Analysis of Toddler's Development Through Theoretical Knowledge

The Registered Nurse is a vital member of the interdisciplinary team that aims to assess the psychosocial, psychomotor, cognitive, physical growth, and linguistic acquisition level of the pediatric patient. As the field of developmental psychology advances, it has become a standard of care to assess and provide care relative to the developmental level of a pediatric patient. This paper will discuss prominent theories of development, compare and assess the observed behavior of a pediatric patient, in relation to his or her peers, based on the Denver II Development Screening Test, and discuss the expected physical, cognitive, and psychosocial stages of development of this observed patient.

There are several distinct hypotheses that endeavor to explain and organize the development of a child, but two of the more prominent theories are extensions of the psychoanalytic and cognitive branches of psychology. Erik Erickson describes the psychosocial development of human beings throughout the lifespan. The theory is characterized by experiencing eight essential conflicts, or critical periods that, depending on whether the conflict experience was favorable or unfavorable, influence the development of the personality. Accordingly, Jean Piaget formulated Theory of Cognitive Development, that attempts to explain the acquisition, construction, and utilization of intelligence through the continuous biological maturation and environmental experiences of an individual over the course of the lifespan.

The Denver II Test is a screening tool used by clinicians to assess for developmental aberrations that may indicate developmental problems. There are 125 tasks that are categorized into four main areas; personal-social, fine motor-adaptive, language, and gross motor. Patients must complete certain tasks associated with the relative age of the child with respect to a standardized norm. Although the Denver II Screening Tool is the most widely used surveillance method, it is not currently recommended by The American Academy of Neurology nor is its use recommended by the Child Neurology Society. This lack of support is, in part, due to the assessment tool’s insensitivity and lack of specificity.

With all this information in mind, the patient was analyzed through the lens of each developmental theory, and methodologically assessed using the Denver II Screening Tool. The patient is two years of age. According to Erickson’s Psychosocial Developmental Theory, a child at two years of age should be experiencing a conflict of autonomy versus shame and doubt. Children at this age strive to be in control of their bodies because their motor skills are increasing. This stage is specifically characterized by toilet training, as it demonstrates physical mastery over the body, and promotes a sense of independence and autonomy. The observed pediatric patient is toilet-trained and no longer utilizes diapers. This patient is now differentiating as an individual, and is beginning to develop self-control and self-will. The patient’s subjective experience during this conflict is determined by how the parents, and other social influences, react to the child’s impetus to explore their surroundings and impose his or her own will, and will ultimately determine whether the conflict experience was favorable or unfavorable. Psychosocially, the findings of the observed patient are typical of a two-year-old.

In addition, the patient’s cognitive development was appraised using Piaget’s Theory of Cognitive Development. At this age, children are experiencing the preoperational phase of development. The preoperational phase of development is characterized by language acquisition, and the use of language to construct meanings of symbolism, as well as schemas, that represent how an individual perceives the world around them. The observed patient engaged in parallel play with the other children in the facility. This parallel play behavior illustrates the egocentric thought process that accompanies this stage. In addition, the child exhibited imagination while playing with toy dinosaurs. This demonstration corresponds to the development of imagination and symbolic representation in this stage. Cognitively, the findings of the observed patient are typical of a two-year-old.

While the patient was analyzed through the lens of each developmental theory, the patient was methodologically assessed with the Denver II Screening Tool. From a personal-social standpoint, this patient demonstrated excitement about playing in the same room as other children, but played alongside, rather than with, other children. The child passed most of the tasks in this category that are appropriate for the patient’s age. As a result, the child’s personal-social skills are expected findings for this age group. The fine motor-adaptive skills of this patient were well-established and appropriate for the child’s age. The patient could build a tower with 6 cubes with no delay. The child could imitate and draw a vertical line with little to no discrepancies. As a result, the child’s fine motor skills are expected findings for this age group. The child was able to follow directions, create sentences, and point to at least two of the images on the assessment tool. As a result, the child’s linguistic abilities are expected findings for this age group. When asked to throw a ball overhead, the child was able to comply and effectively throw the ball. In addition, the child was able to jump up in the air upon request. As a result, the child’s gross motor skills are expected findings for this age group.

The nurse must also assess the physical development of a child. It is expected that a child within the toddler age group should experience a weight that quadruples the birth weight by the time the child is a 2-and-a-half-year-old. In addition, the height should be 50% of eventual adult height at two years of age. When physical measurements are used by comparing them to the standardized norms overtime, the findings can be used to determine a child’s progression of development with more accuracy. It is important to note that the most significant factor on growth is nutrition.

In conclusion, nurses are engaging in care that is sensitive to the developmental level of his or her own patients. In the future, nurses must be aware of the norms and aberrations of normal human development, and they must also be aware of how to discern between, and utilize, the various developmental screening tools that exist in the current literature and practice. The observed patient provided an example of the expected findings for a patient in the toddler age group, through the lens of the Psychosocial and the Cognitive Development Theory, using the Denver II Screening Tool as the method of assessment.  

29 April 2022
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