The child whose care I am going to critically reflect on is a child with meningitis. This was a 2-year-old child who presented to the Accident and Emergency accompanied by anxious mother. This was a male child who presented to the A and E with loss of consciousness at home that was preceded by vomiting. This child was diagnosed to be a case of bacterial meningitis and I had to deliver care in the A and E.
Milestones and Development: Obviously many children with the age group that I am going to discuss presented with different diagnoses during my placement in the Accident and Emergency, and milestones and development from both physiological and psychological perspectives have implications in diagnosis and management of these children. To discern an aberration, it is important that an overview of the normal milestones is done. Children accomplish maturation of different biological functions at an anticipated age with a margin of few months on the either side. Ideally, assessment of behavioural development should be interpreted from the time of appearance of definite skills while giving due considerations to environmental and social factors besides the stress of the actual clinical situation. In the phase between 2-3 years, the height increases further with 2.3 kg weight gain per year until the age of 5 years, and at the age of 2.5 years has a full set of 20 baby teeth (Rasen, D.S., 2004).
Psychosocial Milestones: Psychosocially, negativism grows out of child's sense of developing independence and says "no" to every command. Ritualism is important to toddler for security. Temper tantrums may result from toddler's frustration in wanting to do everything for self. The child shows parallel play as well as begins interaction with others and engages in associative play. Fears become pronounced, and the child continues to react to separation from parents but shows increasing ability to handle short periods of separation. The child has daytime bladder control and begins to develop nighttime bladder control. The child becomes more independent and begins to identify sex (gender) roles. The child explores environment outside the home and can create different ways of getting desired outcome (Parker, S., & Zuckerman, B., 1995).
Child in the Accident and Emergency: The primary concerns of this age group that is relevant to the care that I delivered are many. These include "separation anxiety" relationship with mother is intense. Separation represents the loss of family and familiar surroundings, resulting in feelings of insecurity, grief, anxiety, and abandonment. The toddler's emotional needs are intensified by the parents' absence. Presence and treatment in the hospital or A anb E would mean changes in rituals and routines, all of which are important to sense of security, become a source of concern. In this age group, the child has limited capacity to understand reality and passage of time. There is inability to communicate and understanding of language and this affords the child limited communication between self and the world. Moreover while being investigated, examined, or treated, this represents to him loss of autonomy and independence. The child sees self as a separate being with some potential control