GOVT.

COLLEGE OF NURSING SOMAJIGUDA

HYDERABAD
TODDLER ASSESSMENT TOOL
BASI LINE DATA:
Name of the baby___________
Age __________
Sex___________
Name of mother_________
Education______ occupation_____________
Name of father_______
Education________ occupation______________
Address _________________
__________________
__________________
Health facilities________________________________
OBSTETRIC HISTORY OF MOTHER
ANTE NATAL:
General Health of mother during pregnancy Good ____________________
Average _____________________ poor __________________________
Complications of pregnancy : yes ____________ No________________
If yes______________________ Specify

1.________________
2.__________________
3.___________________

Immunization of Mother during pregnancy :yes ___________ No__________________ If yes Specify ___________
Dose

Vaccine

Gestational

Age

INTRANATAL: Normal___________
Delayed labour.: yes__________ no___________
If yes, specify____________
Type of delivery: normal_________
Instrumental delivery. Yes____ no______
If yes, specify__________
LSCS__________
POSTNATAL: Normal___________
Immediate cry: yes_________ no________
FAMILY ASSESSMENT:
Family pedigree:

key:
Male:
Female:
Disease:
Death:
Client:
Sociogram:

Family health history:

H/O Communicable disease___________
H/O Genetic disorders_____________
H/O Consanguineous marriage__________
SOCIOECONOMIC HISTORY:
Earning member of the family____________
Income/month___________
Living condition: good__________ average_________ poor_________
Environmental status: hygienic_________ unhygienic __________

GROWTH & DEVELOPMENT OF TODDLER :

PHYSICAL & BIOLOGICAL DEVELOPMENT:
Weight:_________
Height/ length:__________
Head circumference_________
Chest circumference________
Mid arm circumference_________
Dentition:__________
VITAL SIGNS:
Temperature:_________
Pulse:___________
Respiration :________
Blood pressure:________
Gross motor Development:
Builds a tower

_____________________ ______________

Pokes finger in hole __________________________________

Makes line with crayon _______________________________
Turn pages

___________________________________

Able to hold up _______________________________________

Fine Motor Development _________________________________
Able to grasp spoon ________________________________

Dress with assistance ________________________________

Dress without assistance _____________________________
Bowel and bladder control ______________________________________

Sensory Development:Vision
Binocular vision

______________________________________

Identifies shapes

______________________________________

Visual acuity:Finds objects brought in front of eyes

_____________________________

Hearing:-

Tactile Stimulation

Taste

Smell
Increase perception ______________________________________
Responds when called by name __________________________________
Psychosocial Development:

Autonomy:-

______________________________________

Egocentric:-

______________________________________

Temper tantrums:- ______________________________________

Thumb sucking:- ______________________________________
Psycho sexual Development:Anal Stage

Anal area is sight for pleasure _____________________________________

Cognitive Development:Experiences only the present: __________________________________
Differentiate self from others: _____________________________________
Shift of attention: ______________________________________
Increased sense of time ______________________________________
Limitation:

______________________________________

Problem solving through trail and error: _______________________

Spiritual development:Intuitive development faith:
Follows parents behaviour bowing the head in prayer
_________________________________________

Language and speech:Recognizes Name:- ______________________________________

Responds of familiar simple commands____________________________
say 26- words- ______________________________________
Speaks 10 Leal words ______________________________________
Knows about 300 words - ______________________________________
Uses 4-5 word sentences ______________________________________

Play :Balls

Musical toys:

Favorite toy:
Paroled
Group play or parallel play ______________________________________
Any delay in developmental mile stones:______________________________________
Reason for delay:-____________________________________________
Congenital defects:- ______________________________________
Neurological defects :- ______________________________________
Genetic disorders :- ______________________________________

Past Health History:Healthy _________ unhealthy___________ If Yes

Nature of health problem :- Mild _________ Moderate________
Severe____

Any History of medical problems Such as:Diarrhoea______________ mumps______________ Measles _________

poliomyelitis _____________ whooping cough _____________ febrile
convulsion__________ Skin infections ________________ nutritional
disease____________
if yes period of suffering ______________ few days ______________
15 days_________ 3-4 weeks___________ months __________
Hospitalization- yes _____________ No_________ If yes ________ Specify
reason __________________
Treatment:Homeopathy_____________ Allopathy ___________ Unavi___________
Another ___________ Home remedies __________________
If yes specify________________
History of Surgery:Yes _________ No___________ If yes specify cause ___________

Type of surgery _______________ post operative period _____________

Outcome of surgery____________________
History of Traumatic injuries:Yes ________ No ___________ if yes specify
Accidents:- Road ______________Home _________ Another__________
Injuries :- yes ________________ No _____________ if yes specify
Reason : Falls _______________
Burns :- yes _____________ No __________ if yes specify reason _______

History of allergies:- yes_________ No_____________ If yes specify type

of allergen _______________
Intensity: wild__________________ Moderate __________ severe ______
Treatment :-____________________

Delayed mile stones:Growth retardation: yes _____________ No______________

if yes specify reason_____________________
Visual defects:- yes ___________ No__________________
If yes Specify ________________
Speech delay :- yes ____________ No__________________

If yes Specify ________________

Hearing defects :- yes ___________ No________________
If yes Right ear ____ left ear _____
both _______ reason_______________________

Physical Examination:General Appearance :- Healthy ______________ Acutely ill____________

Chronically ill ____________________
Stages of comfort:- comfortable __________ Distressed_____________
Apathy___________ Lethargy _______________ Restless _____________
Pleasant___________________
Mood :- Pleasant_____________ depressed_________ cooperative ______
Non-cooperative ______________
Level of consciousness :- Conscious _____________ drowsy___________
Semiconscious ______________ unconscious ______________ stupor____
Withdrawal ________ Agitation____________ Facial expression_________
Appropriate eye contact_____________________
Speech : Clear __________ Blurred _____________ Fluent _____________
measuring ___________ a Phasia______________

Orientation: Place ______________ time ___________________ person

Personal Hygiene:- Good ________Clumsy__________ Appropriate _____
Inappropriate _______________ Body odor______________Perspiration : Profuse __________ Moderate _____________ Absent______
Position of body symmetric ___________ asymmetric _________ Kyphosis
lordosis ___________ Scoliosis.
Body built :- obex _______ Moderate _____ thin ____ HT ____ Wl_____.
Recent weight gain : yes _______ No__________ If yes
Specify__________
Recent weight loss yes _______ No__________ If yes Specify _________
Vital signs ___________ Temp________ pulse______ Rep ________ BP__
Inspection : Head for hydrocephalus :_____________________
Head circumferences _____________________
Bulging fontanel : yes _________ NO_______________
Anterior fontanel :-__________ Closed __________ open _______ ____ if
closed when _______________
Posterior fontanel L- open ________ closed _________ if closed when ___
Scalp: Hair distribution thick __________ scanty_________________
Texture _________ soft __________ silky ________________ shieness of
scalp _____________crushing

Face : Normal ____________ pallor _________ cyanosed ________ flushed

Patty ___________ periorbital selling __________ moon face ________ ___
Skin color ___________ normal cyanotic _______________ if yea centre_
peripheral ________________
Nails:- Normal _________ cyanosis ___ clubbing_____ vertical folds _____
Eyes :- Symmetric _________ Asymmetric ___________ dry ______ moist
Red _________ yellow __________pale _____________ discharge______
Exopthalnus ______________ blueing ____ sumet eyes_______________
Constructive : dly ______ moist ______ red _______ yellow____ pale_____
Eye balls : ________ Normal ______ Nystagnus _____ Strabismus_______
Eyelids : Normal ________ Swelling_________ style __________ pupil
Reaching to light. Constriction_____________
Dilatation :Lens:_______ transparent ______ opaque_______________
Ears: Symmetric ___________ asymmetric ___________ pain __________
Discharge ______________ duration ______________
Low set: Unequal positing _________ foreign bodies ______________
Tenderness _____________ Impaction_____________
Hearing: Normal _____________ partial deafness __________ deafness
Nose: Normal __________ Septal deviation_________ Rhinorrhoea_____

Epistaxis ________________ polyps__________ injuries_________

Mouth:- oral mucosa : Normal _____ pallor______ redness________
leukoplakia__________
Lips: Pink ______ pale________ dry ___________ cyanosed __________crackles______________ cleft lip ________ unilateral _________ bilateral
Guns: Pink _______ Red __________ Swollen ________ Bleeding_______
Teeth :Occasion_________ Malocclusion ________ Permanent__________
Temporary __________ pyolehoea_____________
No of teeth upper an lower jaws ___________ cavities _________
Tongue : Pink __________ Pale ___________ Red _____ Cayuses________
Coated ______ Dry __________ moist __________ tongue tic ________
Plate : Normal ____ cliff palate __________ Hard palate _______________
Soft palate______________
Neck : Tonsils _________ Normal

Short ____ stiffness _________ web

Tonsils: Palpable______ Non palpable______ lynephedinopathy________

Thyroid : Normal ______________ enlarged ________ nodular_________
Trachea : Middle___________Mobile ___________ Shifted __________
Trachoesophageal fistula _______________
Chut : Symmetric ______________ asymmetric _____________ Shape ___
Normal ____________ Pegion_________ barsel chuyt __________ founed

Breast: Symmetric________ Asymmetric__________ Tender___________

Non tender ________ manes_______ Discharge________ Cynaconiastic___
Abdomen: Shape __________ flat ___________Concave________ Round _
Distended __________ Ascitis __________ upshunt___________
Umbilical : Position colour________ Hernia __________ Discharges_____
Moist ________ Dry ________
GI. Tract:- Appetite __________ vomiting ___________ Diarrhoea______
Esophageal Atresia ___________ Anorexia______________ Abd pain ____
Constipation __________ Mauna________ Impectorate Auns___________
Stool: Normal _____________ Abnormal Characteristics ______________
Pin warms in stool_______________ perennial Pruritis______________
Suprapubic pain ______ yes ______No________ If yes duration _________
Dysuia _________Haumaturia ________ Anuria _____ dribbling ________
Incontinence ______ yes __________ no _____ Polyluria ______ oliguria_
Male genital Birth defects _____________ if any ___________
Urethral Meatus: central ___________ dorral _______ventral__________
Scrotum Tender : Non tender_____ swelling _____________ Redness_____
Illumination(or) undescended testis________ Any congenital anomalies
/defects _____________
Eternities Symmetric _____________ Asymmetric _____________
deforming

_____________

Oedema : Pitting (or) non pitting __________

Palpation :Abdomen: Soft man palate _____________ non Palpable ______ tender
ness ___________Ascites ___________
Liver:- Non Palpable ___________ palpable __________ tender ________
Spleen :- Non Palpable __________ palpable __________ tender ________
Urinary bladder_________ distended_____________ Non distended ______
Percusion:Skilu ________ malemens Sign
Lungs_____ Resonance, Dullness
Hyper resonance ______________ Flatness ___________ clean_________
Tympanic ______________
Abdomen : Dull __________ shifting dullness thrill _____________
Bladder ___________ Dullness _____________ Tympanic___________
Auscultation:Heart : S1_____________ S2_____________________ S3__________________ S4
Mulnus: present_____________ Absent___________
Lungs : Normal breath sounds__________ crepitus _________ Ronchi____
Wheeze _______-: Bowel sounds_______ present _________ Absent _____
Regular _______________ Irregular_____________

Lab investigations:

NUTRITIONAL ASSESSMENT:
Expected calorie requirement: ____________
____________
Menu plan:

Health practices regarding child care______________________

______________________
_______________________
Problems identified:_____________________
_______________________________________

Impression_____________________________________________
Interventions:_______________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________