Jack Is a 5-Year 4-Month-Old

Jack is a 5-year 4-month-old male seen on pediatric rotation. He was hospitalized for the placement of PE tubes secondary to recurrent otitis media. He was the result of a full term birth, delivered via cesarean section. Pregnancy was uneventful. He is the only child of a single mother, Donna. Jack is in daycare most days as Donna works full time as a bookkeeper in a local office. Jack's meals are prepared at home or by the daycare worker. Donna offers a full range of foods to include milks, meats and proteins via peanut butter and legumes. Jack prefers carbohydrate and sodium rich foods like macaroni cheese, and Donna often defers to his tastes for expediency and out of frustration. Jack has three meals per day, eating breakfast and dinner with Donna. Dinner is often eaten in front of the television. Jack has a snack in the morning, usually crackers and fruit juice, and a snack mid-afternoon, usually cheese and another serving of juice. Donna has noted the mid-afternoon snack often appears to decrease Jack's hunger for dinner. Jack eats appropriately using knife, fork and spoon, demonstrating more than age appropriate pre-hensile ability regarding grasp of utensils. (Siddiqqi, 1995)

After initial stranger anxiety in our interview, Jack initiated play with toys in the room at an age appropriate level. After several episodes drawing his mother's attention to his activity, he soon became absorbed in play with Lego figures re-enacting a scene from a popular movie. Another child in the room shared toys with him, but there was little interaction between Jack and the other child, they did demonstrate parallel play patterns and were able to interact appropriately. The most appropriate toys for Jack at this point would be imagination toys like building blocks, cars, airplanes and other items which can be used in sharing or parallel play. Any toy which will allow Jack to work out problems and aggression issues would be helpful. Donna reports that Jack's favorite toy is a science fiction gun given to him by an older uncle. Donna reports she is unhappy with the toy but has explained to Jack never to point the gun even in jest at another and does not let Jack use this toy in play with friends, fearing how other mothers may react. Jack showed little interest in books around the room, but he as yet cannot easily read and flipped through a few picture books without much interest. He was willing to recite the alphabet with some prompting from his mother, and able to identify letters out of context of the song.

As previously noted, Jack was initially somewhat hesitant to be far from his mother in the hospital setting, but soon became comfortable in the room and with the staff. He was very excited about learning the controls to the bed and the television and had many questions about blood pressure and temperature measurement, both the devices for the measurement and meaning of the results. Jack was initially anxious when Donna left to get a coffee downstairs, asking several times when his mother would return. He was only calmed by watching a video, but was more comfortable in subsequent absences. Jack used some elements of guilt surrounding his hospitalization in an attempt to persuade his mother to get him a treat at the cafeteria. This attempt to maintain control over his mother is appropriate to this developmental age according to Erickson's stages of development, and Donna easily managed his request by explaining that his diet was restricted prior to surgery. Jack was able to accept this answer, but continued to request assurances he would obtain the treat later in the day. Jack responded appropriately to all staff requests and his behavior appeared age appropriate and unremarkable. He maintained eye contact with staff and initiated conversation on several occasions.

The staff provided some coloring books and paper for Jack once he was confined to his bed in preparation for surgery. Jack appeared to be able to manage crayons without difficulty and easily wrote his name in block capital letters which were easy to read. When asked to draw some pictures of his mother and his pet cat he made a half-hearted attempt to draw some stick figures without significant detail. This was felt to represent disinterest with the project rather than lack of motor skills. Jack was able to easily manipulate the buttons on the bed controls and the fine volume tuning control on the television controls. Later on in his hospitalization, he had the opportunity to visit the game room and play video games for a short period with other patients. Jack has an extraordinary degree of manual dexterity in the manipulation of game controls which involved flying a space ship and avoiding hostile ships. Jack appears to have no significant developmental delays, in that he can readily dress himself, he can write his first name, plays cooperatively with other children, and is able to identify gender (Marcia, 1966). He does not know his address and phone number, and was not observed skipping.