Children’s Functional Health Pattern Assessment Functional Health Pattern Assessment (FHP) | Toddler Erickson’s Developmental Stage: Autonomy vs. Shame/ Doubt | Preschool-Aged Erickson’s Developmental Stage: Initiative vs. Guilt | School-Aged Erickson’s Developmental Stage: Industry vs. Inferiority | Pattern of Health Perception and Health Management: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | A toddler may complain that they feel sick. At this stage, parents or caregivers are responsible for health management. Health promotion can be taught to toddlers by teaching the importance of personal hygiene and nutrition, ie. taking vitamins. | Preschoolers have an accurate perception about their own bodies, but do not understand yet that there are vital processes and organs internally. Preschoolers can localize and verbalize pain. | School-aged children have a good grasp on body systems and what’s occurring during illness. School-aged children are developing cognitively, therefore are beginning to understand concepts related to health promotion, such as importance of eating well and visiting the doctor. | | Toddlers have a higher instance of accidental injuries due to environmental hazards and developing bodies. Nutrition may be affected if caregivers are not knowledgeable about feeding their picky, growing toddler. | Caregivers are charged with the task of seeking medical attention for their preschooler, including keeping current with vaccinations. Children not vaccinated are at risk for disease. Preschoolers develop a concern about mortality and death. | Learning disabilities present during this stage of a child’s stage of development. School-age children are exposed to various illnesses while among the general population. Child hood cancers are also a possibility at this stage of life. | Nutritional-Metabolic Pattern: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Toddlers are making the final transitions to solid foods, and beginning to grow preferences for what they are eating. Toddlers can begin to feed themselves versus relying on others. They may assert some dominance at this stage and only consume what they decide. | As preschoolers being exposed to a variety of food in and outside of the home, very conscious preferences emerge. Preschoolers want to be involved in family oriented activities, and being included in household baking and cooking is a good way to incorporate food knowledge and togetherness. | School-age children should be included in the weekly grocery shopping, as they are developed enough to help choose foods that they like. School-aged children also have the ability to choose between unhealthy snack foods, and foods like fruits and vegetables that hold nutritional value. | | Because of food preferences, toddlers may not receive all of the vital vitamins and minerals that their growing bodies need. Food allergies may begin to present themselves. | Because of the snack choices available to preschoolers, they may decide that they do not have a taste for things like fruits and vegetables. Based on food selection and availability, the nurse may see either overweight or underweight preschoolers. | Due to the family’s potential lack of ability to provide healthy meals, the child may be at an increased risk for developing illness because of a compromised immune system. If the school-age child eats a lot of sweets, cavities may be present upon dental exam. | Pattern of Elimination: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Toddlers are making the change from diapers to toilet training. Parents and caregivers should develop a consistent schedule to establish a toileting routine early. | Preschoolers should be fully toilet trained. Preschoolers may still need assistance when wiping, for example, but get the general idea they need to clean themselves after using the toilet. | The school-age child has full bowel and bladder control. They can effectively clean themselves and perform hygiene after using the toilet. They will recognize inconsistences in elimination, such as pain or diarrhea. | | Parent or caregiver may become frustrated by child not catching on quickly and still having accidents. Parent or caregiver my lose hope and give up on toilet training child. Child has increased risk of skin breakdown if caregiver does not change child when child has soiled pants or diaper. | Preschoolers may now be potty-trained, but wetting the bed at night is still a common problem. Although they understand wiping and cleaning after using the bathroom, hand hygiene may need to still be reinforced. | During school, a child may be afraid to hold their hand up in class, thus leading to urinary insentience because they don’t have time to make it to the bathroom. Bedwetting, if present, may cause extreme embarrassment if present during sleepovers. | Pattern of Activity and Exercise: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Toddlers are very energetic and are constantly in motion while awake. Child is dependant with self-care, including dressing and brushing teeth. | Preschoolers continue to be very energetic, and play is main activity. Child is able to play with other children and separate from adults easier than before. | School-age children are engaging in many physical activities including gym, recess, sports, ect. Children this age are fully able to make decisions about their self-care and perform on their own. | | Due to toddlers active lifestyle and walking, may be more prone to injury. Child still depends on caregiver for safety during physical activity, and care must be taken to avoid dangerous situations, like swimming pools when not supervised. | Child may be withdrawn from play with other children, signaling future social problems. Child may have activity intolerance due to nutritional status or sedentary lifestyle at home. | School-age child may develop problems with breathing while performing physical activities like sports, which can be attributed to illness such as asthma. Watching television or playing many video games instead of exercising or physical activity may lead to obesity and associated complications. | Cognitive/Perceptual Pattern: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Toddlers cannot yet make decisions for themselves, and rely on caregivers to aid them. Toddler is able to find object even when hidden or 2 to 3 deep. | Preschoolers can make mechanical toys work. Preschoolers have the cognitive ability to play make believe with other children or by themselves. | School-age children have ability to sense and understand others feeling and emotions. Child gains a feeling of empowerment from solving problems independently. | | Toddler may feel that things happen as a result of his or her behavior. Has difficulty understanding death, illness, or divorce. | Preschooler can only understand problem from one side and does not understand more than one answer to a question. Does not yet understand why things are the way they are, such as why is the sky blue? | Still do not possess the ability to think abstractly. School-age child may try to exert dominance over adult and push boundaries. | Pattern of Sleep and Rest: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Bedtime should be at the same time each night. By doing so, the toddler will know what to expect and experience restful sleep. Adopting a nighttime routine, like reading a story before bed, helps the child understand it will soon be time for sleep. | Keeping the preschooler on a sleep schedule is important to avoid situations where the child gets too little or too much sleep. Child should be sleeping in own bed to promote restful sleep. | School-age children should have a bedtime routine. Engaging in activity, such as a quick cleanup of their room before bed establishes a routine and helps the child sleep better in a clean environment. School-age children should wake up within an hour of regularly scheduled time on the weekends to keep routine. | | Toddler may resist going to sleep, especially if other siblings are still awake. Toddler may try and sleep in the same bed as parent or caregiver. This should not be allowed, as it makes it harder for the child to fall asleep by themselves. | Nightmares or night terrors happen during the child’s latter stages of sleep and may make the child afraid or hard to sleep. Child may call out to parent to delay sleep. | School-age children can suffer from sleepwalking or sleep talking. Avoid injury to sleepwalking child by implementing a plan of action, such as an alarm on the child’s door. | Pattern of Self-Perception and Self-Concept: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Toddlers are aware of themselves as separate from others. Child will assist with dressing, feeding, and completes activities. Toddler should be praised to help develop high self-esteem. | Preschoolers see themselves as separate and unique individuals. They define themselves in concrete terms. Preschoolers have pictures of themselves that include physical attributes, age, gender, and abilities. | School-age children desire competition and want to become good at whatever they are doing. This builds self-esteem. School-age children are busy with self-discovery. | | Toddler may have temper tantrums when having a power struggle with another person. Toddler should respond to name at this stage. If not it could signal developmental delays. | Fine muscle control develops at this stage, which if a problem occurs, can harm self-esteem. Preschooler may become embarrassed around others. | Self-esteem can be challenged by peers and trying situations. Poor hygiene may be an issue for this age group. They may not be interested in self appearance. | Role-Relationship Pattern: List two normal assessment findings that would be characteristic for each age group. List 2 potential problems that a nurse may discover in an assessment of each age group. | Toddler becomes very attached to the primary caregiver or givers. Socialization is an important milestone in order for the toddler to understand who is in charge, and to shape the child’s behavior. | Preschoolers have a large desire to play with other children, and become less attached to caregivers. Separation anxiety and behaviors are usually present for the first half of this stage, and then disappear in the latter. | School-aged children tend to create relationships outside of the home and family. As a school-aged child, the general role within the family is understood. | | Siblings may fight and bicker, which can be stressful for the family. The toddler may become more attached to one parent, which can be upsetting for both the parent and child. This may cause the child to exhibit unwanted behaviors, such as crying. | Preschoolers are impressionable about gender roles, and may develop a skewed view of them in the world. Developmental delays may be suspected when the preschooler does not want to play with others. | Limits must be set for school-aged children in order to set behavioral expectations. Those who do not may experience children who will not follow rules. School-age children may find more satisfaction spending time with friends than with family. | Sexuality – Reproductive Pattern: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Toddlers may touch their genitals while using the bathroom or bathing. Toddlers gain gender identity and understand the difference between girls and boys. | Preschoolers begin touching themselves purposefully. Preschoolers also will have boyfriends or girlfriends. | School-age children will start to ask about sex, and even ask about the sexual habits of animals that they see engaged. Parents should explain reproduction and sexual organs with their child. | | Special attention should be paid to elimination patterns. If pain is present, there may be a medical reason, such as a uti. Gender roles should be taught by parent’s to avoid confusion later in development. | Preschoolers may touch themselves around others, and it should be explained that it should be done in private. May sometimes play doctor with other children. The parent should calmly explain differences between genders after removing the child from the situation. | School-age children may begin telling inappropriate jokes they most often don’t understand. School-age children often pick up bad language. It’s important to call attention to it being inappropriate and suggest better words to use. | Pattern of Coping and Stress Tolerance: List two normal assessment findings that would be characteristic for each age group. List wo potential problems that a nurse may discover in an assessment of each age group. | Child will test limits and test limits of caregivers. May react with anger and frustration. Rest and nutrition can play key role in coping with stress. | Spending quality time with children can help cope. An expressed interest in the child gives them an outlet. Preschoolers can talk to others about what is bothering them, and may seek solutions to problems. | School-age coping mechanisms include humor, exercise, and controlling behaviors. Children this age may also turn to music or friends for stress relief and coping. | | Toddlers may have tantrums and physical means to express coping. Caregivers may feel ineffective at teaching coping or keeping stress away from toddlers when these behaviors are exhibited. | Preschoolers may try to take control and have behavior tantrums. Preschooler may become withdrawn thinking about problems that are worrying them. | School grades may suffer from not being able to cope with stress. Childs attitude and behavior may change when stressed about a situation. | Pattern of Value and Beliefs: List two normal assessment findings that would be characteristic for each age group. List two potential problems that a nurse may discover in an assessment of each age group. | Toddler responds to positive feedback. These are healthy and helps teach values. Toddlers learn right and wrong values from family. These values should be taught early on, and boundaries set so that the child understands them. | Preschoolers are able to attend church and, in certain classes and teachings, can begin to understand religion and belief systems. Preschoolers can express their values through stating what they want to do when they get older. | Religious factors may influence how the child develops morally and ethically. School-aged children can make decisions themselves based on right or wrong. | | Parents may not scold for bad behaviors. Parents may only respond to the toddler when they are misbehaving, essentially rewarding the wrong behavior. | Preschoolers may not always make the right decision, because they are still don’t have a full understanding of the concept of right and wrong. Television and movies may influence a preschoolers values and beliefs. | School-age children may lie because they think doing so may get them out of trouble. Children may also bend their values and beliefs due to peer pressure. + |

Short Answer Questions

Address the following based on the above assessment findings. Expected answers will be 1-2 paragraphs in length. Cite and reference outside sources used.

1) Compare and contrast identified similarities as well as differences in expected assessment across the childhood age groups.
For this assessment, there were many similarities as well as differences that were noted. The first sets of similarities are the toddler and preschoolers. There were many times when the two age groups shared common information. For example, for the pattern of coping and dealing with stressors, both toddlers and preschoolers tend to throw temper tantrums when they are not getting their way, or not able to deal with stress that has presented itself to the child. Another example of a similarity would be role relationship patterns of preschoolers and school-age children. They both enjoy the company of other children, sometimes more than that of family members. The largest difference between the groups is present in the cognitive/perceptual pattern. There are leaps and bounds between what each age group can do in regards cognitive growth and development.

2) 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.

A nurse assessing a child would want to do so carefully, with the parent or caregiver present. The child needs to be with someone that he or she trusts. The nurse needs to explain to the child what she is doing in terms that the child can understand. The same should be done for examinations, possibly with the aid of a doll or stuffed animal so as not to frighten the child. Educating the child needs to be done on two separate levels; one on the parent’s level, and one with the child. A child should not be expected to understand things being told to an adult, in adult terms. Again, if educating a child about something like hand washing, it might be beneficial to show a child with a doll. Culturally, the nurse needs to respect the parent and their beliefs. In some cultures, the parent is the only one who should be giving information and learning about anything to do with the child. For example, Gypsy women will not divulge personal information about themselves, as they feel that it is not proper to tell non-gypsy individuals. It is very important to keep differences in mind, and not let anger or frustration at the situation interfere with the assessment.

References
Jarvis, C. (2008). Physical examination and health assessment (4th ed.) Philadelphia: W. B. Saunders.

Edelman, C., & Mandle, C. (2009). Health promotion throughout the life span (7th ed.) St. Louis, MO: Mosby Elsevier.

Koshar, Jeanette. (2013). N 340 Women’s Health & illness in the expanding family & n345 clinical practicum. Retrieved from http://www.sonoma.edu/users/k/koshar/n340/N345_Gordon_FHP.html