Ch. 26: Growth and Development of the Toddler
Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching? Remained relatively calm even though embarrassed Made sure the child was rested and not hungry before going to the mall Reasoned with the child to stop the behavior Tried to refocus the child's attention as tantrum behavioral cues appeared
Reasoned with the child to stop the behavior RATIONALE: The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.
Which gross motor developmental milestone is least likely for a 2-year-old? Stands on one foot with help Climbing stairs with assistance Jumps in place Rides a tricycle
Rides a tricycle RATIONALE: Gross motor developmental milestones for a 2-year-old include jumping in place, standing on tiptoes, kicking a ball, and running. At 3 years old, the child should be able to pedal a tricycle, run easily, and walk up and down the stairs with alternate feet. At 12 to 18 months of age, the child should be able to stand on one foot with help, walk independently, climb the stairs with assistance, and pull toys.
The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old. Explain that the child looks normal. Some children have large heads but that does not signal a problem. Share that the heads of children at this age are large in proportion to the rest of their body.
Share that the heads of children at this age are large in proportion to the rest of their body. RATIONALE: Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel (fontanelle) should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? "I give my daughter juice at breakfast and when she is thirsty during the day." "New foods are offered along with ones she likes." "She drinks three 6-ounce cups of whole milk each day." "When she doesn't eat well at meals we give her nutritious snacks."
"I give my daughter juice at breakfast and when she is thirsty during the day." RATIONALE: High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new.
Which statement by a parent would best prepare the toddler for the parent's return if the parent must leave the hospital? "I will be back after you eat your dinner and SpongeBob goes off." "I will be back in the morning. Mommy loves you." "I will come back when it is time for your bath tonight." "I will be back later this afternoon."
"I will be back after you eat your dinner and SpongeBob goes off." RATIONALE: Toddlers have no real concept of time and equate time to events in their lives. So, the best way for the mother to tell the child when she will be back at the hospital is to relate her arrival to events such as the child's dinner and TV programs the child likes.
Parents are asking a pediatric nurse how to deal with separation anxiety every time they try to have an adult night out. Which advice by the nurse sounds like the most appropriate way to handle this situation? "If your child starts crying, stay a little longer and read a story before leaving." "Try to sneak out the back door to avoid the long crying scene at the door." "Note if your child cries as you leave because this may be an indication the babysitter is ignoring the child." "Inform the child that you are going out but the regular babysitter will care for them and put them to bed."
"Inform the child that you are going out but the regular babysitter will care for them and put them to bed." RATIONALE: Most toddlers react best to separation if a regular babysitter is employed or if the day care center has consistent caregivers. It helps if toddlers have fair warning they will have a babysitter. No matter how well prepared toddlers are, they may cry when the babysitter actually appears or may greet the babysitter warmly only to cry when the parents reach for their coats. It helps if parents say good-bye firmly, repeat the explanation they will be there when the child wakes in the morning, and then leave. Prolonged good-byes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen a child's fear of abandonment and so should be discouraged.
The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? "Calorie requirements for toddlers are less than infants." "You may have to serve a new food 10 or more times." "Give him more healthy choices with less junk food available." "Serve only healthy foods. He'll eat when he's hungry."
"Give him more healthy choices with less junk food available." RATIONALE: Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the timeline for acceptance of a new food does not offer a practical reason for making a change in diet.
Parents are beginning to potty train their 2-year-old child and seek advice from the nurse on how to be successful in this endeavor. Which statement by the parents indicates that further teaching is needed? "We will place him on the potty for 5 minutes for each session." "I will wait until he is off the toilet before flushing it." "I bought him 'big boy' underwear for him to use instead of diapers." "He wants to accompany me to the bathroom but I prefer to go alone."
"He wants to accompany me to the bathroom but I prefer to go alone." RATIONALE: Allowing a toddler to observe a parent or older sibling going to the bathroom serves as a positive role model and helps the child understand what he or she is to do there.
During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" What would be appropriate for the nurse to suggest? Select all that apply. "Offer her something she would like, such as ice cream, to distract her." "Use time-out every other time she tells you no." "Make a statement instead of asking a question." "Limit the number of questions you ask of her." "Offer her two options from which to choose."
"Make a statement instead of asking a question." "Limit the number of questions you ask of her." "Offer her two options from which to choose." RATIONALE: A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. In addition, using statements instead of asking questions and giving the child a choice of two options are effective. Using time-out is a discipline measure and would be inappropriate to counteract a toddler's negativism. Offering a choice rather than a bribe such as ice cream is more effective and long-lasting for modifying the child's behavior.
The nurse is teaching good sleep habits for toddlers to the parent of a 3-year-old client. Which response indicates the parent understands sleep requirements for the client? "My child needs 12 hours of sleep per day including a nap." "The routine at bedtime can fluctuate from day to day." "I'll put my child to bed at 7 p.m., except Friday and Saturday." "I should give my child a glass of milk before bed."
"My child needs 12 hours of sleep per day including a nap." RATIONALE: The father understands the child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. Changing the routine from day to day leads to the child not knowing when it is time to go to bed. Giving the child a glass of milk before bed can cause diaper leakage or, if the child is potty-trained, having to get up during the night to void.
A group of caregivers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is appropriate related to this form of discipline? "Our time-out chair is in the master bedroom so my child cannot see anyone else in the family." "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." "My child is 3 years old now and I put my child in time-out for 5 to 10 minutes when misbehaving." "We use the time-out chair when our child gets tired but does not want to take a nap."
"When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." RATIONALE: A method for a young child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary. The chair should be used for discipline, not because the child will not go take a nap. It can be used for all ages of young children.
A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response? "When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." "You will just have to condition yourself to take her to the potty chair every hour until they get the hang of it." "It doesn't hurt to start when they turn 2 as long as you don't punish them for having many accidents." "I started training my kids when they started to pull themselves up to a standing position."
"When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." RATIONALE: The markers of readiness are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers, or they may bring a parent a clean diaper after they have soiled so they can be changed. The other answers do not address this. Usually the child needs to walk well independently before training can occur.
The nurse is caring for an 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value? 5 ml/hr 15 ml/hr 10 ml/hr 20 ml/hr
10 ml/hr RATIONALE: The normal urinary output for a toddler is approximately 1 ml/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 ml/hr.
The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? Put shapes into matching openings Ability to hold a crayon to write Able to use a spoon to self-feed Ability to turn door knobs
Ability to turn door knobs RATIONALE: Turning knobs opens doors and may allow the child access to the outdoors or unsafe areas within the home. Close to follow will be the ability to unscrew lids, creating poisoning risks. The other abilities promote growth and development and involve lesser safety hazards.
What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums? Promise the toddler a special activity if the toddler will stop Distract the toddler with a toy when the toddler begins holding the breath Appear to ignore the toddler Mimic the toddler's behavior by also holding the breath
Appear to ignore the toddler RATIONALE: Temper tantrums are the natural result of frustration that toddlers have. Toddlers do not behave badly on purpose. They need time and maturity to learn the rules and regulations. During a temper tantrum, the advice is for the parent to ignore the behavior but ensure the toddler is safe. Rewarding temper tantrums can teach the toddler that tantrums are an effective method of interaction. Ignoring tantrums teaches the toddler that tantrums are ineffective. The parent needs to use self-control when dealing with a temper tantrum. This is a way to model acceptable behavior for the toddler.
A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take? Explain that children can take their first steps as late as 18 months of age. Explain that the child could start walking any day. Refer the child to a developmental specialist for evaluation. Ask the parent if the child has been ill recently.
Explain that children can take their first steps as late as 18 months of age. RATIONALE: Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.
The nurse finds the diet of a 30-month-old girl to be low in calcium. What suggestion can significantly increase this toddler's calcium intake? Include dark greens and spinach in her meals. Give her slices of cheddar cheese as a snack. Use unsweetened applesauce as a dessert. Offer chocolate milk to increase milk intake.
Give her slices of cheddar cheese as a snack. RATIONALE: Two and one-half ounces of cheddar cheese provides the toddler's daily requirement of 500 mg of calcium. Chocolate milk provides calcium but the sugar it contains should not be a regular part of a toddler diet. Applesauce provides fiber, not calcium. Spinach and dark greens do contain calcium, but that calcium has limited bioavailability.
A nursing instructor is leading a class discussion exploring the various aspects of Erikson's theories of the developmental tasks of toddlers. The instructor determines the session is successful when the students correctly choose which task as a priority for toddlers? Learning to trust Learning to understand and respond to discipline Learning to act on one's own Learning to speak
Learning to act on one's own RATIONALE: Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) while overcoming doubt and shame. Erikson's psychosocial developmental task for infants is to develop a sense of trust. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson.
The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse? The child has difficulty with stairs. The child is pointing to named body parts. The child can stand on his tiptoes. The child speaks in one-word sentences.
The child speaks in one-word sentences. RATIONALE: A 2-year-old child not using at least two-word sentences is a sign of a potential developmental delay. Normal development for a 2-year-old child is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old child.
A 15-month-old toddler has been brought to the clinic because the toddler is pale and listless. Which finding or observation would lead the nurse to suspect iron-deficiency anemia as the cause of the clinical manifestations? The nurse hears a grade 2 heart murmur. The toddler drinks very little fruit juice. The toddler eats a vegetarian diet. The toddler drinks 32 oz (1 L) of milk per day.
The toddler drinks 32 oz (1 L) of milk per day. RATIONALE: Cow's milk is low in iron content. It should be limited to 16 oz (0.5 L) per day in toddlers. This toddler is drinking 32 oz (1 L) of milk per day, which can contribute to iron-deficiency anemia. A good vegetarian diet would not cause the toddler's symptoms. Generally vegetarian diets are more deficient in vitamins D and B12. The grade 2 heart murmur is most likely innocent. Eating an acidic fruit or drinking the juice with iron-containing foods enhances iron absorption.
A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess? Knowledge of full name Use of a two-word noun-verb sentence Verbalization of 4 to 6 words Ability to name one color
Use of a two-word noun-verb sentence RATIONALE: A 2-year-old should be able to say a two-word sentence that consists of a noun and verb. A 15-month-old can say 4 to 6 words. A 30-month-old knows his full name and can name one color.
The nurse is observing a 36-month-old boy during a well-child visit. Which motor skill has he most recently acquired? undress himself push a toy lawnmower pull a toy while walking kick a ball
undress himself RATIONALE: This child has most recently acquired the ability to undress himself. Pushing a toy lawnmower and kicking a ball are things he learned at about 24 months. He was able to pull a toy while walking at about 18 months.
The parent of a preschool-aged child reports that the child seems to believe in imaginary things. The parent voices concern that this "fantasy world" may become a problem. What response(s) by the nurse is indicated? Select all that apply. "Fantasy play is most often seen in lonely children in an attempt to occupy themselves." "Your child is engaging in what we call magical thinking." "This type of thought process allows your child to begin to observe the differences in the world." "This type of imagination is not normally seen until a child is school aged." "While imagination is normal, this type of fantasy world can cause problems for your child and should be discouraged."
"Your child is engaging in what we call magical thinking." "This type of thought process allows your child to begin to observe the differences in the world." RATIONALE: Magical thinking is a normal part of preschool development. In magical thinking, the preschool-aged child believes that one's thoughts are all-powerful. The fantasy experienced through magical thinking allows the preschool-aged child to make room in his or her world for the actual or the real. Through make-believe and magical thinking, the preschool-age child satisfies curiosity about differences in the world around him or her. There is nothing problematic about this type of imagination.
A 3-year-old child is hospitalized. The parents are concerned because the child is now refusing to use the potty and is wetting the bed even though the child has achieved toilet training. Which response by the nurse is most appropriate? "Once discharged, your child will quickly learn to use the toilet again." "Why do you believe your child is refusing to use the potty?" "Do not worry. This is a normal response to being in the hospital." "Your child is experiencing regression as a result of stress."
"Your child is experiencing regression as a result of stress." RATIONALE: Regression is a change from present behaviors to past developmental levels of behavior. This is a normal response among children during times of intense stress, such as a hospitalization or the birth of a new sibling. The nurse should not tell the parents not to worry. The child will not have to learn to use the toilet again. The behavior is already learned. Asking why is not a therapeutic form of communication and may cause the parents to become unnecessarily defensive.
The parents of a 2-year-old child born with short-gut syndrome feed their toddler via a feeding tube. Knowing this is a developmental time when children usually feed themselves, the parents are asking the nurses what they can do to help foster the child's independence. Which suggestion would be most appropriate at this time? Try to focus the child's energy on learning to read simple books that are age appropriate. Imitate placing food in the child's mouth as long as the food is large enough so it cannot be swallowed. Let the child choose what clothing he or she will wear the next day. Play catch with the child while others are eating so they do not have to feel left out.
Let the child choose what clothing he or she will wear the next day. RATIONALE: If children are tube fed, they receive no experience at all with finger foods. For these children, parents should try to provide other, comparable experiences in independence, such as letting them choose what toy to take to bed or what clothing to wear. Playing, reading, or pretending a toy is food at feeding time are not appropriate activities since the child's feeding is usually scheduled around normal meal times.
The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? There is an increased risk for physical injury in this age group. Spanking a child this age predisposes the child to a pro-violence attitude. Spanking demonstrates a poor model for problem-solving skills. The child will become resentful and angry, leading to more outbursts.
There is an increased risk for physical injury in this age group. RATIONALE: Spanking should never be used with toddlers younger than 18 months of age because there is an increased risk for physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk for physical injury in this age group is paramount.
The nurse is assessing a 2-year-old boy during a well-child visit. The nurse correctly identifies the child's current stage of Erikson's growth and development as: industry versus inferiority autonomy versus shame and doubt trust versus mistrust initiative versus guilt
autonomy versus shame and doubt RATIONALE: The Erikson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children.
Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply. cheese slices raisin oatmeal cookies orange slices sugar-free candy bars yogurt
cheese slices orange slices yogurt RATIONALE: Toddlers often need between-meal snacks. To help prevent dental caries from frequent snacking, encourage parents to offer fruit (e.g., bananas, pieces of apple, orange slices) or protein foods (e.g., cheese, pieces of chicken) for snacks rather than high-carbohydrate items such as cookies and candy bars to limit exposure of the child's teeth to carbohydrates. Calcium (found in large amounts in milk, cheese, and yogurt) is especially important for the development of strong teeth.
The nurse is preparing a presentation for a health fair which will illustrate various ways to help introduce siblings to a new member of the family. Which suggestion should the nurse prioritize to help older siblings, especially toddlers, understand the change in the family dynamics? Plan time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant. Have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit. Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. Move the toddler to a new bedroom with a "grown-up-bed."
Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. RATIONALE: The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special. Moving the older child to a larger bed lets the toddler take pride in being "grown up" now, but it should be done some time before the new baby appears. While acknowledging that time with another adult can be a special time, the main concern is for the toddler to understand they are not being replaced by the newest member of the family.
A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily but is thinking of weaning him soon. How should the nurse respond to this mother? "It is normal for toddlers to lose their appetites; try weaning him all at once so that he will be more interested in the solid food." "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition." "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition."
"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." RATIONALE: Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant that this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them.
Which action is appropriate to enhance a toddler's self-esteem? Utilize negative criticism as well as positive reinforcement. Utilize belittling techniques as opposed to time-outs. Avoid applauding for unsuccessful attempts. Include the child in activities that interest the adult.
Include the child in activities that interest the adult. RATIONALE: Parents who give the toddler love and respect regardless of the child's gender, behavior or capabilities are helping to lay the foundation for self-esteem. Toddlers need familiarity with the daily routine to enhance self-esteem development. Routines and rituals not only help develop self-esteem but help develop a conscience. Strategies for enhancing self-esteem encompass including the child in activities that interest the adult. Belittling techniques should not be used. Negative criticism should be avoided. Applauding for unsuccessful attempts as well as successes should be reinforced.
During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy? "When my toddler falls down, they always wants me to pick them up." "My toddler has temper tantrums when we go to the store." "My toddler uses the potty chair and is dry all day long." "Every night my toddler follows the same routine at bedtime."
"My toddler uses the potty chair and is dry all day long." RATIONALE: During the toddler years, the toddler separates from his or her parents, recognizes one's own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way the toddler expresses frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this, so it is not indicative of toddlerhood or autonomy. Having the same routine for bedtime each night provides security but it does not demonstrate autonomy.
A grandmother who is the primary caregiver of a 2-year-old is expressing concern about how to best handle the temper tantrums that can occur two or three times a day, often in public places. She explains she spanked her own children for this but she is worried this is not the best way to handle the situation. Which response from the nurse will best address this concern? "Spanking is controversial but sometimes necessary, so use it if it works." "Remind the child that they are in a public place and ask the child to respect those around them; reward the child if the child responds by calming themself." "Warn the child that they will be punished when they are back at home then follow through with the punishment." "Remain calm, pick the child up, and move to a quiet and neutral place until the child gains self-control; don't give in to the child's demands."
"Remain calm, pick the child up, and move to a quiet and neutral place until the child gains self-control; don't give in to the child's demands." RATIONALE: Remaining calm is a must. It is not easy to handle a small child who drops to the floor screaming and kicking in rage in the middle of the supermarket or the sidewalk, nor are comments from onlookers at all helpful. The best a caregiver can do is pick up the out-of-control child as calmly as possible and carry him or her to a quiet, neutral place to regain self-control. Reasoning, scolding, or punishing during a tantrum is useless. Do not yield the point or give in to the child's whim. That would tell the child that to get whatever one wants, a person need only throw oneself on the floor and scream. The child would have to learn painfully later in life that people cannot be controlled in this manner. Spanking or other physical punishment usually does not work well because the child is merely taught that hitting or other physical violence is acceptable and a child who is spanked frequently becomes immune to it.
Which is the best way for parents to aid a toddler in achieving the developmental task? Help the toddler learn to count Urge the toddler to dress oneself completely alone Give the toddler small household chores to do Allow the toddler to make simple decisions
Allow the toddler to make simple decisions RATIONALE: The toddler years see a refinement of motor skills, continuous cognitive growth, and the acquisition of language skills. During this time the toddler achieves autonomy and self-control. Allowing the child to make decisions is a good way to help the toddler achieve autonomy and gain independence. Rewarding the child for accomplishing the task after making the decision is a good way to reinforce self-esteem. A younger toddler may not successfully dress alone because he or she may not have mastered such techniques as buttons, zippers, or tying shoes. A toddler can help with household tasks but these are generally limited because the toddler's attention span and motor skills may not be refined enough to complete the task. Helping the child learn to count is improving cognitive development but does not necessarily help the child with gaining autonomy or self-control.
A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply. Hard foods such as nuts, raw carrots, and popcorn Vegetables such as corn, green beans, and peas Fruits such as peaches, pears, and kiwi Round foods such as hot dogs, whole grapes, and cherry tomatoes Sticky foods like peanut butter alone, gummy candies, and marshmallows
Hard foods such as nuts, raw carrots, and popcorn Round foods such as hot dogs, whole grapes, and cherry tomatoes Sticky foods like peanut butter alone, gummy candies, and marshmallows RATIONALE: To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.
A parent with a 2-year-old invites a friend with a toddler over for a play date when they notice their children are not really interacting while playing. The children are playing side-by-side when one toddler gets up and grabs a toy car out of the hands of the other toddler, which results in both toddlers crying. To prevent this from occurring again, which intervention should the parents make? Parent of the toddler who started the fight should put this child in "time out." Parents should decide that they need to wait about a year when the children are more ready to share toys. Sit the toddlers down and give a lecture about "sharing." Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy.
Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy. RATIONALE: All during the toddler period, children play beside other children, not with them. This side-by-side play (parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Caution parents that if two toddlers are going to play together, they must provide similar toys because an argument over one toy is likely to occur. Avoiding introducing playing with others, time out, or lecturing toddlers about "sharing" concept are inappropriate at this time.
The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? has persistent separation anxiety goes from calm to tantrum suddenly sucks his thumb periodically is unable to share toys with others
has persistent separation anxiety RATIONALE: Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.
After teaching the mother of a 13-month-old boy about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states: "I'll wash his hair everyday with just plain soap." "I'll drain the tub while he's still in it so he won't fall." "It might be best to give him a bath in the evening." "I can use bubble baths to lure him into the tub."
"It might be best to give him a bath in the evening." RATIONALE: The young child's increased activity level necessitates bathing daily or every other day. A good time to bathe the child is after eating, either after breakfast or in the evening. Hair is washed two to three times per week with a mild shampoo. Bubble baths should be avoided, to prevent urethral irritation and possible development of cystitis. Some children may have fears associated with bathing such as being afraid of being sucked down the plug hole. In this case, do not drain the tub until the child is out of the room.
The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement? "We will place our child in time-out for 5 minutes after the tantrum." "We will offer our child a treat to stop having the tantrum." "We will attempt to reason with our child to limit tantrums." "We will ignore our child while having the tantrum."
"We will ignore our child while having the tantrum." RATIONALE: The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.
A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate? "Your daughter can understand holding urine and stool by about 1 year of age." "Most children are ready for toilet training by the time they are 18 months old." "You'll probably notice that your daughter is uncomfortable in wet diapers." "Don't worry, your daughter will probably give you very definite signals."
"You'll probably notice that your daughter is uncomfortable in wet diapers." RATIONALE: The markers of readiness for toilet training are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. Although the rectal and urethral sphincters are mature by the end of the first year, children are not cognitively and socially ready. In fact, many children do not understand what is being asked of them until they are 2 or even 3 years old.
The parent of a 2-year-old toddler tells the nurse she needs to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable? Deficient parental knowledge related to inappropriate method for toilet training Excess fluid volume related to inability to control urination Ineffective coping related to lack of self-control of 2-year-old toddler Total urinary incontinence related to delayed toilet training
Deficient parental knowledge related to inappropriate method for toilet training RATIONALE: Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule. This toddler is not toilet trained independently. The toddler does not display total urinary incontinence. The toddler is only incontinent when playing and not reminded to potty. A 2-year-old toddler has limited coping skills. Frequent wetting of the pants does not indicate too much fluid intake. It is a symptom that the toddler does not feel the urge to urinate until the bladder is too full and the toddler cannot get to the toilet on time.
The parents are asking their health care provider to give them some advice on how to start toilet training their toddler. Which information is most appropriate to share with this family? Select all that apply. Begin training with urination since this is the most frequent and costly part of potty training. Don't let the child use the potty chair as a place to sit at the play table since it might confuse the child of its purpose. Flush bowel movements right away to keep the child from playing with the stool. Allow the child to sit on the potty chair for up to 30 minutes until the child actually defecates or urinates. Praise the child every time the child sits on the potty chair and tries to defecate.
Don't let the child use the potty chair as a place to sit at the play table since it might confuse the child of its purpose. Praise the child every time the child sits on the potty chair and tries to defecate. RATIONALE: Begin with defecation training because this is so much easier to grasp than urination. Sit the child on the potty chair or toilet at the time the child usually defecates. Praise the child if he or she does defecate. Be careful not to flush the toilet while the child is sitting on it because 2-year-old children are unable to realize they will not be flushed away. Encourage the child to flush the toilet independently after getting redressed. Do not allow a child to remain on a potty chair for much longer than 10 minutes (less than that if the child is resistant). Also, do not allow the child to use the chair to eat or as a play table so the child does not become confused as to its purpose.
A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply. Toddlers cannot learn self-control until at least 3 to 4 years of age. If a child hits or bites another child, the parents should scold them, saying such things as "You are very naughty for biting Rachel." If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Consistency in the rules is important so the child understands what is expected. Even at this young age, children need boundaries.
If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Consistency in the rules is important so the child understands what is expected. Even at this young age, children need boundaries. RATIONALE: Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries—it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.
A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply. There is no need to worry about the amount of trans fats in a toddler diet. Milk is still important to incorporate in the diet for bone health. Try to limit the fat intake to less than 35% of total calories. Children can have as many cookies they want if that is the only thing they will eat from breakfast. Active, "busy" toddlers may need up to 1,400 cal/day.
Milk is still important to incorporate in the diet for bone health. Try to limit the fat intake to less than 35% of total calories. Active, "busy" toddlers may need up to 1,400 cal/day. RATIONALE: Active children in this age group may need up to 1,400 kcal daily. Children over 2 years old should have a total fat intake between 30% and 35% of calories, with most fat coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils, the same as adults. Adequate calcium and phosphorus intake is important for bone mineralization. Milk should be whole milk until age 2 years, after which 2% milk can be introduced. Trans fats should be kept to a minimum. Diets high in sugar (like cookies) should be avoided to help prevent toddler obesity.
A nurse hands a toddler a toy hammer. Instead of hitting or pounding the hammer on an object, the toddler begins shaking it. What concept related to growth and development is this toddler displaying? logical reasoning assimilation analytical exploration imitation
assimilation RATIONALE: At the end of the toddler period, children enter a period of cognitive development termed preoperational thought and begin to use a process termed "assimilation." Because they are not able to change their thoughts to fit a situation, they learn to change the situation (or how they perceive it). This ability is what causes toddlers to use toys in the "wrong" way. For example, if a child is given a toy hammer, instead of pounding with it, the child may shake it to see if it rattles. Imitation would be when the toddler remembers a parent using a hammer and correctly pounds and object with it. The other concepts are not relative to the toddler period of growth and development.
The nurse is talking to the parent of a 19-month-old toddler about setting limits and supervising activities. In which situation will the nurse recommend letting the toddler do as he or she pleases? exploring one's body playing on the picnic table choosing one's own foods deciding one's bedtime schedule
exploring one's body RATIONALE: Children learn about gender differences during the toddler years. They observe differences between male and female body parts if they are exposed to seeing it. They question their parents about the differences. It is normal for toddlers to explore their genitals as they develop their own sense of self. The parent should allow this and not punish the child. Choosing food and deciding bedtimes need to be done by an adult. Likewise, safety dictates that the picnic table is not a safe play area.
