METRO MANILA

DEVELOPMENTAL
SCREENING TEST
A CASE STUDY
STU DY ON A TODDLER

By: Michael Jones G. Balansag

BSN 2A
 Chapter I
A. Background of the Study

 The study of Metro Manila Screening

Test is not an IQ test;
 it is sought to establish baseline
information on the developmental
characteristics of Filipino toddlers.
 Chapter I
A. Background of the Study

 The study of Metro Manila Screening

Test is not an IQ test;
 it is sought to establish baseline
information on the developmental
characteristics of Filipino toddlers.
 It helps in determining as to what are
the developments and progress of
child.
 This is a tool which is used to detect if
there are delays on children age 2
weeks - 6 ½ years of age.
B. Objectives
 General
◦ Be able to determine and evaluate child’s
development and developmental delays
through the use of MMDST.
 Specific
◦ To conduct the test which enhances child’s
ability to participate and cooperate.
◦ To let the child do the test items that
intersect in her age line and observe if she
is able to do the said tasks.
◦ To determine the growth and development
of the child using MMDST.
◦ To help parents identify child’s
developmental delays and aid them to
resolve the delays.
◦ To enhance parents willingness
will ingness in setting
plans to resolve these delays.
◦ To give recommendations for the family and
proposals for the community.
C. Glossary of Terms
◦ a. Age Line – a vertical line which intersects test
items that a child is going to perform.
◦ b. Delay – a test item which is failed and falls
completely to the left of the age line.
◦ c. Failed – refers to the inability of a child to
perform a test item.
◦ d. Fine – Motor Adaptive – the movement of a
child utilizing small groups of muscles
◦ e. Full Term – the fetus that had reach 38  – 42
weeks before delivery.
◦ f. Gross Motor – refers to the movement of a
child utilizing large amount of muscles.
◦ g. Language  – the ability of the child to hear,
speak and follow directions.
 h. Metro Manila Developmental Screening
Test (MMDST) – a screening instrument used
in determining the development of a child.
 i. Normal Spontaneous Vaginal Delivery
(NSVD) – refers to the normal delivery of a
child through the vagina.
  j. Passed – used to indicate that a child had
successfully done a test item.
 k. Personal- Social – the ability of the child
to get along with other people.
 l. Refused – indicates that a child did not
perform a test item.
 m. Test item – an activity to be done by a
child.
 n. Toddler – age period of childhood from 1
year to 3 years old.
D. Significance of the Study
 To the client
 This study will bring enjoyment to the child and it
enhances child’s abilities and capabilities to
discover new things to her environment.
 To the parents
 This will help them understand the child’s growth
whether the child can perform the developmental
tasks at her age.
 To the students
 study will help students to understand the
importance of growth and development
through actual evaluation of qualitative and
quantitative changes seen in growth and
development of children.
E. Client’s Profile
 Name of the client: Cristal Khate B.
Guerra
 Age: 1 year and 11 month
 Sex: Female
 Birth Date: October 21, 2009
 Birth Place: Mercy Maternity Center #10
First Opal Street Near Corner
Veloso/Dacudao Agdao/Obrero, Davao City
A. Present Medical Condition

 During the time of the assessment the

child has no signs or symptoms of
health problem. The child appeared to
be healthy and was very much
energetic during the conduction of the
test.
B. Past Medical History
 According to the client's mother the child
had experienced some illness in the past
such as diarrhea, high fever that reached
40 degree centegrade and
Thrombocytopenia (reduced platelet count).
The mentioned health problems were
resolved through management obtained in
the clinic and medications were given.
C. Family History
 Birth order of the client: 1st child
 Total number of siblings: 1
 Number of living siblings: 1

 Heredo- familial Disease:

 Father side: Hypertension

 Mother side: Arthritis
 D. Maternal and Prenatal
History
 Illness during pregnancy 1 st trimester
- none
 X-ray during 1st trimester
- none
 Term
- Full term- 38 weeks
 Place of delivery
- Mercy Maternity Center
 Type of delivery
- NSVD
 Attendant
- Midwife
 Infants Problem during 1 st month
- Fever
 E. Developmental History
 TYPES OF DEVELOPMENT AGE ACHIEVED
 Rolled Over 6 months old
 Sat alone 8 months old
 Stood alone 11 months old
 Walk alone 1 year
 Talked 1 year and 4 months
 Toilet Trained 1 year and 8 months
 Coordination 1 year and 8 months
 F. Nutritional History

TYPES OF FEEDING AGE STARTED DURATION FEEDING INTERVAL

Breast feeding At birth 1 yr & 2 mo. 3 hrs

Artificial feeding 1 yr & 2 mo. 1yr and 6 mo. 4 hrs

to present
G. Immunization
 Is a process by which vaccines are
introduced into the body before
infections sets in. Immunization are
also called vaccination’s a method of 
stimulating resistance in the human
body to specific disease using
microorganism that have been
modified and being injected to the
body.
NEWBORN 1ST DOSE 2ND DOSE 3RD DOSE 4TH DOSE 5TH DOSE 6TH DOSE
SCREENING

BCG (at birth) 11/11/09 ----------- ----------- ---------- ---------- -----------

DPT (6 weeks, 10 01/02/10 02/10/10 03/17/10 ---------- ---------- ----------

weeks, 14 weeks old)

OPV (6 weeks, 10 01/12/10 02/10/10 03/17/10 --------- ---------- ----------

weeks, 14 weeks old)

Hepatitis B (6 weeks, 11/11/09 ------------ ----------- ---------- ----------- ----------

10 weeks, 14 weeks)

Measles (9 months) 01/12/10 03/17/10 07/28/10 ---------- ---------- ----------

Vit. A (start at 6 04/28/10 ---------- ---------- ---------- ---------- ----------

months)

Deworming 05/21/10
 H. Physical Assessment
Anthropometric measurements Results

Length 84 cm

Head Circumference 44.5cm

Chest Circumference 45.5 cm

Abdominal Circumference 44.5 cm

Vital Sign Results

Temperature 36.2 °C

Respiratory Rate 23 bpm

Pulse Rate 87 bpm

Weight 8.62 kg
Parts Assessment

Skin No presence edema, the skin color is brown

Eyes Pinkish conjunctiva; Eyelashes are equally distributed. The pupil is color black.

Ears No presence of cerumen, the skin color is brown.

Nose No lesion, Sinuses are not tender to palpation and no crepitus is evident.

Thorax No deformities of the Thorax, Normal Breathing expansion, Symmetric, .

Neck No mass noted, with range of motion

Lung No masses and tenderness noted.

Heart  Normal heart sounds characterized by “lub dubb”. No murmurs heard during

auscultation.

Spine vertically aligned and she has straight spinal column.

Abdomen No lesion; the abdomen is not distended.

Extremities No loss of extremities; Nails are properly cut and clean.

 Chapter III
Methodology
A. Settings
◦ The study was conducted last September 22,
2011 at the residence of Guerra family located
at Km. 10 Emerald St. Doña Salud Subd., Sasa
Davao City.
◦ The family does not owned the house they
share only a renters there for two years now.
◦ The house is semi concrete, it is made up of
blocks and wood. They only have one bedroom
which is located at the right side of their house.
The house does have adequate lighting
facilities. The living space is also adequate and
B. Methods Used
◦ INTERVIEW- this is an approach in
gathering information from the person
involved in the growth and development
of the child.
◦ This method was done by asking the
parent the facts and information about the
child’s abilities and skills.
◦ This method also helped the group to
gather data on the profile of the client and
family background.
 MMDST tool - the bars that intersect her
age are the items give by the
administrators and being performed by
the client.
 OBSERVATION - this method was used
when the group allowed this child to
perform the different task to be able to
determine what she can do at her age.
This s considered as the most important
tool since most of the item requires
careful observation of the client’s
behaviour. This method was also used to
study the surroundings of the child’s
environment.
 RECORDING AND DOCUMENTAION
- this method was to record and
document all gathered information.
 PHYSICAL EXAMINATION - I used
different methods in conducting
physical assessment to identify our
client’s development, if the client is
growing according to his age
development. Our client was able to
do the entire test without any
difficulties.
C. Test Materials
◦ Clear small glass with 5/8 inch opening
◦ Cheese curls
◦ Small Rubber Ball with 12.5 inches in
diameter
◦ Pencil and Bond Paper
◦ 8pcs of 1 inch blocks
D. Test Procedures
 The toddler may sit on the lap of her mother/ caretaker.
 Set test materials on the table.
 Put mother or caregiver at ease and establish rapport stating that
the tester is interested in knowing what toddler can do in a certain
age.
 Every effort is made to see what a toddler can actually do rather
than asking the parent.
 Generally the test starts with personal sector: this gives the toddler a
chance to get used to the tester.
 The fine motor adaptive follows: toddler can perform the task at
hand without having the talk to the tester directly at yet.
 The language sector comes next: toddler will be more comfortable
with the task and much more likely imitates speech sound and
noises that the tester asks to imitate.
 The gross motor comes, the toddler is allowed three trials to perform
each item before a failure is scored
 Items may be scored either of 4 ways of scoring.
P- PASS F- FAIL
R- REFUSED
NO -No opportunity (not considered in the total score)
 Criteria in Interpreting the Scores
Criteria Interpretation

1. Two or more sector with two or more delays. Abnormal

2. One sector with two or more delay or more sectors with one Abnormal

delay and in that same sectors no passes intersecting age line.

3. One sectors with two or more delays Questionable

4. One or more sector with one delay and in that same sector Questionable

no passes intersecting age line.

5. When refusal occurs in number large enough to cause test Untestable

result to be questionable or abnormal these were scored as

failures.
 G. Calculation of Toddler’s
Age
 To get the chronological age of a
toddler, subtract the birth date of the
client from the date of administration.
 Date of Test: September 22, 2011
 Date of birth: October 21, 2009

Year Month Day

- 2011
2009
09
10
22
21
Total Age: 01 11 01

Child’s Age: 1 year and 11 month and 1 day

Chapter IV

 The result, analysis and justification of

the four sectors of MMDST.
  Personal-Social
Item used Skills
Result Analysis Justification

Uses Spoon spilling Pass The client was able to use spoon Helps feed self; enjoys holding spoon (often upside
little while eating and a little spilling of  down) and drinking from glass or cup; not always
food was noticed. accurate in getting utensils into mouth; frequent
spills should be expected. Eisenberg, A., Murkoff,
H.E.&,Hathaway, S.E. According to what to expect 
the toddler years.

Puts on Clothing Pass The client was able to wear her Toddler gradually will become more cooperative
dress without asking supervision during dressing and learn to extend legs and arms
from her mother. to help put on coats and pants. At the age of two,
he or she will be able to pull on simple clothing.
Pillitteri, A.(2005).  Maternal and Child Health
 Nursing care of the childbearing and childrearing

 family (4th Edition.)

Removes Garment Pass The Child was able to remove her Toddler may e able to remove one or two loose
clothes without any help from her items of clothing. Lippincott W. & Wilkins (2005)
mother.  Maternal and Child Health Nursing care of the

Childbearing and childrearing Family.

 Fine Motor Adoptive Skills
Tower of 4 cubes Pass The child failed on the 1st The 22 months old can make tower of four
attempt of making the tower blocks. One year later, he can stack eight blocks.
of 4 cubes but on the 2 nd and Pilliteri, A (2007).  Maternal and child health
3rd attempt she does it well.  Nursing.

Dumps Cheese Pass The child spontaneously The child is ale to perform the given task y just
Curls from bottle –  dumps the cheese curl out of  telling her to transfer the cheese curl to the other
spontaneously. the small glass according to bottle. The eye-hand coordination is developed
what had been told to her resulting manipulation of objects.
without a demonstration how Pilliteri, A (2007).  Maternal and child health
to do it. nursing.

Dumps cheese Pass The child dumps the cheese The child was able to do it after the examiner
curl out of the bottle with a
curls form the demonstration given how to showed how the task done. The eye-hand
bottle - do the task. coordination is developed resulting manipulation
demonstration. of objects.
Pillitteri, A. (2005).  Maternal and child Health
 Nursing Care of the childbearing and 

childrearing family (4th edition).

  Language Skills
3 words other than mama Passed The client was able to spoke 3 Uses 2 – 3 words other than mama and dada at 12 – 15 months.
and dada words other than mama and papa Lippincott W. & Wilkins (2005)  Maternal and Child Health Nursing care of the
like “hello”, “bye  bye”, “hi!” childbearing and childrearing family.
and “hawa”.
Combine 2 words Passed The client was able to combine Combines 2 words at 16 – 24 months, there is a range of ages at which children are first able
two words like “hello mama” to combine words into sentences; if a toddler cannot do so by 24 months, parents should
and “bye bye mama”. consult to their health care provider.
Pilliteri, A. (2008). Maternal and child health nursing.

Points to 1 named body Passed The client was able to point body The easiest things that a child is able to identify at the earliest onset of life would be those
part parts like nose, lips, ears, eyes most commonly taught by elders, such basics as letters, body parts, colors, and shapes These
and arms. would then progress into the more complicated nuances of language and development of 
thought expression.
Pilliteri, A. (2007). Maternal and Child Health Nursing.

(14) Names one picture Passed The client was able to name fish Toddler name familiar people and objects. Their Attention span is short. Recognition of 
and dog during assessment. pictures of familiar persons. Eisenerg, A., Murkoff, H.E.&,Hathway, S.E.  According to what 
is expected to toddler years.

(13) Follows Direction 2 Passed The client was able to follow Once the children becomes toddlers, they are ready to learn how to follow directions.
or 3 directions given like getting the Pillitteri, A. (2005).  Maternal and child health nursing care of the childbearing and 
ball on the other side of the chair childrearing family (4th Edition.)
and putting it to the table.
  Gross Motor
Skills
Kick Ball Forward Passed The client was able to kick the ball Around 18 months, your toddler will
forward. probably be able to kick a ball forward.
Pilliteri, A. (2008).  Maternal and Child 
health nursing.

(24) Throwing ball Passed The client was able to Throw the ball By the age of 24 months, many toddlers can
overhead overhead 3 feet within arm’s reach of  now throw a ball overhead.
tester. Pilliteri, A. (2005)  Maternal and child 
health nursing care of the childbearing and 
childrearing family. (4th Edition)

Balance on 1 foot Passed The client was able to balance her body The capacity of the child in balancing on 1
1 second for about 3 seconds with 1 foot. foot for about 1 sec. Is less than 30% out of 
2 of 3 90%.
Lippincott W. & Wilkins (2005)  Maternal
and child health Nursing Care of the

childbearing and Childrearing Family

Jumps in place Passed The client was able to perform jumping Toddlers like to jump. Place pillows,
in place slowly. Cushion, or a mattress on the floor.
Pilliteri, A. (2008).  Maternal and Child 
 Chapter V
A. Summary
◦ The study aims to determine the developmental
status of a toddler. The chosen client was Kristine
Hermosa (not her real name), 1 year, 11 months
and 1 day old. From Km. 10 Emerald St. Doña
Salud Subd., Sasa Davao City an assessment
was done to the client and his family to determine
the factors that contributes to the growth and
developmental status of the child. This will help
you to determine if the child development is
within his normal age. And taking particular of the
child’s ability to do whatever was required for him
and evaluated accordingly.
 During the test, the client was a little bit
shy but still cooperates with the test. After
a while the shame was replace with a very
energetic and noisy child. The child
passed the entire task that belongs in his
age line. The child obtained to pass the
item intersecting of his age line, with the
score of passed item of 15 out of 15 items
intersecting age line. The test results
reveals the interpretation that the growth
and developmental status of the chills is at
the normal level, in all the four sectors of
the test personal-social, fine motor
adaptive, language and gross motor.
 I therefore concluded that my client is
developing properly within his age.
Because she was able to do the entire
test properly without any problems. In the
personal  – social skills the task of the
client is to put on clothing, know how to
remove garments and use spoon but with
the consideration if it spills a little. In fine-
motor skills the task are to make a tower
of 4 cubes, dumps cheese curls from
bottle spontaneously and demonstrate it.
She was able to do all of these without
any help from others.
 Part of the developmental growth of the child
is the language skills that may help the client
in communicating to others, especially soon
when she will be attending in school. The
tasks is to spoke 3 words other than mama
and papa, combines two words, points to 1
named body parts, name’s one picture and
follows direction. The client passed these
tasks and she properly done the task without
asking any help from his mother. Knowing
words that she talk’s can help the client so
that he can properly understand and explain
words within his capacity and knowledge. The
gross motor skills use group of muscles in
doing tasks. In this test the client is using his
whole body to perform the task like kicking
the ball forward, throwing the ball overhead,
balancing on 1 foot and jumping in place.
C. Recommendation
 To The Client
 she should stop eating candy.
 she should avoid eating junk foods; and replace it with
good and nutritious foods that are necessary for health.
 To the Family
 The family should continue in supporting the child mentally
emotionally, physically, socially and spiritually so that the
child will attain the optimum level of functioning.
 To community:
 The parents should teach their children in proper hygiene,
and not to throw their garbage anywhere to provide clean
environment in order to have a healthy lifestyle.
 The elders of the community must be aware for any
problem that is present to their community.
 hey should be united for easy promotion of health that
could lead to healthy community.
 To The Student
 They should be more knowledgeable in conducting
the interview; establishing trust is needed.
 They should continue to conduct studies regarding
the growth and development.
 They must give appropriate health teaching to the
people in the community.
 Be a role model to the people in the community
especially to the client.
Bibliography
 Internet:
 http://www.yahoo.com
 http://www.wikipedia.com
 http://www.google.com
 http://pediatrics.about .com
 http://www.alpharubicon.com
 Books:
 Fundamental of Nursing by Kozier, Erb, Berman 7th
edition.
 Maternal and Child Health Nursing: Care of the
Childbearing and Childrearing Family by Adele Pillitteri
5th edition.
 Health Assessment In Nursing by Janet Weber and Jane
Kelley 3rd edition.
 Maternal and Child Health Nursing Care of The
Childbearing and Childrearing Family by Lippincott W. &
Appendices
Marriage Certificate and Birth Certificate
Vaccination