The Growth & Development of Elle

The Growth & Development of Elle Daniel Taylor California State University, San Marcos School of Nursing

Introducing Elle Elle is 2 years old–28 months, 1 week, and 5 days

to be exact. She was born on May 23, 2015, in San Diego at 39 weeks, 4 days of gestation, weighing 5 lbs., 5 ounces, and measuring 34 inches.

She has light brown hair that grows longer and wavier by the day. She has a fair complexion and piercing blue eyes. Currently, Elle weighs 24 lbs., and stands at 34 inches tall. She is both pensive and thoughtful.

Elle had some issues with oxygen perfusion and bradycardia, both idiopathic, despite her low birth weight, which dropped as low as 4 lbs., 8 ounces. A doctor was prompted to prescribe caffeine to increase heart rate and breathing, and she eventually made it home after 8 days in intensive care. She remained on caffeine therapy and an apnea monitor for 30 days.

Elle does not appear to suffer any ongoing issues from these early experiences.

Elle lives in a dual-earner household with her father and mother, in a traditional nuclear family. Their house is in an upper-middle class neighborhood. Her parents have been together for 8 years, and have been married for 6 of these years. They parent with an authoritative parenting style as they tend to advocate for Elle’s needs and wants, fostering independence by allowing her to make many decisions for herself. However, they also set Boundaries for her, and enforce them with simple punishments, such as timeouts. They prefer to have discussions with her when there is a problem, allowing Elle to adjust her behavior before she is put in time out. Her mother described the difficulty of parenting in a dualearner household in hiring help. She expressed the inability to truly know if Elle is receiving the parenting style that she tries to impart on hired nannies (A. Taylor, personal communication, October 3, 2017).

Plays wELLE A Busy with Others… ScheduELLE

Elle grows attached to different

stuffed animals for varying

amounts of time. Most of

them are animals with human

qualities. She also loves

playing in the sand, playing

tea party, pretending to cook

in her pretend kitchen,

accompanying mom to the

grocery store or going to LEGOLAND with her stroller. She has a propensity for putting diapers on her dolls and other stuffed animals.

Around other children, she has begun to interact with others in a manner that seems to indicate a sense of role play. She has mini conversations reminiscent of adult conversation with some of the friends with whom she is more familiar.

However, most play still appears to be parallel.

One example of Elle progressing along with others her age through play is her use of role play, or fantasy. The sandbox and cooking are examples of tactile play in which she can use her recently developed sensorimotor skills.

These activities also provide

an unstructured

environment conducive

to freedom of expression

(Perry et al., 2014).

Elle loves to stay busy. She attends preschool on Mondays and Fridays. She has two good friends at school, Valley and Tiff. Elle could not give a reason why, but her mom confirms that while they have similar demeanors, they mostly engage in parallel play. At preschool, she is shy and reserved, seeming to observe more than interact. She is an excellent sharer, however.

She stays at home with a nanny on Tuesdays and Wednesdays, and spends Thursdays with her maternal grandmother who lives nearby. Elle’s maternal grandfather passed away when she was an infant.

When she is not in school, Elle goes to dance classes, gymnastics, the zoo, and LEGOLAND. She loves to push her stroller, another example of role playing.

She sees her paternal grandparents when they come to visit 2-4 times per year from St. Louis. She has one uncle who lives nearby, and visits her as often as possible, usually several times per month.

Elle has some separation anxiety with her mom, especially when she is tired or sick. Generally, she does adapt well to new caretakers relatively quickly.

Growth & Development Elle falls in to the category of “Early Childhood,” and more specifically, that of a Toddler. This stage is marked by activity and discovery as language and motor skills develop steadily (Perry et al., 2014). Language and social skills develop, along with a sense of self and independence.

Current Weight: 24 lbs.

Current Height: 34 inches

Elle falls right around the fifth percentile according to the Centers for Disease Control (CDC) length-for-age chart (2016).

However, according to the weight-forstature chart (CDC, 2016), Elle is within normal limits.

Her weight, as has been the case since birth, is below the fifth percentile, according to the CDC (2016) weight-forage percentile charts.

Let’s Get PhysicElle She Talks the Talk and Walks the Walk (Gross Motor Skills)

Elle walks on her own, and is quickly learning how to use her body to accomplish various goals. She can run, hop, stand on one foot, and is getting better at throwing. At dance, she has succeeded in doing pliés with her legs together, jumping in and out of a circle, holding one foot out, pointed, marching, and jumping . At gymnastics, she loves to swing on the bar, and can do it for hours, according to her mom (A. Taylor, personal communication, October 3, 2017). Elle hasn’t quite mastered throwing as she does not fully extend her arm when engaging in this task.

At 30 months, children can typically jump with both feet, jump from chair or step, stand on one foot momentarily, and take a few steps on tip toes (Perry et al., 2014). Elle seems to be mostly on schedule for this level of gross motor development.

She Walks A Fine Line (Fine Motor Skills) Elle loves to color, though she has not yet mastered the art of staying in the lines. She loves stickers, too. With a little help to remove it from it’s sticky home, Elle can use her thumb and forefinger to grab and place a sticker on various sticker recipients. She can string beads if they are large enough.

She is working on perfecting buttons, but zippers are still out of reach for her.

Toddlers at this stage typically have good hand-finger coordination, move fingers independently, and begin making vertical and horizontal strokes in drawing (Perry et al., 2014).

Elle falls in line with these milestones as well. There is no indication of delay.

NutritionELLE Elle’s mom focuses less on calories and more on nutrients. Elle’s doctors, given her height and weight, have always suggested Elle consume as much as possible. Her appetite varies greatly, but her mom tries to cover all of the food groups throughout the day.

Elle’s favorite foods include pasta, cheese, yogurt, sweet potatoes, corn, pears, apples, blueberries, and chicken. These are all generally healthy options.

Elle also has a picky streak, which can be explained by her cognitive development as an independent person. She does not like things mixed together, which is a trend observed in her mom’s dietary habits. Elle also is not very adventurous when it comes to textures. She is especially opposed to crunchy foods.

Around 18 mojnths, toddlers typically develop a sense of pickiness, known as physiologic anorexia (Perry et al., 2014).

Rituals of eating are also emphasized, as evidenced in cognitive development.

At her age, she should be consuming between 1000 and 1200 calories per day. The above chart by the USDA indicates the variation in diet. Elle’s diet falls within the range of what is recommended.

One area that could be addressed is her dairy intake. Like most toddlers, she enjoys dairy over other food groups, and it should be monitored to ensure she receives proper calories.

THINKER bELLE (PsychosociELLE, MorELLE, Cognitive DevELLEopment)

This cognitive developmental stage is represented by the child’s

ability to organize processes and thoughts based on his or her own

perceptions. It is triggered by increased language ability that allows

a child to ask “why” and “how,” though still from an illogical

perspective (Perry et al., 2014). It tends to foster social

and spiritual development as well as development of body image and gender identity. Problems can arise from the inability for toddlers to comprehend the full logic of what they are perceiving. This is expressed as egocentrism, animism, magical thinking, inability to conserve, and centration.

Elle’s use of stuffed animals to role play is an example of this type of thought. She also showed this repeatedly through through her pickiness with food, not wanting to eat any piece of food that, in appearance, looked different than the other pieces. It is an example of transductive reasoning.

Piaget: Preoperational

In this second stage of psychosocial development, Erikson: Autonomy

the toddler must learn to successfully navigate the

world to acquire a sense of self-control. Newly acquired motor vs. Shame & Doubt

skills and language allow the toddler to have a new sense of control that fosters a desire to control the environment around them (Perry et al., 2014).

When they are shamed or made to feel guilty or self-conscious, or made to be dependent when they are able to express independence, they may fail to acquire proper self-control or willpower.

Elle falls squarely in to this category. She has what seems to be almost a compulsion ton make decisions for herself from which bowl she wants to eat out of to which sticker she chooses to which parent or caregiver will read to her at bedtime. When this decision process is taken away, she becomes frustrated, and fully focused on this component or activity.

In this stage of moral development, toddlers learn the concepts

of good and bad and right and wrong. Similar to Piaget’s

preoperational stage, however, these values are based

on how the toddler is directly impacted.

Elle displayed evidence of this stage in nearly every area of her life. Her willingness to follow rules initiated by her parents and teachers without the ability to question, but to avoid punishment, is one example. Even in her willingness to share, while seemingly selfless and fair, can be observed as a type of rule-following, as observed when she refers to certain objects as “mine” when she is not in a sharing mood. It could also be suggested that some of her frustration may be related to her undeveloped sense of right and wrong. She may feel sad that a task did not play out as predicted, and interpret that as “morally” wrong or bad because it did not make her feel better, thus triggering those guilty or negative emotions.

Kohlberg: Level 1 Preconventional

Orem Three important areas of care that should be addressed in the Toddler are sleep habits, self-care habits, and toilet training.

Sleep Habits Self-Care Habits Toilet Training Elle sleeps about 10.5 hours a night. She is beginning to be afraid of the dark, and has ďŹ gured out how to leave her room and enter her parents’ room. She also resists going to sleep, and clings to rituals for bedtime. Some of these areas may need to be addressed.

Elle’s motor skill development have helped her to begin taking on some of these tasks. She loves dressing herself, she is able to scrub her hands but not put soap on them, she is getting better at using the fork, is able to use the spoon, and scrubs her body during bath time.

She is improving regularly in toilet training. She forgets about once every three days and will have an accident. She is resisting pooping on the toilet, and will hold it as long as possible. She is not quite ready for night time toilet training.

Patient & Family Teaching Problems 1. Nutrition – In line with other safety measures, Elle is at a higher risk for choking on food as mastication improves with development, and is at a particularly difficult period for pickiness.

Interventions: avoid active play while eating, suggest to mom that she offer her foods of varying shapes and sizes to encourage openness to new foods, suggest that Elle begin with tolerating certain foods visually before expecting her to consume them (Perry et al., 2014)

2. Physical Development – Elle falls in the lower percentile of growth

Interventions: encourage high calorie diet, help toddlers learn to enjoy high calorie foods through exposure (Perry et al., 2014)

3. Developmental/Social Development – Elle has developed normal fears of the dark and resists bedtime, factors that can lead to problems down the line

Interventions: parents should evaluate if bedtime is too early because children who aren’t tired won’t want to go to bed and will think about things that scare them when in bed and not tired, use of a reward system to encourage regular bed times, avoidance of patterns that can lead to additional problems like allowing her to sleep with parents when she comes in to their room (Perry et al., 2014)

4. Safety Teaching – Elle lives at a house with a pool, and given that she is more mobile, is at a higher risk for drowning, as this is a particular for children her age

Interventions: teaching swimming and safety may not be enough to prevent an accident, constant supervision must be utilized, especially with other children around, anticipatory guidance must be used by the nurse to help with CPR education, remind parents that this is also true for bathtubs, even though the child is familiar with the bath (Perry et al., 2014)

References Centers for Disease Control (2016). Growth charts. Retrieved from https://www.cdc.gov/growthcharts/data/set1clinical/cj41c018.pdf

United States Department of Agriculture (2016). My plate: Daily Checklist. Retrieved from https://choosemyplate-prod.azureedge.net/sites/default/ďŹ les/myplate/checklists/ MyPlateDailyChecklist_1000cals_Age2-3.pdf

Perry, S., Hockenberry, M., Lowdermilk, D. & Wilson, D. (2014). Maternal child nursing care (5th ed.). St. Louis, Missouri: Elsevier.