watching activities Watching his elder Normal
months of others sister play
 Has a favorite toy such as a blanket. Had favorite pillow
Motor play:  Large, hollow wooden blocks balls. - Running
 Rocking chair or horse. - Horse ridding
 Low wheeled toys to ride.
 Small chair & table.
 Running & chasing games.
 Hammer & pegboard
Creative play:  Finger-paints, brush paints, large crayons.  Bells around wrist
 Bells around wrist or ankle. or ankle.
 Blocks, bowls Blocks, bowls
Quiet play:  Sand toys. No
 Stuffed animals & dolls to drag, sits upon,
or hug
Dramatic play:  Imitates parental actions in play Action of father
speech, songs
XIV NUTRITION  Calories requirement 100
 Wt = (Age in Years X 2) + 8 kcal/kg/day
  Protein requirement 2-3 g/kg/day

 Fluid requirement 70-150 100 to 150 ml water

ml/kg/day taken
XV BEHAVIORAL 18months-3 years
PROBLEM
 Temper tantrum: Negativism Some times
 Breath holding spells: apneic, cyanotic, 2 years. No
pale, sometime unconsciousness and may
fall.
 Habit disorder or tics:- Self limiting Thumb sucking
 Bruxism (apneic, cyanotic, pale, sometime 6 months-2 :Peak at 16 months
unconsciousness may occur and may fall.) years.
 Tourette syndrome (Severest of tics
disorders followed after 2-3 years by vocal
tics of grunting, barking etc)
 Thumb sucking :Peak at 18-21 months
XVI IMMUNIZA- AGE IMMUNIZATION immunization done
TION STATUS 0 At birth BCG, OPV0 till the period of 2
6 weeks DTP1,OPV1, HEP-B 1ST years
10 weeks DTP2, OPV2, HEP-B
2ND
14 weeks DTP3, OPV3 HEP-B 3RD
9 month Measles, VIT-A 1ST (2
IU)
every 6 monthly,1 lac IU,
total 9 doses
18-24 month DTP+OPV+ Hepatitis B
(1st Booster Dose)
NEEDS OF MOTHER: Heath education to the mother regarding following –

Feeding –

 Provide nutritious foods to the child

 Prepare foods according to child’s likes
 Give milk and fruit juices to the child
 Include seasonal fruits and green leafy vegetables in the diet of child.

Hygiene –

 Advice mother to do proper hand washing before feeding.

 Advice to maintain her personal hygiene- bathing , short nail , clean cloth hand washing before feeding , eating after elimination

Immunization -

 Mother had given immunization according to schedule till encourage for regular visit to under five clinic and wellness baby clinic.

Family planning –

 Advice to mother temporary family planning method like copper T insertion either advice to her husband use of condom.

NEEDS OF THE CHILD:

- Adequate nutrition
- Protection from infection and allergic agents
- Prevention of infection in the ward
- Maintenance of personal hygiene
- Immunization
- Growth monitoring
 SUMMARY

I have taken a male toddler child for assessment. I have informed the mother regarding assessment and did the assessment of the child. There is
no any abnormality is found in the child and he is normal. The child’s needs have been identified and told to the mother to take appropriate care
of the child.

CONCLUSION

From this assessment I have assessed all the growth and development characteristics of the toddler and came to know how to differentiate
between the normal and abnormal characteristics of the toddler child at various stages of age. In this case I found that the child has all normal
characteristics and there is no any abnormality detected. I have assessed the needs of the child and given health education to the mother
regarding the care of child. I have also assessed the mothers need and gave health education to mother also regarding the diet and exercise.
Informed mother to use temporary family planning methods to have 3 years gap between two children.

BIBLIOGRAPHY

1. David Wilson, “Wong’s Essentials of Pediatric Nursing”, 8th Edition(2009), Elsevier Publications, Noida, UP,
2. Manoj Yadav, “Child Health Nursing”, 1st edition, S Vikas & Company (Medical Publishers), Jalandhar
3. Datta Parul, “Pediatric Nursing”, 4th edition, Jaypee brothers Publishers, New Delhi.