| Course | NU 632 Healthcare of Infants, Children and Adolescents |
|---|---|
| Unit | Unit 2 |
| Paper type | Growth and development assessment |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 632 Unit 2
Growth and Development Assessment of a 20-Month-Old Whose Weight Has Crossed Two Percentile Lines
Student Name
Department of Nursing, Herzing University
NU 632: Healthcare of Infants, Children and Adolescents
Instructor Name
January 28, 2026
Growth and Development Assessment of a 20-Month-Old Whose Weight Has Crossed Two Percentile Lines
The Child and the Measurements Available
Ava, a composite 20-month-old girl, is seen for a routine visit. Her father raised no concerns, but the medical assistant flagged her weight. She was born at term weighing 7 pounds 1 ounce. Measurements in the record, all taken in this clinic: at 6 months, weight 16 lb 2 oz, length 26.0 in; at 9 months, weight 18 lb 8 oz, length 27.5 in; at 12 months, weight 20 lb 4 oz, length 29.5 in; at 15 months, weight 21 lb 0 oz, length 29.0 in; at 18 months, weight 21 lb 6 oz, length 31.5 in; today at 20 months, weight 21 lb 10 oz, length 32.0 in. Head circumference has been measured at each visit and today is 47 cm.
Chart Used and Why
Before age two, American clinics are advised to plot on the World Health Organization growth standards, because they describe how healthy breastfed infants should grow under good conditions (Grummer-Strawn et al., 2010). Ava has no condition, such as Down syndrome or prematurity requiring correction, that would call for a condition-specific chart. Switching between the WHO and the CDC charts during the review would produce apparent percentile changes that are artifacts, so one chart is used throughout.
Plotting: Percentiles and Direction
Weight for age: 6 months, about the 50th percentile; 9 months, about the 45th; 12 months, about the 40th; 15 months, about the 25th; 18 months, about the 15th; 20 months, about the 10th. She has crossed two major percentile lines downward, from the 50th to the 10th, mostly since her first birthday. Her weight gain over the past eight months has been about 1 pound 6 ounces, well below what would be expected at her age.
Length for age: 6 months, about the 50th; 9 months, about the 50th; 12 months, about the 55th; 15 months, apparently below the 15th; 18 months, about the 55th; 20 months, about the 50th. Apart from the 15-month value, length is steady near the 50th percentile.
Head circumference: steady near the 50th percentile throughout, with no crossing in either direction.
An Implausible Value
The 15-month length of 29.0 inches is shorter than her length at 12 months, which is not physically possible. The note from that visit records that she was measured standing because she would not lie still. Children under two should be measured lying down on a length board, and standing height is typically slightly shorter than recumbent length. This value is treated as a measurement error and excluded from the interpretation rather than carried forward as evidence of slowed linear growth.
Proportionality
Reading the parameters against each other is what narrows the explanation. Her weight has fallen across percentiles while her length and head circumference have continued along their channels. Weight for length is now at about the 5th percentile. This pattern, in which weight falters first and length and head growth are preserved, points toward inadequate energy intake or increased losses, rather than toward a primary problem with linear growth, such as an endocrine or genetic cause, which would usually affect length as much as or more than weight (Homan, 2016). Head circumference preservation also makes a problem affecting brain growth unlikely.
Dietary and Clinical History Taken in Response
Because the pattern suggested intake, a detailed history followed. Ava was weaned from breastfeeding at 12 months, around the time her weight gain slowed. She now drinks about 32 ounces of whole milk a day from a bottle, including two bottles overnight, and 8 ounces of apple juice. She eats small amounts at meals and is described as a picky eater. She has no vomiting, diarrhea, or change in stools, and no frequent infections. She attends a home daycare. Her father works two jobs, and the family's food budget has been tight since her mother lost hours at work six months ago; they screened positive on a food insecurity screen today. Large volumes of milk and juice can fill a toddler's stomach and reduce intake of solid food; excess milk also reduces iron absorption and is a common cause of iron deficiency at this age.
Development, Domain by Domain
Gross motor: walks well, runs, climbs onto a chair. Fine motor: scribbles, stacks four blocks, feeds herself with a spoon with some spilling. Language: uses about 20 words, points to show things, follows one-step directions. Social-emotional: plays pretend with a doll, looks to her father for reassurance in new situations. These are consistent with the milestones most children reach by 18 months in the updated CDC checklist (Zubler et al., 2022), and her father has no concerns. The Ages and Stages Questionnaire, completed today, was above the cutoffs in all domains. Development is not affected at present. This matters for the interpretation: prolonged undernutrition can eventually slow development, especially language and motor skills, so a normal screen now is reassuring but is also a reason to act before that changes. Her development will be screened again at the 24-month visit, alongside an autism-specific screen, which is due at that age regardless.
Interpretation and Plan
Interpretation: weight faltering after 12 months, with preserved length and head growth, most likely due to inadequate energy intake related to excessive milk and juice, overnight bottle feeding, and food insecurity, with normal development. The plan: check hemoglobin and lead level today; reduce milk to 16 to 24 ounces a day, offered in a cup at meals, and stop the overnight bottles gradually; stop juice; offer three meals and two planned snacks a day; refer to a registered dietitian; connect the family to the WIC program and a local food pantry today, through the clinic's social worker; and recheck weight in four weeks, measured on the same scale, with length on a length board. If weight does not improve in two months, or if new symptoms appear, a broader evaluation for causes of poor absorption or increased needs would follow (Cole & Lanham, 2011).
References
Cole, S. Z., & Lanham, J. S. (2011). Failure to thrive: An update. American Family Physician, 83(7), 829-834.
Grummer-Strawn, L. M., Reinold, C., & Krebs, N. F. (2010). Use of World Health Organization and CDC growth charts for children aged 0 to 59 months in the United States. MMWR. Recommendations and Reports, 59(RR-9), 1-15.
Homan, G. J. (2016). Failure to thrive: A practical guide. American Family Physician, 94(4), 295-299.
Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics, 149(3), Article e2021052138. https://doi.org/10.1542/peds.2021-052138
The Herzing NU 632 Unit 2 instructions
The Unit 2 assignment asks you to assess a child's growth and development using measurements over time and a developmental review. Expect to choose the correct growth chart and explain why, plot each parameter and describe the trend. Implausible measurements should be identified and handled rather than accepted. Many sections ask you to compare parameters with each other, since the pattern suggests the cause. A focused history should follow the pattern, such as diet when weight falls alone. Development should be assessed by domain. The assessment should end with an interpretation and a plan with follow-up. Include a table of measurements if your section allows one, because it makes the trend easier to grade.
How this NU 632 Unit 2 example is built
The paper opens with the child and the measurements recorded at five visits. A short section explains the switch from WHO to CDC charts at age two and why WHO applies here. Plotting gives each parameter's percentile at each visit and the direction of change, which shows weight drifting down from the 50th percentile. The implausible length value is identified and explained as a likely measurement error, and the paper uses the other values. Proportionality compares weight with length and head size, showing that only weight has fallen, which points away from genetic or endocrine causes and toward intake. The dietary history then finds weaning at 12 months followed by heavy cow's milk intake and grazing. Development is normal by domain. The plan sets milk limits, meal structure and a weight check in four weeks.
NU 632 Unit 2 rubric: what full points look like
The Herzing rubric for a growth assessment typically rewards correct chart selection, accurate plotting and trend analysis, data quality, interpretation, history, developmental assessment and plan. Chart points depend on choosing the right standard for the child's age with a reason. Trend analysis is often the heaviest criterion, and graders read for direction across visits rather than a single percentile. Data quality is credited when an implausible value is caught and handled. Interpretation earns points when the pattern across parameters narrows the cause. History points go to questions that follow from the pattern. Development is scored domain by domain. Plan points require specific actions and follow-up timing. APA citations for growth chart guidance and faltering literature are part of the writing score.
Common NU 632 Unit 2 mistakes, and how to avoid them
Growth papers often lose points by reporting a percentile from one visit and calling the child normal or abnormal. Students also use the CDC chart under age two or switch charts without noting the effect. Implausible measurements are frequently accepted, which distorts the trend. Another common gap is looking at weight alone instead of comparing it with length and head growth. The history is sometimes generic instead of focused on what the pattern suggests. Development is often summarized as "on track" without domain detail. Some plans jump to extensive laboratory testing when the history explains the problem. Finally, set a follow-up interval for weight; without it, the plan has no way to show whether the change worked.
Get a NU 632 Unit 2 example written to your instructions
Send the Unit 2 instructions and the rubric from your NU 632 classroom, plus the measurements and history your assessment covers. We write a custom example that reads the trajectory, names the chart and examines proportionality, returned in 24 to 48 hours. The first custom sample is free.
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NU 632 Unit 2 questions, answered
Why does the trajectory matter more than the percentile?
Because position alone is largely inherited and stable. A child who has tracked along a lower percentile since birth is usually growing normally for that child, while one who has crossed downward through two percentile lines has changed and that change is the finding. Reading a single point produces both unnecessary concern and missed deterioration.
How do I know which chart to use?
It depends on age, feeding history and any condition with its own reference. The choice changes the percentile materially, so name the chart, state why it applies to this child, and note if a different reference would place them differently. Using a chart without saying which one leaves the whole interpretation unverifiable.
What if a measurement looks wrong?
Treat it as probably wrong and say so. A value that breaks an otherwise consistent pattern is more often a technique or transcription error than a real change, and acting on it produces unnecessary investigation. Note the inconsistency, say that repeating the measurement is the first step, and interpret the pattern without it until confirmed.
Where can I find a free NU 632 Unit 2 sample paper?
The whole NU 632 Unit 2 assessment is on this page free, including the plotted trends, the implausible value, the proportionality reasoning and the plan. For a different child's measurements, request a custom assessment; there is no charge and it normally arrives in two days or less.
Which growth chart should be used for a toddler?
In the United States, WHO growth standards are recommended from birth to age two and CDC charts from age two. Record which chart you used, since percentiles differ between them.