Infant and toddler EAQ

The nurse is instructing the parents of a 6-month-old infant about sleeping patterns and the best sleeping positions for their child. Which instruction regarding sleep position is most important?

"Place the infant in a supine position for sleep." The nurse instructs the parent to place the infant in a supine position so the infant does not roll over to a prone position. When the infant is less than 6 months old, the infant is placed in a supine position and the head is positioned on alternating sides to prevent positional plagiocephaly. There is a risk for sudden infant death syndrome (SIDS) if the infant is placed in a prone position. If the infant is restless, it should be assessed, but not put to sleep on one side, because the infant can easily roll over to the prone position if placed on the side.

A parent brings an 18-month-old toddler to the clinic. The parent reports, "My child is so difficult to please! He has temper tantrums and annoys me by throwing food from the table." What is the best response by the nurse?

"Toddlers are learning to assert independence, and this behavior is expected at this age." The psychosocial need during the early toddler age is the development of autonomy. The toddler objects strongly to discipline. Excessive discipline leads to feelings of shame and self-doubt, the major crisis at this stage of development. It is frightening for a toddler to be left alone; it fosters feelings of rejection, isolation, and insecurity because toddlers do not understand the reason for the punishment. The development of initiative is attained during the preschool age, not during the toddler age.

A father expresses concern that his 2-year-old daughter has become a "finicky eater" and is eating less. How should the nurse respond?

"Your daughter's behavior is expected in response to her slower growth." Growth slows during the toddler years, and these children generally do not eat as much as they do during infancy; this is called physiologic anorexia, which is typical of this age group. Toddlers may try to manipulate as they assert their autonomy, but usually not through eating behaviors unless the parents express anxiety and concern over their food intake. Although toddlers have difficulty withstanding frustration and are prone to temper tantrums, these eating behaviors are within the norm for toddlers. Eating disorders usually do not occur in children this young; these behaviors are typical of healthy toddlers.

A mother of three children, who was abandoned by her husband shortly after the birth of her youngest child, brings her daughter, now 9 months old, to the pediatric clinic. The infant is found to have nonorganic failure to thrive and is admitted to the hospital. What infant behavior does the nurse anticipate as the mother leaves to return home to care for her other children?

Allowing the nurse to take her but remaining stiff while being held. Going to a stranger without protest usually indicates the lack of a meaningful relationship with the mother. Clinging to the mother is a healthy reaction to strangers that is uncommon in children with nonorganic failure to thrive syndrome. Crying at first is a healthy reaction to strangers that is uncommon in children with nonorganic failure to thrive syndrome. Children with nonorganic failure to thrive avoid eye contact with their mothers and do not prefer them over others.

When teaching the parents of a toddler-age client about normal growth and development, which statements should the nurse include in the teaching session regarding learning through the senses?

Answer 1: "The toddler often puts new objects in the mouth." Answer 2: "The toddler may inspect a new toy by turning it over." Answer 3: "The toddler will shake a new toy when it is first introduced to the play area." The toddler learns through his or her senses by placing new objects in the mouth, inspecting new items by turning them over, and shaking a new toy when it is first introduced to the play area. The toddler will touch a new object several times when learning about it. The toddler will use the sense of smell in order to learn.

A nurse is reviewing the health history and laboratory report of a child with lead poisoning. What complications does the nurse expect in relation to lead toxicity?

Answer: Anemia, Proteinuria, Encephalopathy. Exposure to a high level of lead predisposes the child to anemia. The lead interferes with synthesis of heme. Exposure to a high level of lead predisposes the child to proteinuria and glycosuria because the lead damages the cells of the proximal renal tubules. Exposure to a high level of lead predisposes the child to encephalopathy caused by increased membrane permeability, leading to tissue ischemia and atrophy. There is no direct relationship between lead toxicity and heart failure. Gastrointestinal bleeding does not occur with lead toxicity.

Which step should the nurse refrain from while giving an injection to a preschooler?

Asking the parent to restrain the child. The nurse should not ask the parent to restrain the child. The parent should act as a comforter. Before giving an injection, the nurse should awaken the child. Distracting the child with conversation, bubbles, or a toy reduces pain perception. The nurse should apply lidocaine ointment over the injection site before giving the injection to reduce pain.

A nurse is caring for a 2½-year-old child who is expressing pain. What is the most reliable indicator of this child's pain?

Changes in behavior. Although there are several indicators of pain in children, a change in behavior is the one that occurs most often. Crying is not a valid indicator of pain; there is more than one cause for crying, including pain, separation, fear, and unhappiness. Children often hide their pain; they may perceive it as punishment, or they may fear the treatment that will be given to relieve the pain. Vital signs often do not change, even if the child is in pain.

The parent of a child who has received all of the primary immunizations asks the nurse which ones the child should receive before starting kindergarten. What immunizations does the nurse tell the parent that her child should receive?

DTaP, IPV, MMR Scheduled immunizations for preschool children include diphtheria, tetanus, and pertussis (DTaP), the inactivated polio vaccine (IPV), and measles, mumps, and rubella (MMR) at 4 to 6 years (usually required by law). Hepatitis immunization is given in three doses between birth and 9 months; the tetanus/diphtheria vaccine is given at 7 to 10 years of age, with subsequent doses based on the age when the vaccine was first received. Hepatitis B immunization is not required once immunity is established; administration of a subsequent dose of tetanus/diphtheria vaccine is based on the age when the first dose is received. The Haemophilus influenzae type B (Hib) vaccine is given at 12 to 15 months.

What measure should a nurse take while giving an injection to a preschooler?

Distract the child with conversation. Distracting the preschooler with conversation, bubbles, or a toy reduces the child's pain perception. The nurse should not ask the parent to restraint the child because this may cause the child to develop a negative association with health interventions. Before giving an injection, the nurse should awaken the child. The nurse may apply lidocaine ointment over the injection site to reduce pain perception.

After abdominal surgery, a 5-year-old child is experiencing pain, and an opioid analgesic is prescribed. What should the nurse consider about children in pain and their response to opioid analgesics when an opioid analgesic is prescribed?

Even though children do not like taking medicines, analgesics will make them more comfortable. Children are as much in need of analgesics for relief of pain as adults are. It is an unsound belief that children are more prone to opioid addiction than adults are. It is a myth that children do not feel pain as strongly as adults; it is difficult for children to communicate pain. Playing or trying to sleep may be the child's way of coping with pain; however, the fact that the child engages in these behaviors is not a reason to withhold an analgesic.

What pain scale is used to measure the intensity of pain in preschoolers?

FACES scale. The FACES scale is used to measure the intensity of pain in a preschooler. The scale consists of six cartoon faces ranging from a smiling face ("no hurt") to increasingly less happy faces to a final sad and tearful face ("hurts worst"). The visual analogue scale, numerical rating scale, and verbal descriptor scale can be used in young children and adults.

The nurse observes dental caries in an 8-month-old infant. Which action of the parents is likely responsible for this condition?

Giving the infant fruit juice in a bottle. Giving an infant fruit juice in a bottle can result in dental caries. Giving an infant canned fruits and vegetables can result in lead poisoning, not dental caries. Giving an 8-month-old infant 960 mL of milk is appropriate and does not result in dental caries. Cheese can be given as a finger food to an 8-month-old infant and may not result in dental caries.

During the course of treatment a toddler is to receive an intramuscular injection. What is the priority nursing intervention that should be included in the plan of care to comfort the child?

Involving the parents in comforting the toddler after the injection. The parents are the most significant people in the young child's life, and their involvement in comforting the child is the most supportive intervention for the toddler. Distraction does not provide an outlet for the toddler's feelings. Explaining the procedure to the parents does not comfort the child. Offering choices for the toddler is incorrect because this type of choice is not a viable option; the medication must be administered as prescribed.

The parents of a 3-year-old tell the nurse that their child is afraid to sleep alone because of monsters under the bed. They ask for suggestions. What should the nurse recommend?

Leave a small light on at night and state, "Monsters aren't allowed in the house." Leaving a light on and announcing that monsters aren't allowed in the house may reduce the toddler's level of stress without damaging self-esteem. A light allows the toddler to see familiar objects in the room and reduces fears associated with a dark environment. Toddlers see their parents as capable of all things and will be accepting of this house rule. Telling the child that monsters do not exist denies the toddler's concerns and is beyond the concrete thinking of a toddler. Sleeping with the parents may interfere with their ability to get a restful night's sleep. With additional emotional support, the child should be encouraged to remain in his or her own bed. A toddler thinks in concrete terms, and telling the child that there are no monsters under the bed may not relieve the fear of monsters; it also denies the toddler's concerns.

What safety measure should the nurse instruct parents to follow when their child is a toddler?

Place window guards on all windows. Parents should make their home environment safe for the exploring toddler. Parents of toddlers should be advised to install window guards on all windows so that the toddler does not fall out of the window. Infants should be put to sleep on their back or side to lower the lowest risk of sudden infant death syndrome (SIDS). Preschoolers should be taught to swim at an early age under supervision. Preschoolers should be taught to cross streets and walk in parking lots.

After orthopedic surgery a 15-year-old adolescent reports pain and rates it a 5 on a scale of 0 to 10. A nurse administers the prescribed 5 mg of oxycodone every 3 hours as needed. Two hours after having been given this medication, the adolescent reports pain and rates it a 10 of 10. What action should the nurse take next?

Request that the primary healthcare provider evaluate the need for additional medication. The nurse has made the assessment that the medication has been ineffective in relieving the adolescent's pain for the duration that it was prescribed to cover. This information should be communicated to the primary healthcare provider for evaluation. The prescription is for administration every 3 hours; legally the drug may be given only within these guidelines. There are no data to support an idiosyncratic reaction to the oxycodone; the amount of medication was probably inadequate for the adolescent's pain tolerance level. The nurse should not ignore the adolescent's need for pain relief.

The nurse is caring for a 12-month-old infant with a diagnosis of failure to thrive. The infant's weight is below the third percentile, and development is delayed. Which behaviors of the child suggest to the nurse the possibility of parental neglect?

Stiff, Withdrawn, Minimal smiling, Little interest in the environment. Infants with failure to thrive resulting from parental neglect are either stiff and unyielding or flaccid and unresponsive. These infants have difficulty reaching out to the environment and tend to be withdrawn. They get little response from parents and do not learn how to respond to others. These infants show little satisfaction, are very difficult to comfort, and are nonresponsive or minimally responsive to human contact. These infants have social and language deficits and display minimal interest in the environment or others.

A nurse must restart a peripheral intravenous infusion on a hospitalized 5-year-old child. What should the nurse do to promote the child's sense of security?

Take the child to the treatment room for the procedure. The child's bed offers a sense of security during the stress of hospitalization. If painful invasive procedures are performed in the bed, the child will be left with no refuge, so painful procedures should be performed away from the child's bed when possible. Although telling the child that the procedure will feel like a bee sting is an honest statement, it will not promote a feeling of security. The child should not be asked whether the parents should leave; the parents should be encouraged to stay to provide support for the child. Intellectual rationalization for a painful procedure will not provide security for a 5-year-old child who must cope with the reality of the pain to be experienced.

The mother of a 2-year-old child expresses concern to the nurse in the pediatric clinic that her child still takes a bottle of milk to bed at night. How should the nurse explain to the mother that this practice should be stopped?

The child is at increased risk for dental caries. Allowing a child to keep a bottle of milk or juice overnight results in prolonged exposure of the teeth to sugars, making them susceptible to bacterial invasion and eventual decay. Having a nighttime bottle does not contribute to anemia as long as adequate nutrients are ingested during the daytime. A 2-year-old may still have some need for sucking. A nighttime bottle may predispose a child to middle, not inner, ear infections.