 IDENTIFICATION DATA:

 Name of the child:

 Age:
 Sex:
 Date of birth:
 Patient ID:
 Date of Admission:
 Diagnosis:
 CHIEF COMPLAINTS:
 HISTORY:
 Family history:
- Name of family head:
- Type of family:
- Number of family members & siblings:
- Health history of family members:
- Family tree:
- Family Chart:
 Past history:
 Present history:
- Duration of complaints:
- Treatment given prior to admission:
- Health history of family members:
 Ante-natal history:
 Intra-natal history:
- Mode of delivery:
- History of birth injury:
- Birth weight:
 Post-natal history:
 Immunization:
 JAGANNATH GUPTA INSTITUTE OF NURSING SCIENCE
CHILD HEALTH NURSING
GROWTH & DEVELOPMENT ASSESSMENT FOR INFANT

NAME:
AGE:
SEX:

SL. CONTENT BOOK PATIENT REMARKS

NO. PICTURE PICTURE
1. ANTHROPOMETRIC
MEASUREMENT:
- Height:
- Weight:
- Head circumference:
- Chest circumference:
- Abdominal circumference:
- Upper mid-arm
circumference:
2. VITAL SIGNS:
- Temp.:
- Pulse:
- Resp.:
3. GROSS MOTOR
DEVELOPMENT:
A. Head control:
B. Roll over back to front:
C. Sit with support:
D. Pull to sit from supine
position:
E. Pull to stand creeps:
F. Crawls with belly support:
G. Cruises (walk sideways by
holding & supporting
objects):
H. Stepping movement:
I. Walk a few steps:
J. Walk:
4. FINE MOTOR & ADOPTIVE
DEVELOPMENT:
A. Eye co-ordination:
- Follows an object with
unsteady movements of
Eyeball:
- Follows an object with
unsteady movement of
eyeball & able to focus:
B. Head-Eye Co-ordination:
- Able to hold some toys
pincer finger thumb fine
grasp to pick up a pellet:
- Able to grasp coloured
object:
- Able to hold some toys:
C. Hand to mouth Co-
ordination:
- Try to feed with spilling:
- Feed without spilling:
5. EMOTIONAL & SOCIAL
DEVELOPMENT:
- Social smile:
- Enjoys in watching his/ her
 image in mirror:
- Shows some resistance
while removing a toy from
him/ her:
- Put some effort to get a
toy which is kept out of his
reach:
- Stranger anxiety:
- Solitary play:
- Begins to play ‘PEEK A
BOO’:
6. LANGUAGE DEVELOPMENT:
- Watches mother intently
when she speaks to him/
her:
- Imitates sounds says Mono
Syllables like ‘MA’, ‘BA’,
‘DA’ etc.:
- Says (2-3) words with
meaning:
7. INTELECTUAL DEVELOPMENT:
- Begins to repeat actions
own body voluntarily
(hand to mouth movement
permit sucking):
- Repeats action that affect
an object to get a response
(shaking a rattle):
- Searches briefly for objects
seen being placed
elsewhere:

 CONCLUSION:
 BIBLIOGRAPHY:
 IDENTIFICATION DATA:
 Name of the child:
  Age:
 Sex:
 Date of birth:
 Patient ID:
 Date of Admission:
 Diagnosis:
 CHIEF COMPLAINTS:
 HISTORY:
 Family history:
- Name of family head:
- Type of family:
- Number of family members & siblings:
- Health history of family members:
- Family tree:
- Family Chart:
 Past history:
 Present history:
- Duration of complaints:
- Treatment given prior to admission:
- Health history of family members:
 Ante-natal history:
 Intra-natal history:
- Mode of delivery:
- History of birth injury:
- Birth weight:
 Post-natal history:
 Immunization:

JAGANNATH GUPTA INSTITUTE OF NURSING SCIENCE

 CHILD HEALTH NURSING
GROWTH & DEVELOPMENT ASSESSMENT FOR TODDLER

NAME:
AGE:
SEX:

SL. CONTENT BOOK PICTURE PATIENT REMARKS

NO. PICTURE
1. ANTHROPOMETRIC
MEASUREMENT:
- Height:
- Weight:
- Head circumference:
- Chest circumference:
- Abdominal circumference:
- Upper mid-arm
circumference:
2. VITAL SIGNS:
- Temp.:
- Pulse:
- Resp.:
- B.P.:
3. GROSS MOTOR
DEVELOPMENT:
- Assume standing position
without help:
- Walked with wide based
gait:
- Kneels without support:
- Creeps upstairs:
- Fall when throwing a ball:
- Walk sideways &
backwards:
- Walk upstairs with one hand
help:
- Runs stiffly but falls:
 - Throws ball without falling:
- Walks up & down stairs one
step at time:
- Runs well:
- Jumps with both feet in
place:
- Kicks large ball without
falling:
- Rides on walker:
- Jumps from low step/ chair:
4. FINE MOTOR:
- Builds a tower of cubes:
- Scribble spontaneously:
- Makes line with crayon:
- Injects small objects in a
narrow mouth container:
- Imitate vertical strokes:
- Imitate circular strokes:
- Imitate horizontal strokes:
- Turns pages of a book:
- Unscrews lid of a Jar:
- Opens door by turning door
knob:
- Make train of cubes:
5. SELF-HELP SKILLS:
- FEEDING SKILLS:
a. Ability to use cup:
b. Ability to use spoon:
c. Ability to take drink:
d. Preference for finger
feeding:
- DRESSING SKILLS:
a. Sticks out arms & legs to
help in dressing:
b. Remove shocks:
c. Remove shoes:
d. Unzip garments:
e. Remove simple garments:
f. Can button (specify area):
 g. Can unbutton (specify area):
h. Remove laces:
i. Helps put things away:
- TOILETING & GROOMING
SKILLS:
a. Indicate the need for
toileting:
b. Bowel control:
c. Bladder control (day time &
night time):
d. Verbalizes toileting needs:
e. Brushes teeth:
f. Washes hands & attempt to
dry it:
6. LANGUAGE DEVELOPMENT:
- Comprehence more than
communicate:
- Recognizes names of
various parts of body:
- Says words (specify no. of
words):
- Names familiar pictures, or,
objects:
- Responds to familiar simple
commands:
- Shakes head to
communicate ‘No’:
- Gestures used are less than
words:
- Enjoy a stories with
pictures:
- Identify the body parts
(specify number):
- Questions the events &
objects:
- Uses sentences (specify
number):
7. INTELLECTUAL DEVELOPMENT:
- Remember objects:
 - Very curious about
environment & explore the
environment:
- Exhibits surprise when she
finds another objects
hidden under a sheet
compared to previous
object:
- Searches for an object in
previously known place
than traces other possible
places:
- Imitates simple action:
- Appears always in a hurry:
- Symbolization widens given
example:
- Initiates conversation:
- Uses specific words of
interrogation: (Why, Who,
Where, Whom, When):
- Exhibits imagination while
talking:
- Attention span short &
easily distracted:
8. SENSORY DEVELOPMENT:
- Looks at picture attentively
for a long period:
- Identify geometric forms:
- Places small objects into
appropriate place:
- Recalls visual images:
9. EMOTIONAL DEVELOPMENT:
- Tolerate separation from
parents:
- Less fearful of strangers:
- Imitates parents:
- Exhibits temper tantrums if
things go wrongs:
- Possessives about toys:
- Has great sense of ‘MINE’:
- Resist simple commands at
request:
- Takes time in making
decisions:
- Gets upset by changes in
routine:
- Pulls other to show them
something:
- Knows own sex:
- Emotional problems
(specify):
 CONCLUSION:
 BIBLIOGRAPHY:
  IDENTIFICATION DATA:
 Name of the child:
 Age:
 Sex:
 Date of birth:
 Patient ID:
 Date of Admission:
 Diagnosis:
 CHIEF COMPLAINTS:
 HISTORY:
 Family history:
- Name of family head:
- Type of family:
- Number of family members & siblings:
- Health history of family members:
- Family tree:
- Family Chart:
 Past history:
 Present history:
- Duration of complaints:
- Treatment given prior to admission:
- Health history of family members:
 Ante-natal history:
 Intra-natal history:
- Mode of delivery:
- History of birth injury:
- Birth weight:
 Post-natal history:
 Immunization:
 JAGANNATH GUPTA INSTITUTE OF NURSING SCIENCE
CHILD HEALTH NURSING
GROWTH & DEVELOPMENT ASSESSMENT FOR PRE-SCHOOLER

NAME:
AGE:
SEX:

SL. CONTENT BOOK PICTURE PATIENT REMARKS

NO. PICTURE
1. ANTHROPOMETRIC
MEASUREMENT:
- Height:
- Weight:
- Head circumference:
- Chest circumference:
- Abdominal circumference:
- Upper mid-arm
circumference:
2. VITAL SIGNS:
- Temp.:
- Pulse:
- Resp.:
- B.P.:
3. GROSS MOTOR
DEVELOPMENT:
- Walk in a straight line:
- Walk backward:
- Walk on tip toes:
- Walk on balance – beam/
narrow edge:
- Balance on one foot:
- Skips alternate feet:
- Kicks a ball:
- Imitate dance step:
- Runs without looking at
feet:
 - Hops on preferred foot:
- Pedals on tricycle:
- Jumps from height:
- Catches a ball:
4. FINE MOTOR:
- Builds a tower with blocks:
- Copies a circle:
- Copies a square:
- Copies a triangle:
- Cross a straight line:
- Draw simple face:
- Draw a 3-part man:
- Shows preference for one
hand:
- Uses blunt scissors:
- Helps in small house hold
task:
- Copies some alphabets:
- Can write one name:
- Finger paint:
5. SELF-HELP SKILLS:
- Eating skills:
a. Ability to use a spoon:
- Dressing skills:
a. Puts on shirts/ frock without
assistance:
b. Can undress self:
c. Buttons, side buttons, small
buttons:
d. Manages to zip the back:
e. Puts on socks with help:
f. Puts on shoes without help:
g. Ability to lace shoes:
- TOILETING & GROOMING
SKILLS:
a. Can pull pants/ panties up &
down:
b. Can go to toilet alone:
c. Brushes teeth with
assistance:
d. Washes & dries hand
without supervision:
e. Baths – self/assistance:
f. Combs hair – self/
assistance:
g. Blows nose on request:
6. LANGUAGE DEVELOPMENT:
- Uses complete sentence of
(3-4) words:
- Talks regardless of whether
anyone is playing attention:
- Constantly ask questions:
- Name colours:
7. INTELLECTUAL DEVELOPMENT:
- Has social awareness
- Understand times:
- Uses time oriented
expression:
- Understand place:
 - Think one idea at a time:
- Understand conservation of
size, shape, length:
- Has magical thinking:
- Obey to set limits of
parents:
- Understand others
perspectives:
8. SOCIALIZATION:
- Has increased attention
span:
- Has fear of darkness:
- Has selfishness & is
impatient:
- Shows physically & verbally
aggressive behaviour:
- Participates in parallel &
associative play:
9. FAMILY RELATIONSHIP:
- Identify self with some
sense:
- Has sibling rivalry:
- Questions parents thinking
& principles:
- Has awareness of family
relation & sense role
function:
 CONCLUSION:
 BIBLIOGRAPHY:
  IDENTIFICATION DATA:
 Name of the child:
 Age:
 Sex:
 Date of birth:
 Patient ID:
 Date of Admission:
 Diagnosis:
 CHIEF COMPLAINTS:
 HISTORY:
 Family history:
- Name of family head:
- Type of family:
- Number of family members & siblings:
- Health history of family members:
- Family tree:
- Family Chart:
 Past history:
 Present history:
- Duration of complaints:
- Treatment given prior to admission:
- Health history of family members:
 Ante-natal history:
 Intra-natal history:
- Mode of delivery:
- History of birth injury:
- Birth weight:
 Post-natal history:
 Immunization:
 JAGANNATH GUPTA INSTITUTE OF NURSING SCIENCE
CHILD HEALTH NURSING
GROWTH & DEVELOPMENT ASSESSMENT FOR SCHOOLER

NAME:
AGE:
SEX:

SL. CONTENT BOOK PICTURE PATIENT REMARKS

NO. PICTURE
1. ANTHROPOMETRIC
MEASUREMENT:
- Height:
- Weight:
- Head circumference:
- Chest circumference:
- Abdominal circumference:
- Upper mid-arm
circumference:
2. VITAL SIGNS:
- Temp.:
- Pulse:
- Resp.:
- B.P.:
3. GROSS MOTOR
DEVELOPMENT:
- Rides bicycle:
- Throws a ball skilfully:
- Involves in various physical
activity:
- Use skipping rope well:
- Performs tricks on swings,
parallel beams:
4. FINE MOTOR:
- Draws a figure:
- Prints fluently:
 - Hands co-ordination is
good:
- Bounces a ball:
- Uses sharp scissors:
5. SELF-HELP SKILLS:
- Eating skills:
a. Chews without making
noise & with closed mouth:
b. Uses only one hand while
eating:
c. Avoid spilling of food
around:
d. Criticizes the parents for
their eating manners:
e. Eats with fingers, spoon,
fork:
f. Handles eating utensils
skilfully:
- Dressing skills:
a. Bath self:
b. Prefers playing in water:
c. Dressing ability:
d. Combing of hair:
e. Requires reminders to
change cloth:
f. Preference for their cloths
(parent preference, or their
own):
g. Needs constant reminding
of personal hygiene:
h. Leaves their clothes
wherever they changed:
- TOILETING & GROOMING
SKILLS:
a. Able to wash their hands
after toileting:
6. LANGUAGE DEVELOPMENT:
- Follow more than three
commands given
 simultaneously:
- Response to request
depend on moods:
- Responds to praise, or
recognition:
- Uses sentences:
- Enjoys telling jokes:
- Enjoys riddles:

7. INTELLECTUAL DEVELOPMENT:
a. Questions with meaningful
words:
b. Knows days of a week,
months of a year, etc.:
c. Performs arithmetical
operations -
- Memories multiplication
tables (specify to what
extent):
- Able to perform addition
(specify to what extent):
- Able to perform division
(specify to what extent):
- Write numbers in ascending
order:
- Write number in descending
order:
- Describes objects in relation
to their own aspects:
- Observe different rather
than similarities:
- Ability to arrange objects in
order to size, colour,
texture:
- Differentiates between
geometrical figure:
- Can read time:
- Provides reason does not go
to school:
8. EMOTIONAL DEVELOPMENT:
- Volunteers to take part in
house work:
- Takes interest in school
activities:
- Complete school work
without problem:
- Easy to get along with at
home:
- Takes responsibility for
younger siblings:
- Confident in ability to
accomplish task:
- Eager to please others:
- Exhibits consistent
manners:
- Complaints about minor
injuries but brave about
major one:
9. SOCIALIZATION:
- Co-operates with others:
- Often jealous on younger
brother/ sister:
- Imitates adults:
- Cheers to win games:
- Steal money/ attractive
items:
- Likes the rewards system:
- Likes to complete play
game:
- Likes to please mother in
many ways:
- Respect parents:
- Choose friends selectively:
 CONCLUSION:
 BIBLIOGRAPHY: