This paper applies Gordon's Functional Health Pattern assessment framework to three major childhood developmental stages—toddler, preschool-aged, and school-aged—aligned with Erikson's psychosocial theory. For each age group, the paper identifies normal assessment findings and potential problems across eleven functional health patterns: health perception and management, nutritional-metabolic, elimination, activity and exercise, cognitive and perceptual, sleep and rest, self-perception and self-concept, role-relationship, sexuality and reproductive, coping and stress tolerance, and values and beliefs. The paper concludes with clinical applications for nursing assessment, communication, and culturally sensitive care across developmental stages.
Normal assessment findings: Children at this age cannot distinguish differences in health-related issues. Illness is often associated with general feelings of pain or discomfort, so when the child feels any discomfort, he or she may incorrectly describe it as sickness. Complete care of the child is dependent on adult caregivers.
Potential problems: Two potential problems a nurse may discover are attachment anxiety, where the child has an unhealthy attachment to a parent, and lack of proper hygiene, such as when the child may not want to participate in handwashing or tooth brushing.
Normal assessment findings: Children in this stage have a greater understanding of their bodies and can be more vocal about what is hurting or bothering them. They can be more helpful with caregivers in diagnosing problems. Still, they do not understand the internal workings of the body.
Potential problems: Preschoolers are in greater contact with other children and can contract and spread illnesses and infections if all immunizations are not kept up to date. Additionally, preschoolers may have increased anxiety and phobia over injuries and death because of a lack of knowledge regarding body functions. There may be a lack of concern for hygiene that can be potentially damaging. This is the period where children have a much greater likelihood of injuries, cavities, and illnesses because of a more active and social lifestyle.
Normal assessment findings: School-age children have a much better understanding of how the body works and can thus be more active in helping diagnose issues. Familial and cultural dynamics can influence how these children understand health and illness.
Potential problems: School-age children are at increased risk when caregivers do not properly maintain their health routines. Additionally, the influence of peer groups and external social factors can lead to unhealthy behaviors related to health perception and management.
Normal assessment findings: Young children are weaned off breast milk and exposed to various food groups. These young children can eat with their hands but may have trouble drinking from a cup or using cutlery.
Potential problems: With increasing exposure to new foods, the child may begin to show signs of food allergies. Moreover, without proper influence from caregivers, the child may develop poor dietary habits that could lead to malnutrition.
Normal assessment findings: It is during this stage that likes and dislikes of certain foods begin to take hold. Additionally, preschoolers can be more active in simple food preparation.
Potential problems: Without guidance, excessive junk food and poor dietary choices could lead to obesity, malnutrition, or increased risk for cavities. The fact that they begin to eat meals at school and elsewhere increases the potential danger for poor diets.
Normal assessment findings: Understanding of nutrition improves greatly during this stage. It is recommended that such children eat anywhere between 1,200 to 1,800 calories a day depending on lifestyle and body type in order to provide enough energy to support growth.
Potential problems: These children are more aware of their bodies and may begin to show signs of eating disorders or overeating. Moreover, children can be at risk of skipping meals because of a more active and independent lifestyle.
Normal assessment findings: Toilet training typically begins during this period. Caregivers should help encourage the desire for independence that potty training provides.
Potential problems: Children can become anxious and frustrated if they are pushed too much by a caregiver to become more independent. They may also develop issues relating to tension with the caregiver if he or she is not patient or encouraging enough.
Normal assessment findings: These children have a much better understanding of how bowel movements work. They begin to control their bowel movements much more and recognize when it is appropriate to use the toilet.
Potential problems: If potty training is delayed, children may become victims of teasing and bullying at school if they have an accident. Moreover, these children may not be practicing safe and effective bathroom hygiene, such as handwashing.
Normal assessment findings: Children are much more independent and can use the bathroom with little to no help from adults. They are in control of their bowel and bladder patterns.
Potential problems: Children may not understand the danger of holding bowel movements in and be prone to infections. Moreover, bedwetting can still occur at this stage, becoming an issue affecting the development of self-esteem.
Normal assessment findings: There are few established patterns of activity in toddlers. Instead, toddlers are active during most of their waking hours when not sleeping. They participate in a number of active behaviors, often engaging in repetitive activities which helps provide learning opportunities and strengthen fine and gross motor skills.
Potential problems: With such young children comes more risk for injuries. They do not have a complete grasp on their own motor skills and also are less knowledgeable about the dangers of external objects and activities. Injuries can also occur when the young child tries to participate in activities that are much too advanced for them.
Normal assessment findings: As children enter school, their play becomes more complex. They begin to learn social constructions and behaviors through social play. They begin to imitate social constructs in the adult world through play activities.
Potential problems: Children are at risk of developing poor play skills and lowered active lifestyles. When children spend too much time indoors watching television, they put themselves at risk for weight issues, like obesity. Moreover, children who are slow to play with other children at school may begin to have issues with self-esteem and become more socially isolated.
Normal assessment findings: These children are much more active on an independent level. They begin to participate in group sports and are required to have physical education in school. During this period, the child's motor skills develop enormously. They are much stronger and capable of performing more intricate activities.
Potential problems: School-age children who spend too much time watching television or playing video games may be at risk for developing unhealthy activity patterns that could lead to weight issues later in life. Additionally, too much pressure placed on these children in sports can lead to issues with self-esteem and social isolation.
Normal assessment findings: Young toddlers begin to learn and understand that there is a world outside their own minds. They begin to lose some of their egocentric tendencies and recognize external stimuli as existing outside of their control, increasing their knowledge of object permanence. They begin to understand things in a more complex manner and can start to label objects around them.
Potential problems: The inability of caregivers to recognize potential cognitive issues could be damaging in the long run. Speech impediments, social isolation, and learning disabilities may not be seen at this early stage, which could lead to later complications.
Normal assessment findings: Preschoolers begin to speak in complete sentences and have stronger grammar skills. They are also incredibly imaginative and create make-believe worlds that are quite complex.
Potential problems: Memory capacity is not as strong as in older children. They do not have the cognitive skills to begin learning on a more complex level. Difficulties in speech can also occur if not properly addressed early on.
Normal assessment findings: Older children have much more cognitive development. They think more abstractly and speak at a highly complex grammatical level. At this age, they begin to utilize learning from social constructs, such as being able to tell what is right from wrong, and then apply it to their own behavior independently.
Potential problems: Learning disabilities can become an issue as children begin to read and write. Issues such as ADD and ADHD, dyslexia, and others can hinder learning. This can also lead to self-esteem issues.
Normal assessment findings: Young toddlers need an average of twelve hours of sleep a day. They still need regular naps during the day.
Potential problems: These children may try to avoid sleeping at all costs, which can result in anger, frustration, and temper tantrums if they do not get enough rest. Moreover, when toddlers are too tired because of a lack of sleep, they become less active, which then threatens their physical health.
Normal assessment findings: Need for sleep decreases to about eight hours a night. They do still need regular naps, but not as much as toddlers. Often, these children begin learning bedtime rituals to help them relax before sleep, like reading a story.
Potential problems: Night terrors and nightmares may interrupt sleep and create unnecessary fears and phobias. Those who stay up too late may be overly tired at school, which can result in decreased activity.
Normal assessment findings: Children in school sleep around eight hours a night on a more regular schedule. Their time at school helps provide a stricter routine. They also do not need naps as much as younger children do.
Potential problems: Various sleep issues, like sleepwalking or sleep talking, can begin to appear, which can increase risk for injuries. Moreover, sleep needs to be independent. If the child still sleeps with caregivers, he or she may be at risk for lowered self-esteem, independence, and social skills.
Normal assessment findings: At this stage, toddlers need to learn autonomy or they become too dependent on caregivers. They must be encouraged to perform activities on their own and be rewarded for their success.
Potential problems: Some toddlers may want too much autonomy, putting them at risk for potential injury. Those who do not want independence at all may be at risk for self-esteem issues later in life.
Normal assessment findings: Increased social activities help the move towards independence. They begin to feel successful and independent. This also helps lead to the creation of an independent personality, with their own likes and dislikes, that may be quite different from the caregiver's.
Potential problems: When these children cannot perform a task they are attempting to complete, it can lead to feelings of inadequacy. They may also begin to feel guilty for not being able to contribute more to the family, especially if they compare themselves to older children. They can tend to take criticism too harshly.
Normal assessment findings: Strong social skills help increase self-esteem. There is also a new desire to prove one's worth and capabilities, increasing levels of competitiveness with peers.
Potential problems: When children fail to be socially accepted, this can greatly harm their self-esteem levels. Moreover, a lack of concern for hygiene can further ostracize them from their peers and make matters worse.
Normal assessment findings: Young children can recognize their family, both immediate and extended. This often leads them to not trust or even fear those they are not familiar with.
Potential problems: Attachment issues can occur when caregivers do not provide healthy situations. A toddler can be overly connected to one caregiver and become anxious when he or she is not around. Also, sibling rivalries can develop when the toddler is trying to find their place within the family.
Normal assessment findings: There is increased affection towards loved ones. Social roles begin to come into play, as preschoolers understand gender norms and adult responsibilities, like working.
Potential problems: Lack of socialization can lead to emotional disturbances later in life. Moreover, these children are increasingly vulnerable to negative social influences from both their peers and caregivers.
Normal assessment findings: School-age children need limits and rules so that they begin to understand restraint. They begin to have more responsibilities within the family, like caring for younger siblings, and take pride in their role within the family.
Potential problems: School-age children can get out of control without proper limits set on behavior. They may begin refusing to listen to caregivers or negatively influencing younger siblings. Moreover, they may begin to remove themselves from the family as they develop stronger peer networks.
Normal assessment findings: Toddlers explore their bodies at this stage, but they may not understand that touching their genitals is not socially acceptable. They begin to show more interest in learning about their bodies.
Potential problems: Toddlers that show extreme distress with bowel movements may have something physically wrong with them. Toddlers also can be negatively influenced by being exposed to negative sexual behaviors.
Normal assessment findings: These children are much more aware of their bodies and what is seen as socially appropriate behavior. Still, there is a general sense of curiosity about the other gender.
Potential problems: As they begin their time at school, teasing about gender-related issues and sexuality can cause serious self-esteem issues. Additionally, there can be development of a negative body image if they fail to connect with gender norms.
Normal assessment findings: Some children may begin to hit puberty during this stage. This requires the need for sexual education. Children are also more curious about sex and sexual relationships.
Potential problems: Without providing sexual education, these children can learn negative behaviors or even practice risky sex-related behaviors. They may use inappropriate dress or behaviors to get attention from the opposite sex.
Normal assessment findings: They begin to form temperament patterns. They explore new coping methods beyond crying and try to control situations more.
Potential problems: Many turn towards aggressive behavior if they do not get what they want or cannot control a situation to their liking. They may also regress to earlier stages of development when faced with challenges.
Normal assessment findings: These children often seem to attach themselves to certain safety or security devices, such as a blanket or doll. They can foster secure interactions from positive reinforcement.
Potential problems: When faced with challenges, they can often revert back to earlier stages. They may also begin to withdraw into themselves, which can be a sign of social or emotional issues.
Normal assessment findings: Children begin to use defense mechanisms, like humor. They also turn to physical activity to relieve stress. They are learning how to cope with stress.
Potential problems: There are increasing stressors, like competition, homework, and social anxiety. This can cause self-esteem issues or even depression.
Normal assessment findings: When positive conditioning is used, it will increase positive behaviors. Toddlers begin to understand family roles and ethical concerns.
Potential problems: Without positive reinforcement, toddlers learn negative behaviors. This can carry on with them later in life.
Normal assessment findings: There are increasing controls exerted by these children independently of caregivers. They begin to learn about social institutions and appropriate social behaviors.
Potential problems: Still, they do not fully understand some more complicated social matters. They can be negatively influenced by peers or television.
Normal assessment findings: School-age children know the difference between right and wrong. They have increased awareness of social institutions and make decisions with a sense of moral knowledge.
Potential problems: However, pressure to fit in can cause them to act against what they know is right or morally correct. Also, they may exaggerate in order to make themselves look more desirable.
"Synthesis of developmental differences in nursing practice"
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