ch26: toddlers development
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. Ask the parent if the child has been ill recently. Explain that the child could start walking any day. Refer the child to a developmental specialist for evaluation.
Explain that children can take their first steps as late as 18 months of age. 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.
What is a true statement regarding the developmental milestones of the 30-month-old child? Head circumference equals chest circumference Triples birth weight Full set of primary teeth Anterior fontanel (fontanelle) closes
Full set of primary teeth Developmental milestones of a 30-month-old child include acquiring a full set of primary or baby teeth. A child at this age is developing a sense of humor, can put on clothes, wash hands and brush teeth. The 12-month-old child should double the birth weight. The anterior fontanel (fontanelle) closes at 18 to 24 months. Head circumference equals chest circumference at 12 months.
The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development? Her vocabulary is between 10 and 15 words. She asks many questions. She talks incessantly. She uses complete 3- to 4-word sentences.
Her vocabulary is between 10 and 15 words. A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem.
A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply. Putting the child on the potty chair at regular intervals during the day Using training pants that slide down easily and quickly Allowing at least 6 weeks to prepare the child psychologically for the training Praising the child when he or she urinates or defecates Keeping the child on the potty chair for as long as necessary
Putting the child on the potty chair at regular intervals during the day Using training pants that slide down easily and quickly Praising the child when he or she urinates or defecates For effective toilet training, parents should allow 1 to 2 weeks to psychologically prepare the child for training, using training pants that slide down easily and quickly, praising the child when he or she urinates or defecates, limiting the time spent on the potty chair to no longer than 10 minutes (or less if the child is resistant), and putting the child on the potty chair at regular intervals during the day.
The pediatric nurse is planning quiet activities for a hospitalized 18-month-old. What would be an appropriate activity for this age group? Using crayons to color in a coloring book Stacking blocks Putting shapes into appropriate holes Painting by number
Stacking blocks At 18 months the child can stack four blocks. The 24-month-old can paint (but not by number), scribble, and color, and put round pegs into holes.
The nurse is assessing speech development in the 2-year-old toddler whose family uses two languages in the home. What finding is of concern? The child mixes words from the two languages within a sentence. Some words the toddler speaks are a blend of the two languages. The toddler speaks 15 words between the two languages. The parents understand the child much of the time.
The toddler speaks 15 words between the two languages. Of concern is the toddler speaking only 15 words between the two languages spoken in the home. At 20 months, the bilingual child should use 20 words. The other findings fit the norms for a bilingual child.
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 Ability to name one color Verbalization of 4 to 6 words
Use of a two-word noun-verb sentence 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.
A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia. The child's condition has improved, and the child is much more active and eager to play. Which toy should the nurse offer the child? board games fabric books squeaky toy large piece puzzle
large piece puzzle An appropriate toy for a 3-year-old child is a large piece puzzle. Board games are more appropriate for preschool and school-aged children; fabric books and squeaky toys are more appropriate for older infants and younger toddlers (10 to 18 month of age).
The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity? painting pictures in the art corner of the room playing with the plastic vacuum cleaner and pushing it around the room watching a movie with other children their age pretending to be mommies and daddies in the play house
playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool-age children have imitative play, pretending to be the mommy, the daddy, or other familiar characters. School-age children enjoy group activities and making things, such as drawings, paintings, and craft projects. Adolescent enjoy activities they can participate in with their peers.
The nurse is providing anticipatory guidance to the parents of an 18-month-old child. Which recommendation should be the most helpful to the parents? When needed, place the child in time out for 1½ minutes. Ignore bad behavior until the child is older. Slap the hand using one or two fingers if the child hits another. Describe proper behavior when the child misbehaves.
Describe proper behavior when the child misbehaves. T Stopping the child when misbehaving and describing proper behavior sets limits and models good behavior. This will be the most helpful advice to the parents. At 18 months, the child is too young to use time out or extinction (ignoring the child's behavior) as discipline. Slapping the child's hand, even done carefully with two fingers, is corporal punishment, which has been found to have negative effects on child development.
Which suggestion by the nurse meant to promote good dental health in the 15-month-old is inappropriate? Wean the child from the bottle. Arrange for your child's first dental visit as soon as possible. Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Avoid grazing (continual snacking) throughout the day.
Brush your child's teeth with a pea-sized amount of fluoride-containing toothpaste. Using fluoride toothpaste prior to age 2 years promotes development of fluorosis. The first dental visit should be made at 1 year. This check-up is overdue. Continual snacking and bottle drinking keep the teeth in contact with cariogenic substances for extended periods.
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 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.
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 Mimic the toddler's behavior by also holding the breath Appear to ignore the toddler
Appear to ignore the toddler 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.
The nurse is assessing the development of a 15-month-old girl during a well-child visit. Which skill would the nurse expect to see? Feeds herself with a spoon Points to her nose and mouth Stands alone Runs to her mother
Stands alone At 15 months, toddlers have mastered standing and walking alone. The child has yet to develop the ability to feed herself with a spoon, point to her nose and mouth, or run to her mother.
A parent brings their 2-year-old child in for a well visit. The nurse assesses their growth since the last appointment. Which finding should concern the nurse? prominent abdomen total weight gain of 15 lb (6.8 kg) in the past year increase in height of 5 in (13 cm) in the past year walks flat-footed and with bowed legs
total weight gain of 15 lb (6.8 kg) in the past year A child gains only about 5 lb (2.3 kg) and 5 in (13 cm) a year during the toddler period, much less than the rate of growth during the infant year. Because the weight gain of the child in this scenario is much greater than normal, the nurse should be concerned that the child is overweight or obese. All of the other findings listed are normal for a 2-year-old child.
The nurse is observing a 36-month-old boy during a well-child visit. Which motor skill has he most recently acquired? pull a toy while walking undress himself kick a ball push a toy lawnmower
undress himself 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.
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition? "New foods are offered along with ones she likes." "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." "She drinks three 6-ounce cups of whole milk each day."
"I give my daughter juice at breakfast and when she is thirsty during the day." 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.
In working with the toddler, which statement would be most appropriate to say to the toddler to decrease the behavior known as negativism? "You love having the same food every day. Do you want apples again with lunch?" "It is time for lunch. I am going to put your bib on." "Are you getting hungry and ready for lunch?" "Do you want help getting into your chair so we can have lunch?"
"It is time for lunch. I am going to put your bib on." Negativism is very typical of the toddler years. It is best to avoid questions with a yes or no answer because the answer will always be no. Limiting the number of questions asked of the toddler and making a statement, rather than asking a question or giving a choice, is helpful in decreasing the number of negative responses from the child. Instead of asking questions like "Do you want help getting in your chair?" make the statement "Get in your chair." The toddler years are also ones where the child becomes a picky eater or "grazes" instead of eating a full meal so the toddler may not actually know if he or she is hungry.
A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers? "Keep all cleaning products and drugs out of the reach of your child." "Have your child wear a helmet when beginning to ride a tricycle." "Turn the handles of your pots away from the edge of the stove when cooking." "Make sure to have your child securely fastened in a car seat."
"Keep all cleaning products and drugs out of the reach of your child." Although all the instructions are important, accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers. However, they occur less frequently than poisonings.
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. "Use time-out every other time she tells you no." "Limit the number of questions you ask of her." "Offer her something she would like, such as ice cream, to distract her." "Make a statement instead of asking a question." "Offer her two options from which to choose."
"Limit the number of questions you ask of her." "Make a statement instead of asking a question." "Offer her two options from which to choose." 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.
During a visit to the pediatric clinic the mother of a 2-year-old tells the nurse that her husband is concerned that their son isn't potty trained yet. The mother states, "There is no way he could be potty trained. His bladder is too small." How should the nurse respond? "The bladder of a 2-year-old is actually the size of an adult's bladder, but there are a lot of variables to when a child is potty-trained." "Your husband is correct, at the age of 2 your son should have a good amount of urine control." "You should talk to the physician about your son not being potty-trained in case there are issues preventing him from being able to control his urine flow." "Two years old is rather early for a boy to be potty-trained."
"The bladder of a 2-year-old is actually the size of an adult's bladder, but there are a lot of variables to when a child is potty-trained." Bladder and kidney function reach adult levels by 16 to 24 months of age, but there are many factors that determine when a child is ready to be potty-trained. The other options are misleading the parent regarding potty-training.
The mother of a 15-month-old son is returning to work and wants to place her son in the day care close to work; however, they will only accept potty-trained children. Which response from the nurse will best address this situation in answering the mother's questions of how best to potty train her son? "Encourage your son to watch his older siblings use the toilet." "Each time you change his diaper, tell your son how important and fun it is to use the potty chair." "Get your son a potty chair and have him sit on it for a few minutes each day." "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained."
"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." To be able to cooperate in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child also must be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event. In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18 to 24 months.
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? "My child is 3 years old now and I put my child in time-out for 5 to 10 minutes when misbehaving." "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." "We use the time-out chair when our child gets tired but does not want to take a nap." "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." 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 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. Vegetables such as corn, green beans, and peas Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows Round foods such as hot dogs, whole grapes, and cherry tomatoes Fruits such as peaches, pears, and kiwi
Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows Round foods such as hot dogs, whole grapes, and cherry tomatoes 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.
During a wellness care visit, the parents of a 2-year-old toddler report that they are struggling to deal with their toddler's daily and increasing number of tantrums. What information should be provided to the parents? Select all that apply. Tantrums at this age can signal the development of an aggression disorder in a toddler. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Tapping the toddler on the hands and voicing displeasure with the toddler's actions can successfully interrupt the behavior. Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums.
Ignoring the behavior is often helpful in reducing the duration of the tantrum. Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Temper tantrums can be a frequent occurrence in toddlers. Some toddlers are more prone to displaying these behaviors than others. For the toddler who experiences frequent tantrum outbursts, maintaining a consistent schedule for activities is helpful. Tantrum-prone toddlers benefit from a consistent nap, meal, and play periods. Ignoring the behavior signals to the toddler that the behavior is futile. Avoiding interaction with the toddler having the tantrum is beneficial.
Which action is appropriate to enhance a toddler's self-esteem? Utilize negative criticism as well as positive reinforcement. Include the child in activities that interest the adult. Utilize belittling techniques as opposed to time-outs. Avoid applauding for unsuccessful attempts.
Include the child in activities that interest the adult. 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.
The caregivers of a 2-year-old are concerned the child is not learning how to share and play well with other children. While acknowledging their concern and devotion, the nurse should point out which activity would be best for this child's developmental level? Sharing finger paints and painting with the caregiver Looking at large print magazines Throwing a baseball-sized ball Mowing the lawn with a toy lawnmower
Mowing the lawn with a toy lawnmower Toddlers enjoy talking on a play telephone. They like pots, pans, and toys such as brooms, dishes, and lawnmowers that help them imitate the adults in their environment and promote socialization. Toys that involve the toddler's new gross motor skills, such as push-pull toys, rocking horses, large blocks, and balls are popular. Fine motor skills are developed by use of thick crayons, modeling clay, finger paints, wooden puzzles with large pieces, toys with pieces that fit into shaped holes, and cloth books. The toddler will not be interested in sharing toys until the later stage of toddlerhood; adults should not make an issue of sharing at this early stage.
The parents of a 2-year-old boy report to the nurse that their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child? Advising the parents to minimize distractions at mealtime. Offering a variety of foods along with the foods the child likes. Encouraging the parents to eat a variety of wholesome foods themselves. Assuring the parents that food jags are normal, and they can be honored safely.
Offering a variety of foods along with the foods the child likes. Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged preferences for particular foods (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful.
The nurse is discussing proper discipline with the parent of a 15-month-old toddler. Which teaching is most important? Physical punishment such as spanking is discouraged. Rules and limits should be simple and few. Only use praise after the child has corrected a wrong behavior. Toddlers are unable to follow instructions easily.
Physical punishment such as spanking is discouraged. Because toddlers younger than 18 months of age are at increased risk for physical injury from spanking than other children, the nurse should prioritize discouraging its use. The American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners recommend against corporal or physical punishment, which includes spanking. The other teachings describe toddler characteristics accurately and are basic to good discipline, but are not the most important for this young toddler.
The parents of a toddler are asking the nurse if their child is lagging behind since the child does not have a very large vocabulary at the present time. Many times their toddler just points to an object and the parents give it to the toddler. Which concepts/statements should the nurse share with this family about language development of a toddler? Select all that apply. Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. When the child points to an object, wait and make the child name the object before giving it to him or her. If the child asks, "Why?" be sure to give him or her a full explanation since the child is showing initiative. Reinforce language by voicing a request, "You want the apple?" Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you."
Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. Reinforce language by voicing a request, "You want the apple?" Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you." The nurse should urge parents to encourage language development by naming objects (e.g., ball, block, music box, doll) as they play and while reading a book with their child. To assess whether parents are encouraging language development, the nurse should ask them what happens when the child wants something (for example, point to an object). Do they provide opportunities for the child to ask for things? Children should not be made to name an object before they can have it because their vocabulary is so limited, but parents can reinforce language by voicing the request (e.g., "You want the ball?"). Reading aloud is another effective way to strengthen vocabulary. Pointing to pictures and describing what the picture shows, such as "See Jane throwing the ball?" assists with language development. Because children learn language from imitating what they hear, if they hear examples of bad grammar, they will not use good grammar. Remind parents that pronouns are difficult for children to use correctly; many children are 3 1/2 or 4 years of age before they can separate the different uses of "I," "me," "him," and "her."
The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development? The child does not use the names of familiar objects. The child repeats what the parents say out of context and at random moments. The child does not speak clearly but shows understanding of what is said. The child puts together sentences of two words.
The child does not use the names of familiar objects. By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist. Repeating words heard or phrases out of context (echolalia) is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age.
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 speaks in one-word sentences. The child is pointing to named body parts. The child can stand on his tiptoes.
The child speaks in one-word sentences. 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.
Parents and their nearly 3-year-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? Asks "why" often Uses two-word sentences or phrases Half of speech understood by outsider Talks about a past event
Uses two-word sentences or phrases A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.
