INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR

CHILD HEALTH NURSING

ASSESSMENT OF NEONATE
I. Identification data
1. Name
2. Age
3. Sex
4. Address
5. IP No
6. Ward
7. Date of admission
8. Date of assessment
9. Date of birth
Term/preterm
SGA/AGA/LGA
10. Diagnosis
11. Chief complaints (reason for admission)
II. Present medical history – onset, symptoms, duration, precipitating factors/aggravating
factors, vitals on admission, immediate treatment received and current treatment
III. Family history – Family tree, Family history of illness (hereditary/ communicable), risk
factors, congenital problems, psychological problems
IV. Socioeconomic status – monthly income, expenditure on health, food, education, number
of earning members
V. Birth history
Antenatal - maternal history, previous obstetrical history, current pregnancy
Intra natal -Mode of delivery, Apgar score, cried soon after birth / resuscitation required or
not, Birth weight
Neonatal – Uneventful, any deviations (Hyperbilirubinemia, RDS, Congenital anomalies,
seizures etc) Breast fed within ½ - 1hr of birth, meconium & urine passed or not
VI. Immunization history
VII. Dietary history – Exclusively breast fed/ prelacteal feeds
VIII. Personal history – Sleep pattern, Elimination pattern (Bowel and bladder)
IX. Physical examination
General appearance
Posture – flexion of head and extremities /extended extremities
Cry – Feeble/vigorous, Shrill, Hoarse, and High pitched
Colour – Jaundice, Cyanosis, Pallor, Pink
Vital signs Normal Value Child Value Remarks

Temperature Axillary 36.5 – 37°C (97.7 – 98°F)

Heart rate (Apical) 120 – 140 beats/mt
Respiration 30 – 60 breaths/mt
Head to foot examination
SI.NO Anthropometric Normal Value Child Value Remarks
measurements
1. Weight 2500 -4000gm
2. Height 48-52cm
3. Headcircumference 33 - 35cm
4. Chestcircumference 30.5 - 33cm, 1.2 cm less than
H.C
Skin
Normal – Color – Pink to rosy red
Texture – smooth, soft, on 2nd to 3rd day flaky, dry peeling in hands and feet
Turgor – elastic, returns immediately to normal shape after pinching
Vernix Caseosa, Milia across the bridge of nose, forehead, or chin
Lanugo, Rashes, Erythema Toxicum, Mongolion Spots, Birthmarks, Bruises,
Harlequin color change
Abnormal - Edema around eyes, face, legs, dorsum of hands, feet and scrotum or labia
Yellow tinge/ generalized cyanosis/ pallor / plethora/ acrocyanosis, Petechiae,
Ecchymosis
Head
Normal – Appearance – Round, symmetric and moves easily from left to right and up and
down, soft and pliable
Size – (related to body) greater than chest circumference, head one fourth of the
body size
Common variations – moulding, caput succedaneum, cephal hematoma
Fontanels
Anterior – Diamond shaped, open .Posterior – Triangle shaped, open
Pulsation – slight pulsation
Abnormal – Fused sutures, bulging or depressed fontanels when quiet, widened sutures and
fontanels.
Eyes
Normal – Lids usually edematous
Color – slate gray, brown,Absence of tears
 Reflexes –Pupillary reflex in response to light, Blink reflex in response to light
or touch,Rudimentary fixation on objects and ability to follow to midline
Epicanthal folds, nystagmus.
Abnormal – Purulent discharge, upward slant ,Hypertelorism (>3cm)Hypotelorism
Congenital cataract,Constricted or dilated fixed pupil
Absence of papillary reflux, inability to follow object or bright light to midline,
yellow sclera
Ears
Normal – Position – top of pinna on horizontal line with outer canthus of eye
Startle reflex elicited by loud and sudden noise, pinna flexible, and cartilage
present
Abnormal – Low placement of ears, Absence of startle in response to loud noise
Nose
Normal – Bilateral Nares patent or not
Nasal discharge: thin/ white/ mucoid
Sneezing present or not, nasal bridge – flattened
Abnormal – non patent canals, thick, bloody nasal discharge, flaring of nostrils, single nasal
canal
Mouth and throat
Normal – Intact, high arched palate, uvula in midline, frenulum of tongue, frenulum of
upper lip,
Sucking reflex – strong and coordinated .Rooting reflex, gag reflex present
Absent or minimum salivation ,Vigorous cry
Precocious teeth: present/absent, Epstein pearls
Abnormal – cleft lip, cleft palate, large protruding tongue, profuse salivation, drooling
Candidiasis, Hoarse, high pitched, weak, absent or other abnormal cry
Neck
Normal – short thick, usually surrounded by skin folds
Tonic neck reflex present
Abnormal – Excessive skin folds or webbing, reistance to flexion
Absence of tonic neck reflex, fractured clavicle
Chest
Normal – Round in shape, Slight sternal retractions evident during inspiration
Breast enlargement Funnel chest, supernumerary nipples, and secretion of
milky substance from breasts (witch’s milk)
Abnormal – Depressed sternum, marked retractions of chest and intercostals spaces during
respiration, redness and firmness around nipples, wide spaced nipples
Abdomen
Normal – Cylindrical in shape, Whartson’s jelly, Veins are visible
Umbilicus – Two arteries and one vein
Abnormal – Abdominal distension, localized bulging, distended veins, absent bowel sounds,
ascites, enlarged liver or spleen, visible peristaltic waves, scaphoid or concave
abdomen, moist umbilical cord, presence of only one artery in cord,
periumbilical erythema, cord bleeding, hematoma, omphalocele, gastrochisis
Genitalia (female)
Normal – labia and clitoris usually edematous, urination within 48hr,
Pseudomenstruation
Abnormal – enlarged clitoris with urethral meatus at tip, fused labia, absence of vaginal
opening, meconium from vaginal opening, no urination in 48hrs,, ambiguous
genitalia
Genitalia (male)
Normal – Urethral meatus at tip of glans penis, testes palpable in each scrotum, scrotum
usually large, edematous, pendulous, and covered with rugae, usually deeply
pigmented in dark skinned, urination within 48 hrs
Abnormal – Hypospadias, epispadias, chordee, testes not palpable in scrotum or inguinal
canal, no urination in 48hrs, inguinal hernia, ambiguous genitalia
Back and rectum
Normal – spine intact, no openings, masses, or prominent curves, patent anal opening,
passage of meconium within 24hrs
Green liquid stools in infant under phototherapy.
Abnormal – anal fissures or fistulas, imperforate anus, no meconium within 24 hrs, pilonidal
cyst or sinus, tuft of hair along the spine, spina bifida
Extremities
Normal – 10 fingers and toes, full range of motion, creases on anterior 2/3 rd of the sole,
deep crease on plantar surface of foot between 1 st and 2nd toes
Abnormal – polydactyly, syndactyly, hyperflexibility of joints, persistent cyanosis of nail
beds, yellowing of nail beds, transverse palmar (simian) crease, fractures,
decreased or absent range of motion, dislocated hip
Reflexes- Rooting,Sucking,Swallowing,Gag , Blinking ,Glabellar reflex,Tonic Neck,
Moro,Grasping – palmar & plantar Grasp,Babinski`s reflex,Dancing/Stepping ,Doll`s eye reflex
Conclusion
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING
ASSESSMENT OF AN INFANT
I. Identification data
1. Name
2. Age
3. Developmental age group : Infant
4. Sex
5. Address
6. IP No
7. Ward
8. Date of admission
9. Date of assessment
10. Diagnosis
11. Informant
II. Chief complaints (reason for admission)
III. Present medical history – onset, symptoms, duration, precipitating
factors/aggravating factors, vitals on admission, immediate treatment received and
current treatment
IV. Past health history (Medical and Surgical)
V. Family history – Family tree, Family history of illness (hereditary/ communicable),
risk factors, congenital problems, psychological problems
VI. Socioeconomic status – monthly income, expenditure on health, food, education,
number of earning members
VII. Birth history
Antenatal - maternal history, previous obstetrical history, current pregnancy
Intra natal - Mode of delivery, Apgar score, cried soon after birth/ resuscitation
required, Term/preterm, Birth weight (SGA/AGA/LGA)
Neonatal – Uneventful, any deviations & hospitalization (Hyperbilirubinemia, RDS,
Congenital anomalies, seizures etc) Breast fed within ½ - 1hr of birth, meconium &
urine passed
VIII. Immunization history – Specify the Immunizations taken
Sl no Name of vaccine Recommended given /Not given Remarks
Age

5
IX. Nutritional history – Exclusively Breast feed/Not, Formula feed, weaning
started/Not (food items included in weaning foods), any food allergies
X. Personal history – Sleep pattern, Elimination pattern (Bowel and bladder)
XI. DEVELOPMENTAL HISTORY - Major Mile stones attained
Sl.no Milestones of development Age expected Age attained Remarks

XII.PHYSICAL EXAMINATION
1) General appearance
2) Vital signs
Vital parameter Normal range In child Inference
Temperature 98-99°F (36.6-37.2°C)
Pulse 90-120 bpm
Respiration 30-40/ mt
Blood pressure 90/60 mm of hg

3) Head to foot examination 4) Systemic examination

XIII) GROWTH AND DEVELOPMENT ASSESSMENT
Domain of development Normal In child Inference
1) BIOLOGICAL/PHYSICAL DEVELOPMENT
Anthropometry (nutritional assessment)
a) Weight = 3-12 months- Age in months + 9
2
b) Height = (at 6 months ht=65cm, 1 year ht= 75cm)
c) Head circumference = 2 monthly increments of 4+3+2+1+1+1
Dyne’s formula for HC = length in cm + 9.5 (±) 2.5
(< 2years of age) 2
d) Chest circumference =
Head circumference = Chest circumference by 1 year
Dentition =Incisors 6 – 10 months, Molars 10 – 16 months
(No of primary teeth = Age in months – 6)
Fontanelles = Posterior closes by 1.5 months, Anterior closes by
1.5years - Closed/open, pulsatile/non pulsatile -Normal/ depressed/bulging
2) SENSORY DEVELOPMENT
Vision
Birth – Visual fixation and following in a range upto 45°
Bright light produces blinking with constriction of pupils
1 month – follows up to 90°.
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2 month – social smile can follow objects to midline, tears present
3 month – follows up to 180°. Fixates on near objects, Dolls eye response
disappears
4 month – binocular vision established
6 months – Inspects hands, Can fixate on object at 3 feet, has hand eye
coordination, Adjusts position to see objects
8 months – has depth perception
10 months – can follow rapidly moving objects, recognizes pictures of objects
Normal/ any deviations
Hearing
< 3months – quietens to familiar voice
Responds to loud noise by startle reaction, facial grimace, blink,
cry if quiet, increase in heart beat slowing of respiration
3 month – turns head to the side from where sound is heard
4 month – turns head towards sound and eyes look in the same direction
5–6month – turns head to one side and then downward if the sound is made
below the ear
6 month – turns head to one side and then upwards when the sound is
made above the level of the ear, imitates sound
6–7month – turns head in a curving arc towards the sound source. Responds
to own name
8 –10 months – head is turned directly and diagonally towards the sound
9 –12month – knows the meaning of several words, including the name of
members in the family
1 year – able to localize a sound source
Normal/ any deviations
3) MOTOR DEVELOPMENT
Gross motor development
2 months – head in plane of body on ventral suspension
3-4 months – head control
5 months – rolls from abdomen to back
6 months – rolls from back to abdomen, sits with support
8 months – sits without support with back straight
9 - 10 months – pulls to stand from sitting by self
Creeps, crawls on belly, cruises, drink from cup
7
11 months – stands without support with wide base
12 months – walks 1 – 2 steps,Climbs on sofas and chairs
Normal/any deviations
Fine motor development
2 months – Develops Voluntary grasp
4 months – grasps objects and takes to mouth
6 months – hand eye coordination, Transfers objects from hand to hand,
takes feet to mouth,Can release objects, Able to hold objects
8 months – hand mouth coordination
10 months – Holds crayons adaptively
Isolated use of fingers
12 month – pincer grasp, spontaneous scribbling
Try to feed self with cup and spoon but spills the contents
Normal/deviations if any
4) COGNITIVE DEVELOPMENT - According to PIAGET Theory:
Sensori-motor stage
Birth to 1 month – Sub-stage I – reproduction of reflex action
1 – 4month – Sub-stage II – Primary Circular Reaction
Repeats actions of own body voluntarily
4 – 8 month – Sub-stage III – Secondary Circular Reaction
Repeats actions that affect an object to get a response
8 – 12 month – Sub-stage IV – coordination of secondary schemas
Object permanence (searching for hidden objects)
Imitates and models behaviour, Enjoys peek a boo game
Attempts to flee from unpleasant events, shakes head for NO
Appears interested in picture books
Normal/deviations if any
5) LANGUAGE DEVELOPMENT
1 month – responds to human voices, opens and closes mouth as adult
speaks, begins to coo
3month – alerts to sound, cry patterns develop, makes cooing sound
4 month – oriented to voice, laughs aloud, listen to speaker
6 month – responds when own name is called, babbling, vocalizes to mirror
Image

8
8-10 month – call dada and mama with meaning, responds to own name, says
‘bye bye’
12 month – imitates speech, understands name, responds to simple verbal
requests, communicates by pointing to objects, speaks more than
two words
Normal/deviations if any
6) PSYCHOSOCIAL DEVELOPMENT According to Erikson theory
Trust versus mistrust (Sense of Trust)
2 months – social smile
4months – shows happiness on sight of food
Enjoys cuddling and motion
5-6 months – stranger anxiety
Extends arms to be held
10months – says ‘bye bye’
12 months – social games, peek - a - boo
Offers objects to familiar adults
Talks to mirror image
Normal /deviations if any
7) PSYCHOSEXUAL DEVELOPMENT According To Freud theory
Oral stage –gratification by sucking and swallowing needs
First half of infancy - oral passive substage
Second half of infancy - oral aggressive substage
8) MORAL DEVELOPMENT - According to KOHLBERG’S theory:
Preconventional morality: Egocentrism (0-2 years): (the good is what I like & want)
9) SPIRITUAL DEVELOPMENT – According to FOWLER’S theory of FAITH:
Undifferentiated - Feelings of trust, warmth, and security form the foundation for
the development of faith, not capable of formulating or communicating any conceptual
ideas about self or environment

10) Play
Sense Pleasure play &
Solitary play
Conclusion
Normal / deviations if any

9
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING
ASSESSMENT OF TODDLER (1-3 years)
I. Identification data
1. Name
2. Age
3. Developmental age group : Toddler
4. Sex
5. Address
6. IP No
7. Ward
8. Date of admission
9. Date of assessment
10. Diagnosis
11. Informant
II. Chief complaints (reason for admission)
III. Present medical history – onset, symptoms, duration, precipitating
factors/aggravating factors, vitals on admission, immediate treatment received and
current treatment
IV. Past health history (Medical and Surgical)
V. Family history – Family tree, Family history of illness (hereditary/ communicable),
risk factors, congenital problems, psychological problems
VI. Socioeconomic status – monthly income, expenditure on health, food, education,
number of earning members
VII. Birth history
Antenatal - maternal history, previous obstetrical history, current pregnancy
Intra natal -Mode of delivery, Apgar score, cried soon after birth/ resuscitation
required, Term/preterm, Birth weight (SGA/AGA/LGA)
Neonatal - Uneventful, any deviations & hospitalization (Hyperbilirubinemia, RDS,
Congenital anomalies, seizures etc) Breast fed within ½ - 1hr of birth, meconium &
urine passed
VIII. Immunization history – Specify the Immunizations taken
Sl Name of vaccine Recommended given /Not given Remarks
no Age
10
IX. Nutritional history – Exclusively Breast fed/Not, Formula feed, age at weaning
started,any food allergies, likes/dislikes, Calculate Degree of malnutrition
X. Personal history – Sleep pattern, Elimination pattern (Bowel and bladder)
XI. DEVELOPMENTAL HISTORY - Major Mile stones attained
Sl Milestones of development Age expected Age attained Remarks
no

XII.PHYSICAL EXAMINATION 1) General appearance

2) Vital signs
Vital parameter Normal range In child Inference
Temperature 98-99°F (36.6-37.2°C)
Pulse 110 ± 20bpm
Respiration 26-28/ mt
Blood pressure 99/64 ± 26/24mmof hg

3) Head to foot examination 4) Systemic Examination

XIII) GROWTH AND DEVELOPMENT ASSESSMENT
Domain of development Normal In child Inference
1) BIOLOGICAL/PHYSICAL DEVELOPMENT
Anthropometry (nutritional assessment)
a) Weight = 1-6 year Age in years × 2 + 8
b) Height = 2-12year Age in years × 6 + 77
(At 2year ht= 90cm & at3year ht= 95cm)
c) Mid-arm circumference = 13.5-16.5cm on left arm
d) Chest circumference =
e) Head circumference = (at 2year hc= 48cm & at 3year hc= 49cm)
Dyne’s formula for HC = length in cm + 9.5 (±) 2.5
(< 2years of age) 2
Dentition = Molars 10 – 16 months
Approximately16 temporary teeth - 24 months
Full set of 20 temporary teeth - 30 months
(No. of primary teeth = Age in months – 6)
Fontanelles = Anterior closes by 1.5 years
Closed/open, pulsatile/non pulsatile,
Normal/ depressed/bulging
2) SENSORY DEVELOPMENT

11
1- 2 Years - Vision

• Binocular vision fully developed

• Looks at pictures intently for prolonged periods of time.
• Can identify geometric forms and place round object into its appropriate place or
hole.
• Can see better, thus have intense interest in pictures.
• Identifies various shapes.
Hearing
• Sound localization indicated by head movements in all planes.

2-3 Years

• Accommodation well developed

• Inserts square object into its appropriate place or hole

3) MOTOR DEVELOPMENT
1- 2 Years I. Gross Motor

• Stands without help

• Walks well
• Creep up stairs
• Walk upstairs, sideways and backwards
• Pulls and pushes toys

II Fine Motor
• Scribbles
• Pokes finger in hole
• Holds cup
• Removes socks
• Open boxes
• Can make tower of 3-4cubes
• Turns 2-3 pages at a time
• Can eat with spoon
• Plays with food
• May untie shoes
• Removes simples garments

2-3 Years I. Gross Motor

• Steady gait
• Walk on tip –toes
• Walks up and down stairs holding wall
• Run more quickly in a controlled way, Can stand on one foot
• Jumps well , Can throw large ball over head

II Fine Motor

• Picks up objects from floor

• Can build tower of 6-7 cubes
• Imitates vertical line

12
 • Turns pages, one at a time
• Drinks with glass
• Pulls garments , eg: socks
• Can brush teeth with help
• can feed self
• Can button and unbutton clothes
• Places simple shapes in correct holes

4) COGNITIVE DEVELOPMENT – According to PIAGET Theory

Sensori – motor (0-2year) and preoperational thought (2-7yrs)
1- 2 Years

• Extremely curious
• Identifies geometric shapes
• Opens doors and drawers
• Points to body parts
• Egocentric thinking and behaviour
• Beginning sense of time; waits in response to ‘just a minute ‘

2-3 Years

• Animism
• Increasing attention span
• Understanding of cause and effect relationships is determined by proximity of
two events( therefore the child should be disciplined immediately)

5) LANGUAGE DEVELOPMENT

1- 2 Years -Receptive language

• Recognizes names of body parts

• Comprehends more than communicating
• Understands & responds to simple commands
• Enjoys stories with pictures
Expressive language
• Says 2-6 words
• Names familiar pictures or objects
• Uses gestures more than words to make needs known
• Use of words may be quite inconsistent
• 20 words vocabulary

2-3 Years - Receptive language

• Enjoys stories without pictures

• Understands & responds to commands

Expressive language

• Make simple two or three word sentence

• Knows full name

13
 • Uses pronouns “I”,”me”,”mine” & plurals
• Knows at least 4 body parts
• Has vocabulary of 300 words
• Refer to self by name
• Knows at least 5 body parts.
• Can speak sentence of 4-5 words.
• Asks ‘why’

6) PSYCHOSOCIAL DEVELOPMENT - According to Erikson theory

Autonomy Vs Shame& Doubt (Sense of autonomy)
1- 2 Years
• Egocentric
• Hugs and kisses
• Imitates parents
• Resistant to sitting still on laps
• Wants to move independently
• Imitates adult roles and house works
2-3 Years

• Enjoys play with dolls & cars

• Will do simple house hold tasks
• Knows own sex
• Shows temper tantrums
• Enjoys parallel play
• Possessive of own toys and body

7) PSYCHOSEXUAL DEVELOPMENT - According To Freud theory

Anal stage –Toilet training (started at what age, whether the child enjoys or not)
- Bowel & bladder control (attained or not. If attained, at what age)
8) MORAL DEVELOPMENT -According to KOHLBERG theory:
Preconventional morality: Egocentricism (0-2 years): (the good is what I like and
want) No moral concepts or rules exist &
Punishment –obedience orientation (2-4yrs) (right or wrong determined by physical
consequences)
9) SPIRITUAL DEVELOPMENT – According to FOWLER theory of FAITH:
Intuitive -Projective faith
Learns to imitate the religious customs and behaviour of parents
Mimics the religious gestures although does not comprehend meaning
10) Play -Parallel play
Conclusion
Normal / deviations if any

14
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING
ASSESSMENT OF PRESCHOOLER (3-5 years)
I. Identification data
1. Name
2. Age
3. Developmental age group: Preschooler
4. Sex
5. Address
6. IP No
7. Ward
8. Date of admission
9. Date of assessment
10. Diagnosis
12 Informant
II. Chief complaints (reason for admission)
III. Present medical history – onset, symptoms, duration, precipitating
factors/aggravating factors, vitals on admission, immediate treatment received and
current treatment
IV. Past health history (Medical and Surgical)
V. Family history – Family tree, Family history of illness (hereditary/ communicable),
risk factors, congenital problems, psychological problems
VI. Socioeconomic status – monthly income, expenditure on health, food, education,
number of earning members
VII. Birth history
Antenatal - maternal history, previous obstetrical history, current pregnancy
Intra natal - Mode of delivery, APGAR score, cried soon after birth/ resuscitation
required, Term/preterm, Birth weight (SGA/AGA/LGA)
Neo natal – Uneventful, any deviations & hospitalization(Hyperbilirubinemia, RDS,
Congenital anomalies, seizures) Breast fed within ½ - 1hr of birth ,meconium & urine
passed
VIII. Immunization history – Specify the Immunizations taken
Sl Name of vaccine Recommended given /Not given Remarks
no Age

15
IX. Nutritional history – Exclusively Breast fed/Not, Formula feed, age at weaning
started, food allergies, Likes /Dislikes, Calculate Degree of Malnutrition
X. Personal history – Sleep pattern, Elimination pattern (Bowel and bladder)
Schooling ,Habits
XI. DEVELOPMENTAL HISTORY - Major Mile stones attained
Sl Milestones of development Age expected Age attained Remarks
no

XII.PHYSICAL EXAMINATION 1) General appearance

2) Vital signs
Vital parameter Normal range In child Inference
Temperature 98-99°F (36.6-37.2°C)
Pulse 70-110 bpm
Respiration 20-30/mt
Blood pressure

3) Head to foot examination 4) Systemic examination

XIII) GROWTH AND DEVELOPMENT ASSESSMENT
Domain of development Normal In child Inference
1) BIOLOGICAL DEVELOPMENT
Anthropometry
a) Weight = Age in years × 2 + 8
b) Height = Age in years × 6 + 77
c) Mid-arm circumference =13.5-16.5cm
d) Dentition = Full set of 20 temporary teeth
2) SENSORY DEVELOPMENT
Vision – Colour vision fully intact
4 years –cooperates with Snellen testing
5 years – recognizes colours
Hearing – cooperates with systematic audiometric tests
Clues to hearing deficit include volume of TV, responds of child to questions
3) MOTOR DEVELOPMENT
Gross motor development
3 years
• Walk back ward in a straight line, and on tip toes
• Catch ball with extended arms, and can kick a ball
• Can jump from a height of several inches

16
 • Ride tricycle using pedals and turn wide corners
4 years
• Run on tiptoes
• Balances on one foot for 3-5 seconds
• Pedal a tricycle quickly and turn sharp corners,
• Catch ball with extended arms and with hands
• Hops on preferred foot, Climbs ladders, trees, playground equipment
• Alternates feet when descending stairs
5 years
• Skips, alternates feet
• Jumps rope, and jumps over objects, Imitates dance steps if taught
• Catch a ball smoothly with hands
• Balance on one foot for 8-10seconds, Use Roller skates
Fine motor development
3 years
• builds tower of 9 -10 blocks, Copies a circle
• Uses blunt scissors with one hand to cut
• Shows preference for handedness ,Puts beads on string
• Can help with simple household tasks
• Dressing skills – Can put on coat without assistance, and undress self
• Toileting and grooming skills – Can pull pants up and down and go to toilet
alone, and Brush teeth with help
4 years
• Copies a square, draws a simple face
• Cuts around picture with scissors
• Feeding skills – manages spoon with little spills
• Dressing skills – buttons side buttons, small buttons, can put on socks with
help, Knows back from front of clothes
• Toileting and grooming skills – bathe with assistance
• Washes and dries hands without supervision
5years
• Copies a triangle
• Crosses vertical lines, Copies letters
• Able to write own name ,Draws a three part man
17
 • Dressing skills – may be able to lace shoes, manages zippers in back
• Toileting and grooming skills – Wipes self independently, Flushes toilet after
each use, Bathes self, Combs hair with help
4) COGNITIVE DEVELOPMENT – According to PIAGET Theory
Preoperational thought (2-7yrs) - Characterised by language acquisition
- Thinking egocentric, becomes magical, imitation,
5) LANGUAGE DEVELOPMENT
Receptive language – understands directives (on, under, in front)
Expressive language – names one or more colours correctly, uses I, counts to 10, uses
3-7 word sentences, has a vocabulary of 1500 words
6) PSYCHOSOCIAL DEVELOPMENT - According to Erikson theory
Initiative vs. Guilt (Sense of initiativeness)
Egocentric, selfish and impatient, physically and verbally aggressive, Jealousy of siblings
7) PSYCHOSEXUAL DEVELOPMENT According To Freud theory: Phallic stage –
Sexually curious,
Electra & Oedipus complex demonstrates strong attachment for parent of opposite
sex
8) MORAL DEVELOPMENT-According to KOHLBERG theory: Preconventional
Morality: Punishment –obedience orientation (2-4yrs) (right or wrong is
determined by physical consequences) &
Preconventional morality: Instrumental hedonism & concrete reciprocity (4-7Yrs)
(Child confirms to rules out of self-interest)
9) SPIRITUAL DEVELOPMENT - According to FOWLER’S theory of FAITH:
Intuitive-Projective faith –
-Learns to imitate the religious customs and behaviour of parents
- Mimics the religious gestures although does not comprehend meaning
- Formulate imagined description of God
-Assimilates some of the values and beliefs of their parents
10) Play
Associative Play
Conclusion
Normal / deviations if any

18
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING
ASSESSMENT OF A SCHOOLER (6 -12 years)
I. Identification data
1. Name
2. Age
3. Developmental age group : Schooler
4. Sex
5. Address
6. IP No
7. Ward
8. Date of admission
9. Date of assessment
10. Diagnosis
12. Informant
II. Chief complaints (reason for admission)
III. Present medical history – onset, symptoms, duration, precipitating
factors/aggravating factors, vitals on admission, immediate treatment received and
current treatment
IV. Past health history (Medical and Surgical)
V. Family history – Family tree, Family history of illness (hereditary/ communicable),
risk factors, congenital problems, psychological problems
VI. Socioeconomic status – monthly income, expenditure on health, food, education,
number of earning members
VII. Birth history
Antenatal - maternal history, previous obstetrical history, current pregnancy
Intra natal -Mode of delivery, APGAR score, cried soon after birth/ resuscitation
required, Term/preterm, Birth weight (SGA/AGA/LGA)
Neo natal – Uneventful, any deviations & hospitalization (Hyperbilirubinemia, RDS,
Congenital anomalies, seizures) Breast fed within ½ - 1hr of birth, meconium & urine
passed
VIII. Immunization history – Specify the Immunizations taken
Sl.no Name of vaccine Recommended Age given /Not given Remarks

19
IX. Nutritional history – Exclusively Breast fed/Not Formula feed
Age at weaning started, food allergies, likes/ dislikes
X. Personal history – Sleep pattern, Elimination pattern (Bowel and bladder)
Schooling ,Hobbies
XI. DEVELOPMENTAL HISTORY - Major Mile stones attained
Sl.no Milestones of development Age expected Age attained Remarks

XII.PHYSICAL EXAMINATION 1) General appearance

2) Vital signs
Vital parameters Normal range In child Inference
Temperature 98-99°F (36.6-37.2°C)
Pulse 70-110 bpm
Respiration 20-30/mt
Blood pressure

3) Head to foot examination 4) Systemic examination

XIII) GROWTH AND DEVELOPMENT ASSESSMENT
Domain of development Normal In child Inference
1) BIOLOGICAL DEVELOPMENT
Anthropometry
a) Weight = Age in years × 7 – 5
2
b) Height = Age in years × 6 + 77
Dentition - Permanent teeth eruption
Sl no Permanent teeth Maxillary Mandibular
1. Central incisors 7-8 yrs 6-7 yrs
2. Lateral incisors 8-9 yrs 7-8 yrs
3. Canines 11-12 yrs 9-11 yrs
4. First premolars 10-11 yrs 10-12 yrs
5. Second premolars 10-12 yrs 11-13 yrs
6. First molars 6-7 yrs 6-7 yrs
2) SENSORY DEVELOPMENT
Vision – Normal adult value
3) MOTOR DEVELOPMENT
Gross motor development
6-8yrs
• rides bicycle without training wheels
• Runs, jumps, climbs, hops
• Constantly in motion
20
 • Clumsy and awkward
• Coordination improving
8 -10 yrs
• Performs tricks on bicycles, races
• Begins to participate in organized sports, like basketball, soccer, cricket
• Throws a ball skilfully; overhand and underhand
10 -12 yrs
• Enjoys all physical activities
Fine motor
6-8yrs
• knows right hand from left
• Draws a person with 12 -16 parts
• Writes words; learns cursive writing
• Has improved eye hand coordination
8 -10 yrs
• Uses both hands independently
• Draws a person with 18-20 parts
• Has increased smoothness and speed in fine motor control
• Writes fluently; cursive writing improved
10 -12 yrs
• Coordination continues to improve
4) Self care
6-8yrs
• Feeding skills – likes to eat with fingers, stuffs food in mouth, talkative while
eating
At 7 years
• Feeding skills - improved table manners, less talking
• Grooming and dressing skills – self care managed, Needs to be reminded to wash
hands
• May need some help with dressing
• Wears whatever is selected by parents
• Leaves clothes where they are removed
• Can comb and brush hair
8 -10 yrs
21
 • Feeding skills – handles eating utensils skilfully
• Dressing and grooming skills – dresses self completely; enjoys selecting own
clothes
• Unaware of dirty clothes
• Needs to be reminded to brush teeth
10 -12 yrs
• Feeding skills – criticises table manners of parents
• Dressing and grooming skills - may wear some clothes continually, leaves
clothes where they fall, enjoys wearing current style of clothes, needs constant
reminding of personal hygiene, bathes frequently
5) COGNITIVE DEVELOPMENT According to PIAGET Theory
Preoperational thought - (2-7yrs)
• Increasing attention span
• Can describe objects in picture, knows their use
• Concept of cause and effect
• Can tell time, knows date, month and season
• Follows rules to avoid punishment
Concrete operational thought - (7-11yrs)
• Understands and use abstract symbols and carries out mental operations
• Interested in school work, ashamed of failures
• Rebels against authority
• Understands explanations
Formal operational thought (11yrs – adulthood)
• Abstract and deductive reasoning
• Use problem solving method, define abstract terms, interested in why and how
• Thinks about vocation
6) LANGUAGE DEVELOPMENT
6-8yrs
• Follows series of 3 commands, response dependent on mood
• Responds to praise and recognition
• Can repeat sentences of 10 to 12 words
• Has a vocabulary of 2500 words. Uses all forms of sentence structures, sense of
humor, enjoys telling jokes
8-10yrs
22
 • Follows suggestions better than commands
• Uses shorter and more compact sentences
10-12 yrs
• Oral vocabulary of 7200 words, reading vocabulary of 50,000 words, uses
numbers beyond 100 with meaning, enjoys riddles
7) PSYCHOSOCIAL DEVELOPMENT - According to Erikson theory
Industry vs. Inferiority (Sense of industry)
Egocentric, has a know it all attitude, craves attention, fears bodily injury
Hero worship uses coping behaviour, self regulation of behaviour
8) PSYCHOSEXUAL DEVELOPMENT According To Freud theory:
Latency stage – Sexual feelings are firmly repressed by the superego
9) MORAL DEVELOPMENT- According to KOHLBERG theory:
Preconventional morality: Instrumental hedonism & concrete reciprocity (4-7Yrs)
(child confirms to rules out of self-interest) &
Conventional morality: Good boy -good girl orientation (7-12yrs)
• Concern with authority figures, fixes rules in moral decisions
• Concern with obligation to duty
• Accidents or misfortunes interpreted as punishment
&
Post conventional morality: - Law & Order orientation (Begins @12yrs)
• Rights taken on a religious or metaphysical quality, child want to show
respect for authority and maintains social order, obeys rules for their own
sake
10) SPIRITUAL DEVELOPMENT– According to FOWLER theory of faith:
Mythical-Literal
• Distinguishes religious fact from fantasy
• Respects and relies on authoritative figures such as parents, priest
• Attitude of peers towards faith is influential
• Uses fantasies to explain events or facts he/she does not understand
• Learns to differentiate between natural and supernatural
11) Play: Cooperative
Conclusion
Normal / deviations if any

23
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTHNURSING - CARE PLAN FORMAT
HISTORY OF THE PATIENT
I. Identification data
1. Name
2. Age
3. Sex
4. Address
5. IP No
6. Ward
7. Date of admission
8. Diagnosis
12. Informant
II. Chief complaints (reason for admission)
III. Present medical / surgical history – onset, symptoms, duration, precipitating
factors/aggravating factors, vitals on admission, immediate treatment received and
current treatment
IV. Past health history (Medical and Surgical)
V. Family history – Family tree, Family history of illness (hereditary/ communicable),
risk factors, congenital problems, psychological problems
VI. Socioeconomic status – monthly income, expenditure on health, food, education,
number of earning members
VII. Birth history
Antenatal - maternal history, previous obstetrical history, current pregnancy
Intra natal -Mode of delivery, APGAR score, cried soon after birth/ resuscitation
required, Term/preterm, Birth weight (SGA/AGA/LGA)
Neo natal – Uneventful, any deviations & hospitalization (Hyperbilirubinemia, RDS,
Congenital anomalies, seizures) Breast fed within ½ - 1hr of birth, meconium & urine
passed
VIII. Immunization history – Specify the Immunizations taken
Sl.no Name of vaccine Recommended Age given /Not given Remarks

IX. Nutritional history – Exclusively Breast fed/Not Formula feed

Age at weaning started, food allergies, likes/ dislikes
X. Personal history – Sleep pattern, Elimination pattern (Bowel and bladder)

24
Schooling, Hobbies
XI. DEVELOPMENTAL HISTORY - Major Mile stones attained
Sl.no Milestones of development Age expected Age attained Remarks

XII.PHYSICAL EXAMINATION 1) General appearance

2) Vital signs
Vital parameters Normal range In child Inference
3) Head to foot examination 4) Systemic examination
XIII) GROWTH AND DEVELOPMENT ASSESSMENT

Slno Normal In child Inference

XIV INVESTIGATIONS

Date Name of Findings Normal Remarks

Investigations Value

XV DRUG FILE
X VI NURSING MANAGEMENT
• List of nursing problems according to priority
• Nursing Care Plan
XVII PROGRESS NOTES

Assessment Nursing Goal/ou Nursing Impleme Evaluation

tcome Rationale
diagnosis intervention ntation

Subjective
data:

Objective
data:

XVIII HEALTH EDUCATION

XIX CONCLUSION
XX BIBLIOGRAPHY

25
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
DRUG FILE- Format

CHILD HEALTH NURSING

Name of the Student:-
Date of Submission:-
Name of Dosage & Action Indicati Contraindication Side Nurses
the drug Route on effects Responsibility

• Trade
Name:-

• Chemic
al
Name:-

26
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTHNURSING – CASE STUDY & CASE PRESENTATION FORMAT
HISTORY OF THE PATIENT
I. Identification data
1. Name
2. Age
3. Sex
4. Address
5. IP No
6. Ward
7. Date of admission
8. Diagnosis
12. Informant
II. Chief complaints (reason for admission)
III. Present medical / surgical history – onset, symptoms, duration, precipitating
factors/aggravating factors, vitals on admission, immediate treatment received and current
treatment
IV. Past health history (Medical and Surgical)
V. Family history – Family tree, Family history of illness (hereditary/ communicable), risk
factors, congenital problems, psychological problems
VI. Socioeconomic status – monthly income, expenditure on health, food, education, number
of earning members
VII. Birth history
Antenatal - maternal history, previous obstetrical history, current pregnancy
Intra natal -Mode of delivery, APGAR score, cried soon after birth/ resuscitation required,
Term/preterm, Birth weight (SGA/AGA/LGA)
Neo natal – Uneventful, any deviations & hospitalization (Hyperbilirubinemia, RDS, Congenital
anomalies, seizures) Breast fed within ½ - 1hr of birth, meconium & urine passed
VIII. Immunization history – Specify the Immunizations taken
Sl.no Name of vaccine Recommended Age given /Not given Remarks

IX. Nutritional history – Exclusively Breast fed/Not Formula feed

Age at weaning started, food allergies, likes/ dislikes
X. Personal history – Sleep pattern, Elimination pattern (Bowel and bladder)
Schooling, Hobbies

27
XI. DEVELOPMENTAL HISTORY - Major Mile stones attained
Sl.no Milestones of development Age expected Age attained Remarks

XII.PHYSICAL EXAMINATION 1) General appearance

2) Vital signs
Vital parameters Normal range In child Inference
3) Head to foot examination 4) Systemic examination
XIII) GROWTH AND DEVELOPMENT ASSESSMENT

Slno Normal In child Inference

X IV DISEASE PROCESS
– Definition -Related anatomy & physiology -Aetiology (book &patient
picture) -Pathophysiology - Clinical manifestations (book &patient
picture) -Diagnostic measures &
Date Name of Findings Normal value Remarks
investigations
-Medical/ Surgical Management - Drug file - Complications - Prognosis
- Nursing Management-
1. List of nursing problems according to priority
2. Nursing care plan

Assessment Nursing Goal/ou Nursing Impleme Evaluation

tcome Rationale
diagnosis intervention ntation

Subjective
data:

Objective
data:

XV HEALTH EDUCATION

XVI DIET PLAN

XVII PROGRESS NOTES

XVIII SUMMARY

XIX BIBLIOGRAPHY

28
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING HEALTH EDUCATION FORMAT

NAME OF THE STUDENT: - DATE OF SUBMISSION:-

SUBJECT- CHILD HEALTH NURSING
TOPIC:-....................
DURATION:-...............
VENUE:- .....................
GROUP:-......................
Previous knowledge of the students: ..................
Method of Teaching: -.......................................
AV Aids:-.....................................................................
GENERAL OBJECTIVE
On completion of the health talk the group acquire.......................
SPECIFIC OBJECTIVES
On completion of the class the group will

Specific Time Content Teachers A V Evaluation

objectives /Learning aids
Activity
❖ Introduction
❖ Content
❖ Summary
❖ Recapitulation
❖ Conclusion
❖ Reference

29
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR

Case presentation - Criteria for evaluation

CHILD HEALTH NURSING
Name of the student:-
Topic: - Date of presentation:-
Sl.No Criteria Marks Marks
Allotted obtained
I Content (1)
II Knowledge about patient history (7)
➢ Identification data 1
➢ Chief complaints on admission 1
➢ History of present illness 1
➢ Past medical history 1
➢ Personal history 1
➢ Family history 1
➢ Socioeconomic history 1
III Patient Assessment (8)
➢ Physical Examination 1
➢ Vital signs 1
➢ Head to foot examination 2
➢ Review of systems 1
➢ Growth and development 2
➢ Investigations 1
IV Disease process (25)
➢ Definition 1
➢ Related anatomy & physiology 1
➢ Ettiolgy (book &patient picture) 2
➢ Pathophysiology 1
➢ Clinical manifestations 2
➢ Diagnostic measures 1
➢ Management 1
➢ Drug file 2
➢ Complications 1
➢ Nursing care plan 3
➢ Health education 2
➢ Diet plan 2
➢ Progress notes 2
➢ Summary 1
➢ Bibliography 1

30
V Presentation 3
1. Voice modulation
2. Group participation
3. Continuity
4. Explanations3
5. Relevancy

VI A.V.Aids
1. Neatness 2
2. Visibility
3. Creativity
4. Variety
VII General appearance 2
a) Grooming
b) Emotional stability
VIII Punctuality 1
IX Presentation-Organization, Neatness, 1
Total 50

Signature of Teacher

31
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING HEALTH EDUCATION FORMAT

NAME OF THE STUDENT: - DATE OF SUBMISSION:-

SUBJECT- CHILD HEALTH NURSING
TOPIC:-....................
DURATION:-...............
VENUE:- .....................
GROUP:-......................
Previous knowledge of the students: ..................
Method of Teaching: -.......................................
AV Aids:-.....................................................................
GENERAL OBJECTIVE
On completion of the health talk the group acquire.......................
SPECIFIC OBJECTIVES
On completion of the class the group will

Specific Time Content Teachers A V Evaluation

objectives /Learning aids
Activity
❖ Introduction
❖ Content
❖ Summary
❖ Recapitulation
❖ Conclusion
❖ Reference

32
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING
Health education - Criteria for evaluation
Name of the Student:-
Topic: - Date of Education:-
Sl.No Criteria Marks Marks
Allotted obtained
I Objectives (2)
a) General objective 1
b) Specific objective 1

II Content (4)
a) Completeness 1
b) Co-ordination 1
c) Language 1
d) Bibliography 1

III Presentation (12)

a) Introduction
1
b) Continuity 1
c) Explanation 2
d) Illustrations 2
e) Relevancy 2
f) Voice modulation 1
g) Group participation 2
h) Summary 1
IV A.V.Aids (4)
a) Neatness 1
b) Visibility 1
c) Creativity 1
d) Variety 1
V General appearance (3)
a) Grooming 1
b) Emotional stability 1
c) Eye contact 1

Total 25

Comments: Signature of Evaluator

33
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
CHILD HEALTH NURSING
DRUG FILE- Evaluation Format
Name of the Student:-
Date of submission:-

SL NO CRITERIA Marks Marks

Allotted Obtained
I Content (5)
a) Organising 2
b) Neatness & Completeness 1
c) Co-ordination 1
d) Total number of drugs 1

II Specific areas (10)

a) Name of the drug 1
b) Dosage & Route 2
c) Action 1
d) Indication 1
e) Contraindication 1
f) Side effects 1
g) Nurses Responsibility 3

TOTAL 15

Signature of Teacher

34
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
- CHILD HEALTH NURSING
DEHYDRATION ASSESSMENT - FORMAT
HISTORY OF THE PATIENT
❖ Identification data
❖ Chief complaints on admission
❖ History
- History of present illness
- Past medical and surgical history
- Personal history
a) Birth history
Antenatal Intranatal Postnatal
b) Nutritional
c) Immunization
d) Family history
e) Socioeconomic history
DEHYDRATION ASSESSMENT

Criteria A B C D
ASK ABOUT Less than 4 liquid 4-10 More than • Longer
• stools per day 10 than 14
DIARRHOEA days
duration
• BLOOD IN
STOOL
• VOMITIN None/ Small Some Very
G amount frequent

• THIRST Normal Greater than Normal Unable to

drink

• URINE Normal A small No urine for 6

amount/dark hrs

LOOK AT Well, alert Unwell,sleepy,irritabl Very sleepy, Severe under

• CONDITIO e unconscious,floppy nutrition
N ,
having fits

• TEARS Present Absent Absent

Normal Sunken Very dry & sunken

• EYES
• MOUTH & Wet Dry Very dry
TONGUE

35
 • BREATHING Normal Faster than normal Very fast and deep
FEEL SKIN Pinch –goes back Goes back slowly Very slowly
quickly

PULSE Normal Faster than normal Very fast, weak,

cannot feel
FONTANELLE Normal Sunken Very sunken

TAKE High fever 38.5or

above
TEMPERATUR
E

DECIDE: Patient has no If the patient has 2 or If 2 or more of If chronic diarrhoea

Degre Of signs of more signs, has got these dander severe under
Dehydration dehydration some dehydration signs has got nutrition or high
severe fever , treat
dehydration accordingly.
If there is blood in
TREATMENT Plan A Plan B
stool and high fever
PLAN suspect dysentery
Plan C and treat with
antimicrobials
BOOK PICTURE PATIENT PICTURE
CONCLUSION

36
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
EVALUATION PERFORMA OF CHILD HEALTH NURSING CARE PLAN

Name of the Student: Patient Name:

Year: IP NO:
Date: Diagnosis:

SI NO CRITERIA FOR EVALUATION MAX.MARKS MARKS -

OBTAINED
I. Assessment
History Collection 1
Physical Examination 1
Assessment of Growth & Development 2
Investigation 0.5
Treatment 0.5
II Nursing Diagnosis
Formulate & list nursing diagnosis 1
Establishing Priority 0.5
III PLANNING
State Objectives 1
Nursing Care plan based on Priority 2
IV Implementation
Carry out nursing care based on priority 3
Meet the play needs 1
V Evaluation
Evaluation of Nursing care based on 2
outcome criteria
VI Recording & Reporting, 1
VII Punctuality 1
VIII Competency in Care 1
IX Health education 1
X Conclusion & Bibliography 0.5
TOTAL 20

SIGNATURE OF TEACHER

37
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
EVALUATION PERFORMA OF CHILD HEALTH NURSING CASE STUDY

Name of the Student: Patient Name:

Year: IP NO:
Date: Diagnosis:

SI NO CRITERIA FOR EVALUATION MAX.MARKS MARKS -

OBTAINED
1 Organisation of content matter according to format 3
2 History including Physical Examination, Investigation 5
& Treatment
3 Assessment of Growth & Development 5
4 Review of Anatomy & Physiology 2
5 Case Overview 5
6 Comparison of book picture with patient picture 3
7 Nursing care plan based on nursing process approach 10
8 Health Education, Diet Plan 4
9 Bibliography 2
10 Use of diagrams, appropriate pictures & AV aids 3
11 Competency in caring for child & family as 4
demonstrated through care plan
12 Progress Notes 2
13 Punctuality 2
TOTAL 50

SIGNATURE OF TEACHER

38
 INSTITUTE OF NURSING EDUCATION, SME, GANDHINAGAR
EVALUATION PERFORMA OF CHILD HEALTH NURSING CASE PRESENTATION

Name of the Student: Patient Name:

Year: IP NO:
Date: Diagnosis:

SI NO CRITERIA FOR EVALUATION MAX.MARKS MARKS -

OBTAINED
I Patient Care Phase &Written Material
1 Organisation of content matter according to format 3
2 History including Physical Examination, Investigation 5
& Treatment
3 Assessment of Growth & Development 5
4 Review of Anatomy & Physiology 2
5 Case Overview 5
6 Comparison of book picture with patient picture 3
7 Nursing care plan based on nursing process approach 10
8 Health Education, Diet Plan 4
9 Bibliography 2
10 Use of diagrams, appropriate pictures & AV aids 3
11 Competency in caring for child & family as 4
demonstrated through care plan
12 Progress Notes 2
13 Punctuality 2
TOTAL 50
II Presentation Phase
1 Physical set up of the room 2.5
2 Introduction to the topic 2.5
3 Knowledge about the patient 5
4 Explanation about the subject matter 10
5 Comparison with the patient 5
6 Use of A V Aids 5
7 Group Interaction 2.5
8 Time Limitation 2.5
9 Summarization & conclusion 3
Personal Qualities
10 Appearance 2
11 Voice Modulation 2
12 Confidence 3
13 Language Command 2
14 Punctuality 3
TOTAL 50
Marks Obtained: Max.Marks:
SIGNATURE OF TEACHER:
39
40
41
42
43
44
45