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METRO MANILA DEVELOPMENTAL SCREENING TEST

A CASE STUDY ON A TODDLER

By: Michael Jones G. Balansag BSN 2A

Chapter I
A. Background of the Study
The study of Metro Manila Screening Test is not an IQ test; it is sought to establish baseline information on the developmental characteristics of Filipino toddlers.

It helps in determining as to what are the developments and progress of child. This is a tool which is used to detect if there are delays on children age 2 weeks - 6 years of age.

B. Objectives

General
Be able to determine and evaluate childs development and developmental delays through the use of MMDST.

Specific To conduct the test which enhances childs ability to participate and cooperate. To let the child do the test items that intersect in her age line and observe if she is able to do the said tasks. To determine the growth and development of the child using MMDST. To help parents identify childs developmental delays and aid them to resolve the delays. To enhance parents willingness in setting plans to resolve these delays. To give recommendations for the family and proposals for the community.

C. Glossary of Terms
a. Age Line a vertical line which intersects test items that a child is going to perform. b. Delay a test item which is failed and falls completely to the left of the age line. c. Failed refers to the inability of a child to perform a test item. d. Fine Motor Adaptive the movement of a child utilizing small groups of muscles e. Full Term the fetus that had reach 38 42 weeks before delivery. f. Gross Motor refers to the movement of a child utilizing large amount of muscles. g. Language the ability of the child to hear, speak and follow directions.

h. Metro Manila Developmental Screening Test (MMDST) a screening instrument used in determining the development of a child. i. Normal Spontaneous Vaginal Delivery (NSVD) refers to the normal delivery of a child through the vagina. j. Passed used to indicate that a child had successfully done a test item. k. Personal- Social the ability of the child to get along with other people. l. Refused indicates that a child did not perform a test item. m. Test item an activity to be done by a child. n. Toddler age period of childhood from 1 year to 3 years old.

D. Significance of the Study

To the client
This

study will bring enjoyment to the child and it enhances childs abilities and capabilities to discover new things to her environment.
will help them understand the childs growth whether the child can perform the developmental tasks at her age.

To the parents
This

To the students
will help students to understand the importance of growth and development through actual evaluation of qualitative and quantitative changes seen in growth and development of children.

study

E. Clients Profile

Name of the client: Cristal Khate B.


Guerra

Age: 1 year and 11 month Sex: Female Birth Date: October 21, 2009 Birth Place: Mercy Maternity Center #10
First Opal Street Near Corner Veloso/Dacudao Agdao/Obrero, Davao City

A. Present Medical Condition

During the time of the assessment the child has no signs or symptoms of health problem. The child appeared to be healthy and was very much energetic during the conduction of the test.

B. Past Medical History

According to the client's mother the child had experienced some illness in the past such as diarrhea, high fever that reached 40 degree centegrade and Thrombocytopenia (reduced platelet count). The mentioned health problems were resolved through management obtained in the clinic and medications were given.

C. Family History
Birth order of the client: 1st child Total number of siblings: 1 Number of living siblings: 1

Heredo- familial Disease:

Father side: Mother side:

Hypertension Arthritis

D. Maternal and Prenatal History

Illness during pregnancy 1st trimester - none X-ray during 1st trimester - none Term - Full term- 38 weeks Place of delivery - Mercy Maternity Center Type of delivery - NSVD Attendant - Midwife Infants Problem during 1st month - Fever

E. Developmental History

TYPES OF DEVELOPMENT Rolled Over Sat alone Stood alone Walk alone Talked Toilet Trained Coordination

AGE ACHIEVED 6 months old 8 months old 11 months old 1 year 1 year and 4 months 1 year and 8 months 1 year and 8 months

F. Nutritional History
TYPES OF FEEDING AGE STARTED DURATION FEEDING INTERVAL

Breast feeding

At birth

1 yr & 2 mo.

3 hrs

Artificial feeding

1 yr & 2 mo.

1yr and 6 mo. to present

4 hrs

G. Immunization

Is a process by which vaccines are introduced into the body before infections sets in. Immunization are also called vaccinations a method of stimulating resistance in the human body to specific disease using microorganism that have been modified and being injected to the body.

NEWBORN SCREENING BCG (at birth)

1ST DOSE

2ND DOSE

3RD DOSE

4TH DOSE

5TH DOSE

6TH DOSE

11/11/09

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DPT (6 weeks, 10 weeks, 14 weeks old)

01/02/10

02/10/10

03/17/10

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OPV (6 weeks, 10

01/12/10

02/10/10

03/17/10

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weeks, 14 weeks old)

Hepatitis B (6 weeks, 10 weeks, 14 weeks)

11/11/09

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Measles (9 months)

01/12/10

03/17/10

07/28/10

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Vit. A (start at 6 months) Deworming

04/28/10

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05/21/10

H. Physical Assessment
Anthropometric measurements Length Head Circumference Chest Circumference Abdominal Circumference Results 84 cm 44.5cm 45.5 cm 44.5 cm

Vital Sign Temperature Respiratory Rate Pulse Rate

Results 36.2 C 23 bpm 87 bpm

Weight

8.62 kg

Parts Skin Eyes

Assessment No presence edema, the skin color is brown Pinkish conjunctiva; Eyelashes are equally distributed. The pupil is color black.

Ears Nose

No presence of cerumen, the skin color is brown. No lesion, Sinuses are not tender to palpation and no crepitus is evident.

Thorax

No deformities of the Thorax, Normal Breathing expansion, Symmetric, .

Neck Lung Heart

No mass noted, with range of motion No masses and tenderness noted. Normal heart sounds characterized by lub dubb. No murmurs heard during auscultation.

Spine

vertically aligned and she has straight spinal column.

Abdomen Extremities

No lesion; the abdomen is not distended. No loss of extremities; Nails are properly cut and clean.

Chapter III
Methodology
A. Settings
The study was conducted last September 22, 2011 at the residence of Guerra family located at Km. 10 Emerald St. Doa Salud Subd., Sasa Davao City. The family does not owned the house they share only a renters there for two years now. The house is semi concrete, it is made up of blocks and wood. They only have one bedroom which is located at the right side of their house. The house does have adequate lighting facilities. The living space is also adequate and

B. Methods Used
INTERVIEW- this is an approach in gathering information from the person involved in the growth and development of the child. This method was done by asking the parent the facts and information about the childs abilities and skills. This method also helped the group to gather data on the profile of the client and family background.

MMDST tool - the bars that intersect her age are the items give by the administrators and being performed by the client. OBSERVATION - this method was used when the group allowed this child to perform the different task to be able to determine what she can do at her age. This s considered as the most important tool since most of the item requires careful observation of the clients behaviour. This method was also used to study the surroundings of the childs environment.

RECORDING AND DOCUMENTAION - this method was to record and document all gathered information. PHYSICAL EXAMINATION - I used different methods in conducting physical assessment to identify our clients development, if the client is growing according to his age development. Our client was able to do the entire test without any difficulties.

C. Test Materials
Clear small glass with 5/8 inch opening Cheese curls Small Rubber Ball with 12.5 inches in diameter Pencil and Bond Paper 8pcs of 1 inch blocks

D. Test Procedures

The toddler may sit on the lap of her mother/ caretaker. Set test materials on the table. Put mother or caregiver at ease and establish rapport stating that the tester is interested in knowing what toddler can do in a certain age. Every effort is made to see what a toddler can actually do rather than asking the parent. Generally the test starts with personal sector: this gives the toddler a chance to get used to the tester. The fine motor adaptive follows: toddler can perform the task at hand without having the talk to the tester directly at yet. The language sector comes next: toddler will be more comfortable with the task and much more likely imitates speech sound and noises that the tester asks to imitate. The gross motor comes, the toddler is allowed three trials to perform each item before a failure is scored Items may be scored either of 4 ways of scoring. P- PASS F- FAIL R- REFUSED NO -No opportunity (not considered in the total score)

Criteria in Interpreting the Scores


Criteria
1. Two or more sector with two or more delays.
2. One sector with two or more delay or more sectors with one delay and in that same sectors no passes intersecting age line.

Interpretation
Abnormal
Abnormal

3. One sectors with two or more delays


4. One or more sector with one delay and in that same sector no passes intersecting age line.

Questionable
Questionable

5. When refusal occurs in number large enough to cause test


result to be questionable or abnormal these were scored as failures.

Untestable

G. Calculation of Toddlers Age

To get the chronological age of a toddler, subtract the birth date of the client from the date of administration.
Date of Test: Date of birth: Year September 22, 2011 October 21, 2009 Month 09 10 11 1 year and 11 month and 1 day Day 22 21 01

Total Age:

2011 2009 01

Childs Age:

Chapter IV

The result, analysis and justification of the four sectors of MMDST.


Item used

Personal-Social Result Analysis Skills


food was noticed.

Justification

Uses Spoon spilling Pass little

The client was able to use spoon Helps feed self; enjoys holding spoon (often upside while eating and a little spilling of down) and drinking from glass or cup; not always accurate in getting utensils into mouth; frequent

spills should be expected. Eisenberg, A., Murkoff,


H.E.&,Hathaway, S.E. According to what to expect the toddler years. Puts on Clothing Pass The client was able to wear her Toddler gradually will become more cooperative dress without asking supervision during dressing and learn to extend legs and arms from her mother. to help put on coats and pants. At the age of two, he or she will be able to pull on simple clothing. Pillitteri, A.(2005). Maternal and Child Health Nursing care of the childbearing and childrearing family (4th Edition.) Removes Garment Pass The Child was able to remove her clothes without any help from her Toddler may e able to remove one or two loose items of clothing. Lippincott W. & Wilkins (2005)

mother.

Maternal and Child Health Nursing care of the


Childbearing and childrearing Family.

Fine Motor Adoptive Skills


The child failed on the 1st The 22 months old can make tower of four attempt of making the tower blocks. One year later, he can stack eight blocks. of 4 cubes but on the 2nd and Pilliteri, A (2007). Maternal and child health 3rd attempt she does it well. Nursing.

Tower of 4 cubes Pass

Dumps Cheese Curls from bottle spontaneously.

Pass

The

child

spontaneously The child is ale to perform the given task y just

dumps the cheese curl out of telling her to transfer the cheese curl to the other the small glass according to bottle. The eye-hand coordination is developed what had been told to her resulting manipulation of objects. without a demonstration how Pilliteri, A (2007). Maternal and child health to do it. nursing.

Dumps cheese curls form the bottle demonstration.

Pass

The child dumps the cheese The child was able to do it after the examiner curl out of the bottle with a demonstration given how to showed how the task done. The eye-hand do the task. coordination is developed resulting manipulation of objects. Pillitteri, A. (2005). Maternal and child Health Nursing Care of the childbearing and

childrearing family (4th edition).


3 words other than mama and dada

Language Skills
Passed The client was able to spoke 3 Uses 2 3 words other than mama and dada at 12 15 months. words other than mama and papa Lippincott W. & Wilkins (2005) Maternal and Child Health Nursing care of the like hello, bye bye, hi! childbearing and childrearing family. and hawa.

Combine 2 words

Passed

The client was able to combine Combines 2 words at 16 24 months, there is a range of ages at which children are first able two words like hello mama to combine words into sentences; if a toddler cannot do so by 24 months, parents should and bye bye mama. consult to their health care provider. Pilliteri, A. (2008). Maternal and child health nursing.

Points to 1 named body part

Passed

The client was able to point body The easiest things that a child is able to identify at the earliest onset of life would be those parts like nose, lips, ears, eyes most commonly taught by elders, such basics as letters, body parts, colors, and shapes These and arms. would then progress into the more complicated nuances of language and development of thought expression. Pilliteri, A. (2007). Maternal and Child Health Nursing.

(14) Names one picture

Passed

The client was able to name fish Toddler name familiar people and objects. Their Attention span is short. Recognition of and dog during assessment. pictures of familiar persons. Eisenerg, A., Murkoff, H.E.&,Hathway, S.E. According to what is expected to toddler years.

(13) Follows Direction 2 or 3

Passed

The client was able to follow Once the children becomes toddlers, they are ready to learn how to follow directions. directions given like getting the Pillitteri, A. (2005). Maternal and child health nursing care of the childbearing and ball on the other side of the chair childrearing family (4th Edition.) and putting it to the table.

Gross Motor Kick Ball Forward Passed Skills The client was able to kick the ball Around

forward.

18 months, your toddler will

probably be able to kick a ball forward. Pilliteri, A. (2008). Maternal and Child health nursing.

(24) Throwing ball Passed overhead

The client was able to Throw the ball By the age of 24 months, many toddlers can overhead 3 feet within arms reach of now throw a ball overhead. tester. Pilliteri, A. (2005) Maternal and child

health nursing care of the childbearing and


childrearing family. (4th Edition) Balance on 1 foot Passed 1 second 2 of 3 The client was able to balance her body The capacity of the child in balancing on 1 for about 3 seconds with 1 foot. foot for about 1 sec. Is less than 30% out of 90%. Lippincott W. & Wilkins (2005) Maternal and child health Nursing Care of the childbearing and Childrearing Family Jumps in place Passed The client was able to perform jumping Toddlers like to jump. Place pillows, in place slowly. Cushion, or a mattress on the floor. Pilliteri, A. (2008). Maternal and Child Health Nursing.

Chapter V
A. Summary
The study aims to determine the developmental status of a toddler. The chosen client was Kristine Hermosa (not her real name), 1 year, 11 months and 1 day old. From Km. 10 Emerald St. Doa Salud Subd., Sasa Davao City an assessment was done to the client and his family to determine the factors that contributes to the growth and developmental status of the child. This will help you to determine if the child development is within his normal age. And taking particular of the childs ability to do whatever was required for him and evaluated accordingly.

During the test, the client was a little bit shy but still cooperates with the test. After a while the shame was replace with a very energetic and noisy child. The child passed the entire task that belongs in his age line. The child obtained to pass the item intersecting of his age line, with the score of passed item of 15 out of 15 items intersecting age line. The test results reveals the interpretation that the growth and developmental status of the chills is at the normal level, in all the four sectors of the test personal-social, fine motor adaptive, language and gross motor.

I therefore concluded that my client is developing properly within his age. Because she was able to do the entire test properly without any problems. In the personal social skills the task of the client is to put on clothing, know how to remove garments and use spoon but with the consideration if it spills a little. In finemotor skills the task are to make a tower of 4 cubes, dumps cheese curls from bottle spontaneously and demonstrate it. She was able to do all of these without any help from others.

Part of the developmental growth of the child is the language skills that may help the client in communicating to others, especially soon when she will be attending in school. The tasks is to spoke 3 words other than mama and papa, combines two words, points to 1 named body parts, names one picture and follows direction. The client passed these tasks and she properly done the task without asking any help from his mother. Knowing words that she talks can help the client so that he can properly understand and explain words within his capacity and knowledge. The gross motor skills use group of muscles in doing tasks. In this test the client is using his whole body to perform the task like kicking the ball forward, throwing the ball overhead, balancing on 1 foot and jumping in place.

C. Recommendation
To The Client
she should stop eating candy. she should avoid eating junk foods; and replace it with good and nutritious foods that are necessary for health.

To the Family
The family should continue in supporting the child mentally emotionally, physically, socially and spiritually so that the child will attain the optimum level of functioning. To community: The parents should teach their children in proper hygiene, and not to throw their garbage anywhere to provide clean environment in order to have a healthy lifestyle. The elders of the community must be aware for any problem that is present to their community. hey should be united for easy promotion of health that could lead to healthy community.

To The Student
They should be more knowledgeable in conducting the interview; establishing trust is needed. They should continue to conduct studies regarding the growth and development. They must give appropriate health teaching to the people in the community. Be a role model to the people in the community especially to the client.

Bibliography

Internet:
http://www.yahoo.com http://www.wikipedia.com http://www.google.com http://pediatrics.about .com http://www.alpharubicon.com

Books:
Fundamental of Nursing by Kozier, Erb, Berman 7th edition. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family by Adele Pillitteri 5th edition. Health Assessment In Nursing by Janet Weber and Jane Kelley 3rd edition. Maternal and Child Health Nursing Care of The Childbearing and Childrearing Family by Lippincott W. &

Appendices

Marriage Certificate and Birth Certificate

Vaccination

Thank you for listening!

Have a good day!