Centra College

Nursing 240
Developmental Assessment

The patient is a 3-month female. The patient had a heart rate of 147 and a respiratory rate of 26. The

infant is a onesie, has a beanie, a bib, and socks. The tone of the newborn is undisturbed, was restless, calmed

down when cried, looked at the stranger nurse and its environment, and an active cry when it wanted

food/diaper change. The rate was within normal limits of 25-30 at 38, patient lays on back with arms and legs

flexed, retraction of ribs when inhaling, with a calm demeanor. The skin color was pink, warm, and slightly

moist, the patient had a heart rate of 147 which was within 90-160 beats per minute.

The infant was observed to be calm, and collected, but cried when demanding food and diaper changes. The

infant observed the stranger as he walked in the room but appeared calm and slept for the majority of the

observation. The newborn demonstrated the sucking reflex with his pacifier. The 3-month is in the initial stages

of sensorimotor as she is taking in new sensations and acting from reflex. The newborn has yet to demonstrate

curiosity, problem solving with objects, direct behavior, hold object permanence, or begin to use language.

After she is able to learn these skills, she can use them to become aware of object permanence.

Sensorimotor Thought:
The child should have at least two (2) “yes” answers in a substage to be Yes No
identified as being in that substage. Information enclosed within
parentheses denotes the concept being achieved by the child in each
stage. Items denoted by an asterisk (*) must be answered “yes” for the child
to successfully complete that stage. ___”Yes”___ _______
This stage consists of six (6) substages to be tested.

1. Reflexive: Expected Ages 0-1 month __”Yes”_ _______

a) Does the child primarily sleep and eat

with occasional periods of looking around
or seeming to listen to sounds?
_______ __”No”___
b) Does the child change his activity when
he hears a new noise?
_______ __”No”__
2. Primary Circular Reactions: Ages 1-4 months
_”Yes”___ _______
a) Does the child stop crying for food when
__”Yes”__ _______
 he hears or sees food being brought to
him? (Delayed gratification)

b) Does the child study his hands?

c) * Does the child smile at the primary caretaker?

d) Will the child let strangers pick him up or

touch him without looking away or crying?
(Lack of stranger anxiety)

The patient is a 31-month-old female toddler. The patient has a heart rate of 89 beats per minute and a

respiratory rate of 27 breaths per minute. The toddler has groomed curly hair, a sweater, matching crocs, and a

pink dress. The patient was shy and curious, easy to console, looked as I entered the room, and had clear short

speech patterns. The patient had a respiratory rate of 27 breaths per minute which was within normal limits of

25-30 breaths per minute. The toddler was breathing without complications, no use of accessory muscles,

straight posture, and breathed with retractions. The toddler was a little anxious as they initially hid from first

sight, however, after some moments she was able to sit in a chair. The patient’s heart rate was 89 beats per

minute, which was within the normal range of 80-140 beats per minute. Her skin was warm, pink, and dry.

The toddler seemed to be nervous during the beginning of the assessment and then excited during the

assessment. The toddler had to think about questions and often looked to their mother hoping for her to help

answer questions. The mother answered no with imitating chores, still gets upset when they leave the room and

has a “meltdown,” the child did recognize that the nose was out of site from person 1, does not animate objects,

and does not imitate early behaviors. The child does have a daily routine and gets upset if its delayed, can name

a toy, a television, and door, brought a doll out that was in her play bin, the child did not want to share her doll

when it was found, gets upset when its schedule is disrupted, and the child was able to form very short

sentences. The toddler did say more than 10 words during the assessment. The toddler is in the transitional stage

from sensorimotor to preoperational. The toddler is aware of object permanence, demonstrated representational

thought, egocentric with her toys, and demonstrated concrete and tangible thought. She was able to hear and
think on the here and now and focus hard on my questions in her point of view. Her next step through the

preoperational stage is to ask more questions, use imaginative play, and begin to make associations of ideas.

Then she will be able to transfer into Concrete operational stage where her thoughts will be more logical and

coherent.

Yes No

_______ __”No”__

__”Yes”_ _______

__”Yes”__ _______

_______ __”No”_

__”Yes”__ _______

6. Invention of New Means: Expected ages 18 -24 months

a) Does the child imitate parents doing work or
household chores? Does he act out experiences from
several hours earlier? (Delayed imitation)

b) Is this child very concerned with maintaining

routine in certain aspects of his life?
(Global organization)

c) Can the child name at least three (3) objects he is

familiar with? (Mental representation)

d) Will the child let his caretaker leave the room

without getting upset? (Decreasing separation anxiety)
 e) Can the child find a toy that he has not played with
for several days and is not immediately visible?
(Complete object permanence)

Yes No

_”Yes”__ _______

__ _ __”No”_

_”Yes”_ _______

_______ __”No”__

_______ __”No”_

_”Yes”_ _______

Preoperational Thought:
The child should have at least two (2) “yes” answers in a substage to be in that stage and must have a “yes” for items with an
asterisk (*). Movement into preoperational though usually requires some language skills.

1. Preconceptual Thought: Expected ages 2 – 4 years

a) Is the child very possessive of any of his own

toys or possessions?

b) Does the child say “yes” to the nose test?

Have one person stand facing the child with person #2
behind person #1. Ask the child if person #2 can see
person #1’s nose. (Egocentricity)

c) Does the child seem to get upset if certain parts

of his daily routine are changed? (Global organization)

d) Does the child talk to or treat inanimate objects as if

they were alive? (Animism)

e) Does the child imitate behaviors that he observed

days earlier? (Delayed imitation)
 f) * Does the child have language skills of at least
10 words other than “mom” or “dad”?

The patient is a 5-year-old and 8 months old male. The patient has a heart rate of 91 beats per minute,

and a respiratory rate of 22 breaths per minute. The patient is wearing a Mario graphic t-shirt, pants, running

shoes, and with short, groomed hair. The patient had a relaxed tone, was shy, but active, easily consoled and did

not get disruptive or angry, gaze was mainly on the nurse, but occasionally lost focus and looked around the

room, had clear and concise speech. The patient demonstrated a normal respiratory rate of 22 which is the

normal limit between 20-25 breaths per minute, relaxed and sitting upright, retractions at the ribs, and showed

no signs of anxiety. The preschooler skin color was pink, cool to touch, and dry. The patient’s heart rate of 91

was within the normal limits of 70-120 beats per minute.

The preschool child was playful, active, and slightly shy. He asked tons of questions about me and what

the assessment was for. The child answered no to fear of ghosts or monsters, however, the mother later clarified

with me that the child is embarrassed to answer honestly and does. The patient answered yes to the nose not in

sight, the amount of food he gets is affected by the size of the plate, and can classify color, size, and shape of

blocks. The preschooler was able to count and realize that there was the same number of pennies, but he thought

the clay rolled out made it larger. The preschooler knew that we started with the same amount of water and thus

were both equal but had difficulty conveying these thoughts in words. He thought the crescent shaped clay was

longer than the rest. The patient knew that the number of squares on the paper were equal and taking up equal

space, but had difficulties explaining why by stating, “they just are” and “5 here 5 there.” The preschooler

thought the clay that was wider would be bigger and thus heavier. The preschooler stated that a person who hits

another person is mean and a meanie. He also responded to the cheater as, “bad.” The preschooler is in the later
stages of preoperational as he views the world through his own lens, however, there were moments of

thoughtfulness towards his parents and other friends. His answers through the questions showed transudative

thought as he could deduce the equal amount of water in smaller and larger size glasses were equal. He will

transfer to the concrete operational phase where he will begin to store ideas and information into categories to

develop problem solving skills. His reasoning will change from transudative to a more inductive process.

2. Intuitive Thought: Expected ages 4 – 7 years

Yes No

_______ __”No”__

__”Yes”___ _______

__”Yes”__ _______

__”Yes”__ _______

a) Does the child have fears of ghosts, monsters, or

other non-existent creatures? (Magical Thinking)

b) Does the child say “no’ to the nose test?

(Decreasing egocentricity)

c) Does the child think the amount of food he is

getting is affected by the size of the plate?
(Lack of conservation)

d) Assess for the ability to classify by color, size, shape –

use blocks or toys and allow the child to classify in different
colors, sizes, and shapes. (This skill emerges between 5 – 7 years)

Concrete Operational:
Assess for development of the concept of conservation. Ages in parentheses indicate the average age that each concept is
successfully completed.

1.) Assess for Conservation

 a) Conservation of Numbers: (Expected 5 – 7 years) Arrange two (2) rows of pennies. Ask, “Are there the same number
of pennies in each row?” Now, spread one row out. Ask, “Are there the same number of pennies in each row?” If the
child answers, “yes”, he/she must say why they are equal since they do not look equal.

○○○○○ ○○○○○

○○○○○ ○ ○ ○ ○ ○

2 rows of pennies One row of pennies

Arranged in one-to- elongated or contracted
one correspondence

Does the child have this concept? YES or NO

b) Conservation of Substance or Volume: (Expected 7 – 8 years). Two tests can be done for this:
I. Have the child make two equal balls of clay. Roll one ball into a long shape. Ask, “Is there the
same amount of clay in both?” If the child answers, “yes,” he/she must say why.

⃝ ⃝ ⃝

Modeling clay in 2 balls One of the balls

of the same size rolled into a long, narrow shape

Does the child have this concept? YES or NO

II. Start with two

medium glasses and one large and small glass. Have the child pour equal amounts of water into
the medium glasses. Have him pour the water from one glass into the small glass and from the
other glass into the large glass. Ask, “Is there the same amount of water in each glass?” If the
child answers, “Yes,” he/she must say why.
Does the child have this concept? YES or NO

c) Conservation of Length: (Expected 7 – 8 years) Have the child roll the clay into two equal lengths. Make
one straight but curve the other one.

Ask, “Are the lines of clay the same length?” If the child answers, “yes,” he/she must say why they are
equal, since they do not look equal.

Does the child have this concept? YES or NO

d) Conservation of Space or Area: (Expected 8 – 9 years) Start with 2 pieces of construction and 10 small
squares of paper. Allow the child to place his 5 squares in any fashion on the construction paper
(pretend it is a car lot and the squares are cars). If he lines his up, scatter yours and vice versa. Ask, “are
our lots the same size?” If the child answers, “yes,” he/she must say why, since one lot looks as if it
has more room.

Does the child have this concept? YES or NO

 e) Conservation of Weight: (Expected 9 – 12 years) Have the child roll two equal balls of clay. Leave one in
a ball shape and flatten the other one. Ask, “Do these weigh the same or is one heavier than the other?”
Have the child explain the answer.

⃝ ⃝ ⃝

Does the child have this concept? YES or NO

Has the child completely grasped the concept of conservation? YES or NO

(When all the above concepts are successfully answered, the concept of conservation is complete.)

1.) Assess for concrete thinking (expected ages 5-12) (everything is white or black, good or bad, smart or stupid, etc.)

To do this, ask the following questions:

I. How would you describe a person who hits another person?

“Mean”

II. How would you describe a person who cheats on a test?

“Bad”

The school-aged child is an 11-year-old male diagnosed with autism. The patient is wearing a tight tee

shirt with a shark graphic, shorts, and crocs. The patient was reluctant to be touched, however, allowed me to

get a heart rate of 84 beats per minute, and had a respiratory rate of 23. The patient has short, well-groomed

hair. The patient has a very flat tone when speaking, interacts well with questions, and has a difficult time

consoling the school-age child when he becomes irritable. The patient’s gaze was directed in my general

direction, but would not look directly at myself, and the patient spoke clearly, consistently, and articulated

words well. The patient’s respiratory rate was 23 which was within normal limits of 20 to 25 breaths per

minute, non-labored, no retractions when breathing, sit in an upright position with no abnormal auditory breath

sounds, and did not appear anxious, but rather calm. The school-aged child had normal skin color for ethnicity
as it was slightly pink, warm to touch, and dry. The school-aged child had a heart rate of 84 beats per minute

which was within the normal range of 60-110 beats per minute.

The school-age child seemed serious, became irritable when not getting his iPad, and demonstrated a

few moments of playfulness. The child was cognitive to person, place, and time. The school-aged child was

able to deduce that the lots are the same size because we have the same number of cars, that are the same size,

and same size lot. He was also able to determine the balls were the same weight before so they should be the

same weight after being squished. When asked to describe a person who hits another person the school-aged

child responded. “A bully.” and named a child in his class who has hit him before. When asked how to describe

a person who cheats on a test he stated, “that makes (name of school-aged child) really angry).” When asked

where he would put a third eye, the school-aged child responded by pointing to his other eyes and said beside

them. He clarified, “these are where the eyes go.” With the different size people of Adam, Brian, and Scott, he

was unable to completely understand the question. The child guessed Brian and when asked to clarify why he

admitted to guessing. The school-aged child has not seemed to fully grasp abstract thinking due to these

answers. The school-age child is in the later stages of concrete operations where his thought process is

inductive. His problem solving is concrete where they utilize what they perceive in a systemic fashion. He is

currently going progressive changes in thought process and relationships with others in order to gain more of a

abstract mindset. His autism makes it difficult to become empathetic to others and will always have a difficult

time perceiving other people’s point of view. Hopefully, the school-age child will transfer to a formal

operations stage where he can be more adaptive and flexible. In this next step, he will be able to think about

how others feel and can attempt to see their lens of view.

a) Conservation of Space or Area: (Expected 8 – 9 years) Start with 2 pieces of construction and 10 small
squares of paper. Allow the child to place his 5 squares in any fashion on the construction paper
(pretend it is a car lot and the squares are cars). If he lines his up, scatter yours and vice versa. Ask, “are
our lots the same size?” If the child answers, “yes,” he/she must say why, since one lot looks as if it
has more room.
Does the child have this concept? YES or NO

b) Conservation of Weight: (Expected 9 – 12 years) Have the child roll two equal balls of clay. Leave one in
a ball shape and flatten the other one. Ask, “Do these weigh the same or is one heavier than the other?”
Have the child explain the answer.

⃝ ⃝⃝

Does the child have this concept? YES or NO

Has the child completely grasped the concept of conservation? YES or NO

(When all the above concepts are successfully answered, the concept of conservation is complete.)

1.) Assess for concrete thinking (expected ages 5-12) (everything is white or black, good or bad, smart or stupid, etc.)

To do this, ask the following questions:

I. How would you describe a person who hits another person?

“A bully”, compared him to a classmate with behavioral issues that has hit another person.

II. How would you describe a person who cheats on a test?

 2.) Ask the concrete operational child to explain at least 2 of the idioms under the Formal Operational stage
(below) and record the explanations:

Formal Operational (expected ages 12 – adulthood):

Assess for concrete versus abstract thought by using the following tests:

a) Have the child answer the following:

I. If you were able to have a third eye, where would you put it?

(Younger children generally say that they would put the imagined third eye in the middle
of their forehead. Older children, however, should be able to come up with other,
creative ideas about where to place this hypothetical eye and various ways the eye could
be used. An eye in the middle of one's hand would be useful for looking around corners.
An eye at the back of one's head could be helpful for seeing what is happening behind
them. Such creative ideas represent the use of abstract and hypothetical thinking, both
important indicators of formal operational thought.)

II. If Adam is taller than Brian, and Brian is taller than Scott, who is the tallest?

(Seriation is another new ability gained during this stage and refers to the child's ability
to order objects with respect to a common property.) 

The adolescent child is a 14-year-old girl. She has long brown hair that is well groomed, jeans, a t-shirt,

and running shoes. The patient has a heart rate of 73 and a resting heart rate of 19. The patient’s tone was

sarcastic, excited, and interacted with the questions while being slightly mean as she stated, “You are just

wasting your time, you’re going to fail anyway.” The patient’s gaze was direct at myself making direct and

indirect eye contact. When the patient got overly energetic, she was able to be consoled when asked to focus.

The patient’s speech was fast, clear, and concise. The patient’s respiratory rate was 19 breaths per minute,

which is within the normal limits of 16-20 breaths per minute. The patient sat still, slouched posture, with

moments of changing position, the patient had normal intercostal contractions when breathing, and had a lot of

energy, but did not present anxious. The adolescent skin was cool, slightly moist, and pink color appropriate for

ethnicity. The patient had a heart rate of 73 beats per minute which is within normal limits of 50 to 100 beats

per minute.
 The adolescent was both excited, sarcastic, and seemed to be playfully mean for the sake of finding it

funny. The adolescent was alert and oriented to person, place, time, event, and task. When asked to describe a

person who hits another person the adolescent went on a tangent on what the person has done to deserve being

hit? Is the person being hit a bad human being? Did they just hit them for no reason? Is this a case of self-

defense? The patient refused to give a black and white answer without further detail. When describing a person

who cheats on a test? They responded by saying that they were taught never to cheat but can understand the

appeal to cheating and would not judge a person off of it. When describing where to put a third eye, they

responded with, “the back of their head so that they could always see behind them.” She responded that, “Adam

is the tallest since he is taller than Brain and Scott.” The 4 idioms chosen were “You can’t judge a book by its

cover.”, “The early bird catches the worm.”, “You can’t teach an old dog new tricks.”, “Caught between a rock

and a hard place.” She responded that “You can’t judge a book by its cover,” means, “you should not judge a

person off their appearance.” “The early bird catches the worm,” was described as, “the person who acts first

gets the reward.”

When asked to describe, “You can’t teach an old dog new tricks,” She responded, “A person who doesn’t want

to learn anything knows because they are lost in their ways.” The last idiom was, “Caught between a rock and a

hard place,” and she responded with, “Stuck between two losing or unfavorable choices.” The adolescent is in

the later stage of formal operations. Even though she can be harsh, she can put herself in different points of

views that others may have. She has learnt to be adaptive and flexible and can see the meaning of symbols,

objects, and come to logical conclusions. The adolescent can develop hypothesis and test these hypotheses. For

example, she thought she could get out of babysitting her younger sibling if she faked being sick, however,

when tested with her mother, it did not work. This is the final stage into adulthood, and her ability to become

flexible, and adaptable will grow. She will gain more conclusions and her hypothesis will become more

accurate as she gains more experience. Finally, she will not just be able to see another person’s perspective, but

also the complexities involved with their point of view. For example, she will know the implications of her
actions and how they will affect their emotions, and possibly their future. Formal operations can always be

sharpened and improved with learning and experience as we grow older.

1.) Assess for concrete thinking (expected ages 5-12) (everything is white or black, good or bad, smart or stupid, etc.)

To do this, ask the following questions:

I. How would you describe a person who hits another person?

II. How would you describe a person who cheats on a test?

2.) Ask the concrete operational child to explain at least 2 of the idioms under the Formal Operational stage
(below) and record the explanations:

Formal Operational (expected ages 12 – adulthood):

Assess for concrete versus abstract thought by using the following tests:

a) Have the child answer the following:

I. If you were able to have a third eye, where would you put it?

(Younger children generally say that they would put the imagined third eye in the middle
of their forehead. Older children, however, should be able to come up with other,
creative ideas about where to place this hypothetical eye and various ways the eye could
be used. An eye in the middle of one's hand would be useful for looking around corners.
An eye at the back of one's head could be helpful for seeing what is happening behind
them. Such creative ideas represent the use of abstract and hypothetical thinking, both
important indicators of formal operational thought.)

II. If Adam is taller than Brian, and Brian is taller than Scott, who is the tallest?

(Seriation is another new ability gained during this stage and refers to the child's ability
to order objects with respect to a common property.) 

b) Ask the Formal Operational child to explain at least four (4) common idioms. Please include his/her
explanations. The following are examples – you may use others that you know. (Answers which show an
understanding of the hidden or deeper meanings in the idioms indicate more abstract thinking.)

“You can’t judge a book by its cover.”

“Don’t count your chickens before they hatch.”

 “People in glass houses shouldn’t throw stones.”

“Every cloud has a silver lining.”

“Caught between a rock and a hard place.”

“When it rains, it pours.”

“You can’t teach an old dog new tricks.”

“What goes around, comes around.”

“All that glitters is not gold.”

“The early bird catches the worm.”

“Birds of a feather flock together.”

“If you lie down with dogs, you get up with fleas.”

“The grass is always greener on the other side of the fence.”

“An ounce of prevention is worth a pound of cure”.

References
aelsinax, & Davis, J. (2008, July 8). Pediatric assessment triangle. YouTube. Retrieved October 10, 2022, from

https://www.youtube.com/watch?v=ssqwGjwSI_8&ab_channel=JamieDavis

Holman, H. C., Johnson J., McMichael, M. G., Sommer, S., Wheless, L., Wilford K., & Williams, D. (2021).

Content Mastery Series Review Module: RN Nursing Care of Children, 11th edition. Ati.
Perry, S. E., Hockenberry, M. J., & Olshansky, E. F. (2018). Maternal child nursing care, sixth edition. Elsevier.