PEDIATRIC ASSESSMENT TOOL: INFANCY

0-1 year old

I. Nursing History
A. Birth History: Length: ______ Weight: ______
Apgar Score: _______ Gestational Age: ________
B. Immunization Schedule: __________________________________________
C. Previous Illness, Accidents, Injuries: _________________________________
D. Established Routines:
Feeding Schedules: ______________________________
Sleep Schedules: ________________________________

II. Developmental Milestones

A. Physical Characteristics

Characteristics Birth to 6 months 6 months to 1 year Patient’s Characteristics

Weight Gain 150-210g (5-7oz) / wk 90-150g (3-5oz) / wk Triples
Doubles Birth Weight Birth Weight
Growth Rate 2.5 cm (1in)/ month 1.25 (1/2in) / month
Dentition Average = 8 teeth
Vital Signs
Temperature 37.5°C (99.5°F) 37.3°C (99.7°F)
Pulse Rate 120-140 bpm 120bpm
Respiratory Rate 30-50 bpm 30bpm
B/P 75/30mmHg

B. Behavioral Characteristics

Age Gross Motor Skills Fine Motor Skills Psychological

1 month ●Rounded back when
pulled to sitting position,
turns head to sides
2 months ●Raises head and chest
and can hold in position
3 months ● Raises heat to 45°,
slight head lag when
pulled to sitting position
4 months ● Lifts head and looks
around, rolls eyes from
prone to supine position
5 months ●Rolls over from supine
to prone and back, sits
with back upright
6 months ● Sits with shake posture,
raises abdomen off chest
when prone
7 months ●sits alone, uses hands to
support
8 months ●sits unsupported
● Involuntary hand
movements
●Holds hand infront of face
●Voluntary movements of
ulnar surface of hand
●grasps rattle with hands held
together
●Drops object in hand to reach
out for another object offered
●Transfer objects between
hands
● start of thumb and finger
grasping
●Social Smile
●Coos, Babble
● coughs aloud
●makes constant sound
●enjoys social interaction
●knows mother
●begins solitary plays with toys
●Intersperses vowel and consonants
●Reaches out to be held
● Cries when toy is removed
●combines vowels and consonants
●exhibits stranger anxiety
●Plays peek-a-boo
●Imitates sounds
●Bites aggressively
●resists unwanted objects and food
●combines syllables
●wary of strangers
●Cries when mother leaves
●responds to often used word
●fears strangers
 ●fears separation from mother
9 months ●Creeping begins ●bangs held objects together ●says “mama”, “dada”
abdomen off floor ●performs if rewarded
● plays ball, pat-a-cake
10 ●pulls self to standing ●picks up small objects ●responds to own name
months position ●understand simple commands
11 ●stands securely holding ●offers toys and releases ●aware of approval and disapproval
months on to objects ●differentiates between words
●has 3 word vocabulary
●recognizes objects by name
12 ●sits from standing ●feeds self with cup and ●explores in familiar environments
months position spoon ●has favorite toy or blanket

PEDIATRIC ASSESSMENT TOOL: TODDLER

I. History
A. Previous Hospitalizations: November 24, 2020
B. Common Childhood Illness: Fever and colds
C. Allergies or Allergic Responses: No allergies
D. Immunization: Complete: DTaP, HepB, HepA, IPV
Incomplete: ______________________
E. Special Name/Nickname: Mikmik

II. Developmental Milestones

A. Physical Characteristics

Characteristics 1 to 3 years Patient’s Characteristics

Weight Gain 2-3kg (4.4-6.6lb)/yr The child weighs 26.5lbs. (12kg)
Quadruplets birh weight at 2 ½ years
Growth rate 12 cm (4.8in) during 2nd year The child heights is 33.7” (85.5cm)
6-8cm (2.2-3.2in) during 3rd year
Anterior Fontanel Closed at 1 ½ years Closed
Dentition 20 teeth at 2 ½ yrs 20 milk teeth
Vital signs
Temperature 37.2 C 38.6 C
Pulse Rate 110bpm 160 bpm
Respiratory Rate 25bpm 60 bpm
B/P 97/60mmHg Oxygen saturation- 94%

B. Behavioral Characteristics

Age Gross Motor Skills Fine Motor Skills Psychosocial

13-18 ● walks alone, jumps in ●holds and drinks from ●uses expressive Jargon
months place, falls cup ●has 4-6 word vocabulary
● creeps up stairs, comes ●takes shoes and socks ●says “no” frequently
down backwards off ●understands simple commands
●runs but falls ●helps take off shirt ●fears strangers less
●helps unzip clothes ●expresses affection
●has temper tantrums
27 months ●walks steadily ●uses one hand to hold ●has atleast10 word vocabulary
●kicks ball forward cup ●imitates behaviours
●jumps in place ●uses spoon without ●temper tantrums worsen
●walks up stairsm both spilling ●begins dependence on favourite toy or
feet on step ●undresses self blanket for comfort
 ●goes down stais
holding on
●pick up objects without
falling
30 months ●walks on tiptoes,
climbs stairs with one
foot on step, throws ball
3-4 ft.
36 months ●rides a tricycle, balance
on one foot but falls after
2 seconds
●puts on shirt ●explores everything
●turns doorknobs ●ready to begin toilet training
●builds tower of 6-7
cubes
●holds crayons in ●has 300 word vocabulary
fingers, imitates lines ●uses 2-3 word phrases
and circles, pours with ●verbalizes needs
spills ● uses parallel play
●cannot share toys
●temper tantrums decreases
●exhibits ritualistic and negativistic behaviour
●dawdles
●can tolerate time away from mother
●cooperates with toilet training
●draws recognizable ●can say first and last names
figures ●uses appropriate pronouns and plurals
●puts small objects in ●can spend time away from mother
bottle ●knows own sex
●can use toilet with little help
●negativistic and ritualistic behavior
continues

PEDIATRIC ASSESSMENT TOOL: PRE-SCHOOL

3-6 years old
I. History
A. Previous Hospitalizations: _________________________________
B. Common Childhood Illness: ________________________________
C. Allergies or Allergic Responses: _____________________________
D. Immunization: Complete: __________Incomplete: ___________
E. Special Name/Nickname: _________________________________

II. Developmental Milestones

A. Physical Characteristics

Characteristics 3-6 years old Patient’s Characteristics

Weight Gain 1.9 – 2.3kg (4-5lb)/yr
Growth Rate 5-7.5 cm ( 2-3 in)/ yr
Body Proportions Slender, “wiry”
Agile
Vital Signs
Temperature 37°C (98°F)
Pulse Rate 100bpm
Respiratory Rate 23bpm
B/P 100/60mmHg

B. Behavioral Characteristics

Age Gross Motor Skills Fine Motor Skills Psychosocial

3 years ●ride tricycle ●draws symbols, ● Has 900 word vocabulary
●goes upstairs name them ●uses 3-4 word sentences
alternating feet ●Talkative, ask questions
●broad jumps ●”helps” mother with household chores
●follow simple directions
●fear dark, going to sleep
●understands rudiments of time
 ●tries to please parents
●learns to share
4 years ●skips, hops, on one ●Draws simple ●has 1500 word vocabulary
foot stick figure ●uses 4-5 word sentences
●throws and catches ●perform self-care ●tells imaginative exaggerated stories
ball daily ●has imaginary playmates
●signs simple songs
●is aggressively independent, “boss”
●has mood swings
●engages cooperative, dramatic, imitative play
●identifies with parent of the same sex
5 years ●skips, hops ●Draws ●has 2100 word vocabulary
alternating feet recognizable ●uses 6-7 word sentences
●jumps one objects and figures ●knows coin, colors, name and address
●roller-skaters ●prints letters, ●cooperates with parents
●ties shoelaces numbers, name ●becomes more attached to mother when beginning
●uses simple tolls school
●can follow 3 commands
6 years ●is very active, in ●define objects by ●is “bossy” tense
constant motion use ●is emotionally labile
●prints, paints, ●follows triple ●has separation anxiety when starting school
colors commands ●plays with peers, often fights, cheats to win
●plays simple
board games

PEDIATRIC ASSESSMENT TOOL: SCHOOL AGE CHILD

6 years old – 12 years old
I. History
A. Previous Hospitalizations: ___________________________________
B. Common Childhood Illness: __________________________________
C. Allergies or Allergic Responses: _______________________________
D. Immunization: _____________________________________________
E. Health Status of Family Members: ___________________________
F. Reason for seeking health care: ______________________________

II. Developmental Milestones

A. Physical Characteristics

Characteristics 6 – 12 years old Patient’s Characteristics

Weight Gain 1.5-3kg (3-6lbs)/ year
Average Weight 6 years – 24 kg (48lbs)
12 years – 38kg (84lbs)
Growth Rate 2.5-5cm (1-2in)/year
Average Height 6 years – 117cm (46in)
12 years – 150cm (59in)
Prepubertal Growth Spurt 10-12 years, girls taller than boys
Dentition Loses all baby teeth
6 years – 1st permanent teeth erupt
12 years – has 28 permanent teeth
Vital Signs
Temperature 37°C (98°F)
Pulse Rate 90bpm
Respiratory Rate 21-22bpm
B/P 110/70 mmHg

B. Behavioral Characteristics
 Gross/Fine Motor
Age Intellectual Psychosocial
Skills
6 years old ● is very active in ●declines objects by use ●is “bossy” tense
constant motion ●follows triple commands ●is emotionally stable
●prints, paints, ●plays simple board games ●has separation anxiety when starting --school
colors ●plays with peers often fights, cheats to win
7 years old ●uses knife to cut ●enjoys reading ●enjoys family life, helping
food ●tells time, knows calendar ●spends time alone happily
●practices skills ●can recognize other point ●is quiet, reflective
for mastery of views ●is eager to please
●uses telephone ●sets high standards for self
8 years old ●perfects skills in ●enjoys learning about ●is exuberate, expansive, self confident
games requiring science, nature ●is very curious
large/fine muscle ●classifies objects, starts ●has difficulty completing tasks
coordination collection ●has same sex peer group
●understands concept of ●plays in gang
death ●is proud of success, fears failure
●seeks potential approval
9 years old ●has good hand- ●understands explanations ●is quiet introspective
eye coordination ●follows teacher’s ●importance of same sex peer increases
●perfect skills in directions ●is self motivates
sports with ●describes characteristics of ●finishes tasks
improved timing objects ●begins to rebel against authority
and muscle ●starts meaningful ●has heroes
control collections
●develops
individual skills
10 years ●enjoys all ●understands casual ●is happy, confident, serene
old physical activity relationships ●behavior is predictable, consisted, controlled
●practices fine ●interested in world ●expands peer relationships in cliques, teams,
motor skills for problems scouts
extended periods ●manipulates fractions ●hero worship intensifies
●writes well, fast ●enjoys memorizing
11 years ●is active, agile, ●is interested in religion ●begins preadolescence
old enjoys sports, ●describes abstractions ●is moody, unsettles, ambivalent
may be clumsy ●enjoys learning, resists ●resents adult authority
homework ●begins interest in money, allowance
●seeks challenges ●worries about anything

PEDIATRIC ASSESSMENT TOOL: ADOLESCENTS

12 – 16 years old
I. History (School age)
A. Menarche: ________________________________________________
B. LMP: _____________________________________________________
C. Smoking: _________________________________________________
D. Alcohol Use: ______________________________________________
E. Personal Hygiene: ________________________________________
Bath: ____________________________________________________
Dental Hygiene / Oral Care: _______________________________
F. Attitude towards school : __________________________________
G. Plans to continue education: ______________________________
H. Ambition in life/ career: ___________________________________
I. Attitude toward self and body image: ______________________

II. Developmental Milestones

 A. Physical Characteristics

Patient’s
Characteristics Male Female
Characteristics
Weight gain 7-30kg (15-65lb) 7-25kg (15-55lb)
Growth 10-30cm(4-12in) 5-20cm ( 2-8in)
Growth pattern Spurt begins about 13 years Spurt begins 10-12 yrs
Growth rate varies before onset of menses
Early mature – rapid, Sharp decreases in rate after
Early growth – early cessation menses occurs
Late Mature – steady prolonged growth
– late cessation
Growth Cessation At 18-20 years 1-2 years after menses
Sexual Masturbation 1. Enlargement of testes, scrotum 1. breasts changes
2. Appearance of pubic hair enlargement
3. Appearance of axillary hair 2. increase in size oof
4. Hair in upper lip pelvis
5. Appearance of facial, body hair 3. appearance of pubic
6. Penis grows enlarges hair
7. Nocturnal emissions 4. menstruation
8. spermatogenesis 5. ovulation

B. Vital Signs

Vital Signs 14-16 years

Temperature 37° C (98°F)
Pulse Rate 85bpm
Respiratory Rate 16-22bpm
B/P 120/76 mmHg

Discuss the Psychosocial concerns of the adolescent:

1. Difficulty in adjusting to rapid growth and maturation, revision of body image.
2. Anxiety related to heightened sexual awareness, ability to control sexuality/
3. Stress related to peer pressure, need for group, identify need to conform.
4. Stress related to family pressure, dependency/independence, and ambivalence.
5. Career.
6. Separation anxiety when leaving home, assuming financial and emotional responsibility for self.