The development of a child is a process associated with many different critical issues due to the sensitivity of children’s organisms and psyche. The comprehensive assessment of these spheres in different families makes it possible to reveal the issues that restrain the development of a child and their further modification allows the child to grow healthy. The example of such case is the developmental assessment of a 9-year-old girl, Alicia, who developed chronic low self-esteem, which led to her partial social isolation. The analysis of the factors that caused her condition includes the authority and actions of her grandmother and the absence of dietary and autonomy education from her father and mother. In order to recover the girl’s condition, her family needs to refuse form the practice of pressuring the child psychologically in addition to giving her more space for self-initiative and respecting her decisions. Finally, the family requires education in the sphere of children nutrition, as the child developed harmful dietary habits that have raised Alicia’s risk of becoming overweight and developing caries.
Procedure for the Visit and Parameters
The child at the focus of the investigation is Alicia, a female of African-American ethnicity of the 9 years of age born on 1 July 2008. The primary growth parameter of the child is the height of 128.2 centimeters (20th percentile of height for girls of tall stature aged between 2 and 20 years (Medscape, 2017)). The girl’s weigh is 31.1 kilograms, which is 83.6th percentile for a girl aged between 2 and 20 years, and her body mass index is 18.9 (Medscape, 2017). The nutritional status of the child is adversely affected by her lifestyle, as the girl intakes more nutrients than required for covering the energy needs of her organism.
The girl is moderately physically developed, as she has a normal stature and weight for her age, although the body mass index is close to the borderline for considering her overweight. Alicia has no physical disabilities or any kind of restrained physical development, although she does not incline to maintain active lifestyle. The girl tends to ignore participation in active sports games such as basketball or table tennis and refuses the requests of her friends to play.
Alicia is a well-performing student at school, as her cognitive abilities are well-developed and allow her to achieve high marks for many activities. The favorite school subjects of the girl include mathematics and arts whereas she dislikes languages. Alicia is especially good at performing such operations as multiplication, division, and other. Her short- and long-term memory skills are also well-developed, as Alicia is capable of declaring small poems as well as cite and retell different texts from her textbooks.
The language and socialization skills of the girl are well-developed, though she faces specific daily problems related to her articulation. The verbal speech of the girl is fluent and comprehensible, but she occasionally mispronounces a consonant sound “r”. Alicia forms grammatically correct and meaningful sentences that adequately render her ideas and intentions. Disregarding the fact that the girl has well-developed socialization skills, she spends most of the time at home helping her parents or playing indoor and computer games and doing her homework.
The psychical development of Alicia corresponds to the normal development of the girls of her age, although some disturbing indicators are also present. Thus, Alicia is a calm girl that tends to avoid any form of the conflict by means of leaving or hiding from a potential aggressor. She never initiates any form of an argument preferring to agree with an opponent, even though she admits that her point of view is correct. A disturbing issue is associated with the claims of the girl that she is fat and attempts of getting rid of her excessive weight by the means she collects on the internet.
Alicia’s family is composed of her mother and father, two brothers aged 5 and 7 years, and grandmother, who live in a semi-detached house. The parents are not required to devote much time to their children due to their tight working schedule; thus, the grandmother shouldered this duty. In fact, Alicia’s grandmother is a strict woman that often disciplines the children for different minor and moderate flaws. Moreover, she is heavily concerned about the proper nutrition of her grandchildren; thus, their diet has become excessive in calories. Rarely, the children go outside with the parents, and they do not have restrictions on their dietary choices and consume many sweets, ice-cream, chocolate, carbonated drinks, and others.
The home environment in Alicia’s family is generally safe, as the parents do not have weapons or potentially dangerous substances by means of consuming the drugs and alcohol. At that moment, the house has at least one potentially dangerous area where the children are capable of injuring themselves. This area is the kitchen with many domestic appliances, including blenders, knives, and others. However, the grandmother strictly monitors the activity of the grandchildren and does not allow them to play with tools and equipment.
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The Analysis of Data
The interpretation of Alicia’s growth percentiles gives the opportunity to state that despite the child has normal height and weight for the age her body mass index (BMI) allows to predict the potential future problems. Therefore, the body mass index of the girl is 83.6th percentile whereas, for her age and height, the BMI percentile above 85th is the sign of overweight (Hockenberry & Wilson, 2011). The analysis of the dietary habits of the girl and her physical activity indicate that Alicia is endangered by the risk of becoming an overweight child. A secondary potentially dangerous issue related to unhealthy dietary habits is the danger of developing caries, hence the adverse effect of sugar on the child’s teeth (Hockenberry & Wilson, 2011). In that moment, Alicia is required to occasionally suffer from constipation, as the grandmother has a habit of feeding the children with an excessive amount of food.
According to the first stage of Erikson’s theory of psychosocial development, the child has to transit from the third to the fourth stage. This transitional state indicates that she is required to struggle between industry and inferiority (Scheck, 2014). According to the theory, Alicia possesses skills of differentiating and coping with trust and mistrust along with achieving autonomy in movement and partially in judgment and balancing between initiative and guilt (Scheck, 2014). The evidence demonstrates though that the autonomy of the child is strictly regulated by her grandmother and the child’s initiative, which is suppressed by her authority.
The analysis of the child’s development from the perspective of the theory of cognitive development by Piaget demonstrates that the development of the cognition of the child corresponds to the standards of cognitive development of her age. According to this theory, the child should have undergone through the sensorimotor, preoperational stages, and experiencing the concrete operational stage of cognitive development (Shaffer & Kipp, 2013). Alicia successfully developed motor and sensory skills, and learned to use the language which gives her the opportunity to establish social contacts. According to the scholars, the indicator of the concrete operational stage of cognitive development is that a child learns thinking logically, but struggles to embrace abstract concepts (Shaffer & Kipp, 2013). In the case with Alicia, this indicator is relevant; thus, she is capable of comprehending the concept of individual beauty and understand the uniqueness of each person. Alternatively, Alicia imitates different celebrities, especially the ones of slim complexity, claiming that she wants to be as slim as they are. The will of imitating others and neglecting individuality also indicates that the girl has a problem related to the adequacy of her self-perception (Shaffer & Kipp, 2013). As a consequence, Alicia requires an additional moral and psychological support in order to overcome her problems successfully.
In terms of the impact of the environment, the child obtains an unbalanced level of cognitive and social-emotional support. Therefore, it potentially leads to different psychological impairments. For example, Alicia is under her grandmother’s significant influence; thus, she pressures her moral will, autonomy, and the will for self-identification. As a consequence, the girl’s requirement for autonomy and initiation is still not met. Therefore, Alicia is a quiet child and lacks initiative (Scheck, 2014). However, her parents resort only to harmful dietary behavior, stimulating Alicia’s autonomy and initiative.
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The evidence obtained from direct observation of Alicia in domestic and outdoor setting allows stating that the child has developed at least one problem and some spheres of her life require modification. The analysis of Alicia’s physiological condition, habits, behavior, and psyche lead to the conclusion; consequently, she has developed chronic low self-esteem accompanied by social isolation. These diagnoses are supported by scholar’s claims as the first condition is deficiency of self-valuing caused by perceived body defects whereas the second one is often the outcome of low self-value (Ackley, Ladwig & Makic, 2016). The main spheres that require addressing in order to assist the child to overcome her condition are communication and relationship areas that would modify her self-esteem and daily habits. The primary requests of the child, including the assistance of her parents, valuable guidance and motivation, and absence of suppressing authority (Ackley et al., 2016). The meeting of the identified needs would allow the child to feel valuable and modify her self-esteem along with the changing her body and dietary habits.
The Goal for the Family
As the revealed NANDA diagnosis in the case of Alicia is chronic low self-esteem, the girl and the family require assistance in order to manage her psychic condition. Therefore, the major goal for the family is removing the adverse effect of the girl’s chronic low self-esteem by means of different supportive and preventive interventions. The achievement of the goal can be observed by the presence of the three key outcomes, namely the autonomy in taking individual decisions and judgments, improvement of physical condition, and mutual support from the parents.
The Need for the Increase of the Child’s Autonomy
The autonomy in taking individual decisions is a complex aspect that requires at least three interventions in the direction of increasing Alicia’s autonomy disregarding her environment. The first intervention is the request for removing the pressure of the grandmother, as she persistently distresses the girl and stimulates her irritability increasing the risk for depression (Ackley et al., 2016). This outcome can be achieved by means of educating the grandmother about the children and adolescents’ psychology basics. In addition, this outcome can be achieved by means of implementing the strategies of communication with Alicia’s contemporaries. The efficacy of this intervention can be measured by surveys and independent or group interviews of Alicia and her parents.
The second intervention is the education of the father and mother of the nature of Alicia’s problem and their engagement in a problem-solving initiative. At the moment, the child has the request for experiencing self-confidence, self-worth, and self-esteem through active socialization (Ackley et al., 2016). Scholars admit that the best practice of active socialization for individuals with impaired self-esteem is community functioning such as volunteering (Ackley et al., 2016). Therefore, the parents are required to encourage Alicia to become a volunteer in organizations similar to pet rescue or the support of the poor or disabled people. The ability to help others is expected emotionally to empower the girl. Furthermore, she is capable of autonomously assisting different individuals. The level of success of this intervention should be measured by means of surveying Alicia according to her experience and the perceived level of self-comfort and self-esteem.
Finally, the autonomy of the child can be increased by means of engaging in the games. She is required to imitate different roles and act accordingly in them. The most common examples of such games include Mafia or Monopoly, but it is capable of any board or outdoor game to require autonomous decisions ranging from chess to soccer. This intervention should be measured by generally surveying Alicia regarding her success in sports and physical activities.
The Need for the Improvement of the Girl’s Physical Condition
The improvement of the physical condition of the girl is the next outcome the achievement of which requires the support of the parents, as they impact her dietary and exercising habits. First, Alicia requires participation in active outdoor games or athletic clubs, which would allow her to spend more calories than she consumes. This intervention should be measured by surveying Alicia’s supervisors and coaches, which have to report about physical activity and progress.
The second intervention that would allow her to achieve the established outcome is the education of Alicia’s parents of human physiology and the physiology of the children in particular. This need is the result of the observations, which demonstrate that the grandmother and the parents are unaware of the basic issues associated with dietary habits and physical activity in humans. As a consequence, the grandmother is required to refuse the excessive feeding the children. Furthermore, the parents are not required to allow consuming them unhealthy food. This outcome should be measured by means of interviews with the parents and children.
The third intervention required for the child to achieve the established outcome is Alicia and her siblings’ education of the basics for healthy nutrition and the threats of unhealthy dietary behavior. Therefore, the children are allowed anything to consume an excessive amount of food with sugar in it. As a consequently, their education is required to modify the dietary choices and rationalize the refusal from the excessive consumption of carbonated drinks and chocolate. This outcome should be measured by surveys, but it is also advised to use a glucometer for objective testing of the level of sugar in the child’s blood.
The Need for the Mutual Support of the Family
The mutual support of the family is one of the crucial aspects in the mitigation of the problem with Alicia’s self-esteem, as her family is not united and each member of the family tried to act themselves for a long time. The first intervention for mitigating this problem is the parent education, considering their role in the family, and their stimulation toward correct decisions, while they were selecting between their work and children. The parents are detached from the children most of their time failing to recognize that Alicia and her siblings feel uncomfortable with their grandmother. The deficiency of psychological comfort is one of the causes of depression (Ackley et al., 2016). As a consequence, the parents are required to devote more time to their children. This outcome should be measured by the interviews with the complete family.
The second intervention is the establishment of the family’s tradition to have a family supper. The observations demonstrate that although the members of the family are at residence in the evenings they do not eat together but in small groups. Nevertheless, the tradition of having an activity shared by every member of the family increases the level of trust and communication establishing a positive rapport (Ackley et al., 2016). As a consequence, the new tradition for the family will allow Alicia to simultaneously receive the required moral support from the complete family. It will be required to increase its positive effect.
The third intervention for the family for filling the gap in supporting the child is the parental assistance with Alicia’s education. At that moment, the parents do not participate in the girl’s learning and education process; thus, she is depressed as the deficiency of the skill of deficiency of the skill learning does not allow her overcoming this problem. Therefore, the parents should devote some of their time to reading and writing together with the girl so that she feels cared for. Such practice would also frame the role of a parent as a supporter and friend (Hockenberry & Wilson, 2011), as opposed to supervisor and the monitor of the family’s finances. The measurement of this intervention is required to be performed by means of independent surveying of the parents and the child.
The developmental assessment of Alicia demonstrated the deficiency of the psychology education and nutrition of children in her parents led to the development of her chronic low self-esteem and social isolation. At the same time, the girl faces a perspective of becoming overweight and developing caries, as she has unhealthy dietary habits supported by her parents. In order to restore the child’s psychological condition, the family requires refusing form the tactic of psychological pressure and authority practiced mostly by the grandmother. Instead, the parents should respect and accepts the child’s opinion correcting it if needed and feeding Alicia’s deficit for moral support. In addition to it, the family is required to establish limits on the child’s consumption of unhealthy food and playing digital games. As a consequence, the parents have to stimulate the girl’s motivation to play active games outside mitigating the problem of social isolation. Therefore, the correction of Alicia’s dietary and daily activity habits would remove the risk of becoming overweight and increase her self-esteem. Moreover, the respect to her opinion and the moral support of the parents are required to assist the girl to overcome chronic low self-esteem and refuse from the practice of social isolation.
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