The Toddler and Family: Growth and Development of the Toddler

Walk up and down stairs, creeps up stairs

· Gross Motor Skills of Toddlers: § 12-13 months: walk alone using a wide stance for balance § 15 months: _________

1. Waking up dry from nap or overnight sleep 2. Being dry for at least 2 hours during the day 3. The toddler must be able to recognize the urge to go and hold it. 4. The toddler must be able to communicate that sensation to their parent

- 4 markers that the child is ready to toilet train: 1 2 3 4 § Begin teaching the readiness phase of toilet training by teaching the toddler how the body functions in relation to voiding and defecating. Keep it simple and easy. · Potty chairs help foster security on the toilet and planting the feet helps with defecation. · Praise the child for cooperative behavior and success. Daytime accidents are common, so encourage toddlers to urinate before trips or car rides (they might wait until it is too late to communicate urge)

· Remove stinger as quickly as possible · If systemic response, call 911 and administer EpiPen · Be aware of brown recluse and black widow spiders; enough venom to require immediate medical attention

Animals and Insect Contact · Arthropod Bites and Stings § Children bitten by brown recluse or black widow spiders should receive medical attention ASAP § Bee Stings: - - -

copious amounts of saline/Lactated Ringers

Animals and Insect Contact · Dog & Cat Bite Wound Care: § For bites or scratches, rinse with ____________________, and use a mild soap to wash surrounding skin § Clean pressure dressing is applied and extremity is elevated if bleeding § Medical evaluation is advised due to Tetanus, rabies, and possible need for antibiotic treatments (especially if puncture wound) § Cat scratch disease is mostly supportive, and analgesics are given for discomfort § Prevention is best: · Monitor child's behavior around animals · Prevent child from surprising, interfering with sleep, interfering with eating, or invading animal's territory

Individuation- The toddler forms an identity

Body Image · 2 years old: Becomes aware of gender differences. They can identify themselves in a mirror and refer to self by name/pronoun. · 3 years old: _____________________ · Toddlers refers to body parts and appreciate usefulness of body parts · Toddlers being to recognize that words can describe appearance § Avoid negative labels to physical appearance § If they hear that one pregnant women is "fat", they might believe all "fat" women are having babies · For toddlers, body integrity is poorly understood and intrusive experiences are threatening. Taking vitals does not hurt them, but they find it intrusive so they protest strongly. · May explore body parts by stimulation; parents should express that this is done in private · Certain associations between words and functions can influence future sexual attitudes and emotional relationships

Becomes aware of gender differences. They can identify themselves in a mirror and refer to self by name/pronoun.

Body Image · 2 years old: _______________ · 3 years old: Individuation - Forms an identity · Toddlers refers to body parts and appreciate usefulness of body parts · Toddlers being to recognize that words can describe appearance § Avoid negative labels to physical appearance § If they hear that one pregnant women is "fat", they might believe all "fat" women are having babies · For toddlers, body integrity is poorly understood and intrusive experiences are threatening. Taking vitals does not hurt them, but they find it intrusive so they protest strongly. · May explore body parts by stimulation; parents should express that this is done in private · Certain associations between words and functions can influence future sexual attitudes and emotional relationships

daily routine

Building Self-Esteem: Consistency · Built through familiarity with __________ · Show love & respect regardless of gender, behavior, or capabilities · Appropriate expectations and discipline for guidance and boundary setting

§ For infants, use back blows and chest thrusts § For children and adolescents, use abdominal thrusts § Remove any visual obstruction or large debris from mouth, but do not perform blind finger sweep Place the recovered child into recovery position (side lying with legs bent at knees)

Care of Obstructed Airway:

Toilet training

Common Developmental Concerns · Toilet Training Readiness: - ___________________ can begin when toddlers have the sensation of needing to urinate or defecate. Parents need to show patience and consistency in training; and remember nighttime control might develop last § Anticipatory guidance for toilet training should begin during well-child visits before the child's readiness to learn. -Nighttime control of voiding develops last. Bedwetting is normal in girls up to 4 years old and boys up to 5 years old. Children who do not have nighttime dryness by 6 usually require intervention. -Bowel training is usually accomplished before bladder training because of greater regularity and predictability - 4 markers that the child is ready to toilet train: 1. Waking up dry from nap or overnight sleep 2. Being dry for at least 2 hours during the day 3. The toddler must be able to recognize the urge to go and hold it. 4. The toddler must be able to communicate that sensation to their parent

Sibling Rivalry

Common Developmental Concerns · ________________: natural jealously and resentment of children to a new child in the family. It is not because they hate the other child, but because the introduction of a new child disrupts the routine, parent's love is shared, they might lose their crib room, etc (all in a time when they through they were in control) § Start discussing the new sibling when the toddler can tell the mother is pregnant. Discuss anticipated changes and routines that will remain, well in advance of birth. § When visitors come to see the infant, try not to let them shower only the infant with love. Discuss the toddler's needs for attention. § spend individual time § Encourage the toddler to become involved in care of the new infant, such as getting diapers

Regression

Common Developmental Concerns: · __________ - going back to an earlier stage due to traumatic/stressful event or inability to cope; this usually occurs in times of discomfort/stress when one attempts to conserve energy by reverting to patterns of behavior that were successful in earlier stages. § Regression can be frightening for children due to loss of autonomy and awareness of helplessness. § When regression occurs, the beast approach is to ignore it while praising patterns of appropriate behavior. It is also good to suspend new areas of learning temporarily.

Negativism

Common Developmental Concerns: · ___________ - natural assertion of self-control; children will test limits to gain understanding; § Parents should deal with this by giving the toddler choices ("You can have soup or sandwich") because they usually will answer "no" to close-ended questions § When nurses examine a child, they should say "I am going to examine your heart", not "Can I listen to your heart?"

Temper Tantrums

Common Developmental Concerns: · ______________ result when toddlers are frustrated with restrictions on independence. It is an indication of the child's inability to control emotions. Toddlers are prone to this because their strong drive for mastery and autonomy is frustrated by lack of motor/cognitive skill. § expressing autonomy § The best approach to temper tantrums requires providing consistency and developmentally appropriate expectations, discipline, consequences, and rewards. § Prioritize what rules are important and develop consequences reasonable for the child's development § At 18 months, time-outs work for managing temper tantrums. § During tantrums, stay calm and ignore the behavior. Provide a feeling of control and security to the child when the tantrum is gone. Afterwards, provide feedback on behavior § Temper tantrums that occur past 5 years of age, last longer than 15 minutes, or occur more than 5 times per day are abnormal and could indicate a serious problem.

-Lead based paint, solder, crystal, fishing sinkers, curtain weights, bullets, and battery casings -Ceramic ware, water, pottery, pewter, dyes, industrial factories, vinyl miniblinds, playground equipment, collectible toys, artists paints, chalk, imported toys/jewelry -Hobbies: battery/aircraft manufacturing, lead smelting, brass foundry, radiator repair, construction work, furniture refinishing, bridge repair, painting contracting, mining, ceramics work, stained glass making, jewelry making

Lead Poisoning · Lead is a heavy metal (similar to mercury) that have an affinity for certain essential tissue chemicals, which must remain free for correct functioning. When lead binds to these substances, enzyme activity is inactivated. Treatment involves chelation, use of a chemical compound that combines with the metal for rapid, safe excretion. · Lead based paint in older homes (built before 1978) is a common source of exposure · Remodeling/renovation can expose a toddler to inhalation exposure of lead · Sources of Lead: - - -

Use a "smear" or "rice-size" amount of toothpaste for toddlers younger than 3 years old. --Use a "pea-size" amount of toothpaste for children 3-6 years of age.

Dental Health · Infants should have the first oral exam at 6 months or within 6 months following first tooth eruption · Toddlers should have an established dental provider by 1 year old · Because toddlers react negatively to new/frightening experiences, the initial visit to the dentist should involve meeting dentist, seeing the equipment, and sitting in the chair. · Plaque removal: § For young children, brushing and flossing should be implemented by the adult to prevent dental decay, cavities, or gum disease · Facilitating access to the mouth: Hold the child with head in lap, sit on the floor with child's head resting between thighs, or stand with child's back toward parent in front of a mirror so both can see what is happening § Toddlers should use a toothbrush with soft bristles and toothpaste at 2 years. Use a _______ amount of toothpaste for toddlers younger than 3 years old. --Use a _______ amount of toothpaste for children 3-6 years of age. · Brushing should occur after meals and at bedtime. Nothing to eat/drink (except water) is given after bedtime cleaning · Childhood dental caries is a form of tooth decay that is common in children who are put to bed with a bottle of juice or milk

6 months or within 6 months following first tooth eruption

Dental Health · Infants should have the first oral exam at ______________ · Toddlers should have an established dental provider by 1 year old · Because toddlers react negatively to new/frightening experiences, the initial visit to the dentist should involve meeting dentist, seeing the equipment, and sitting in the chair. · Plaque removal: § For young children, brushing and flossing should be implemented by the adult to prevent dental decay, cavities, or gum disease · Facilitating access to the mouth: Hold the child with head in lap, sit on the floor with child's head resting between thighs, or stand with child's back toward parent in front of a mirror so both can see what is happening § Toddlers should use a toothbrush with soft bristles and toothpaste at 2 years. Use a "smear" or "rice-size" amount of toothpaste for toddlers younger than 3 years old. Use a "pea-size" amount of toothpaste for children 3-6 years of age. · Brushing should occur after meals and at bedtime. Nothing to eat/drink (except water) is given after bedtime cleaning · Childhood dental caries is a form of tooth decay that is common in children who are put to bed with a bottle of juice or milk

§ Differentiation of self from others (mother) § Toleration of separation from parent § Ability to withstand delayed gratification § Control over body functions § Acquisition of socially acceptable behavior § Verbal means of communication § Ability to interact with others in a less egocentric behavior

Developmental Theories · Toddlers are faced with mastery of several important tasks they begun during late infancy, including:

do not induce vomiting; intubate with cuffed ET tube prior to gastric decontamination if performed, symptomatic treatment of chemical pneumonia includes high humidity, O2, hydration, and antibiotics

Hydrocarbon poisoning: gas, kerosine, lamp oil, mineral seal oil, lighter fluid, paint thinner § Symptoms: gagging, choking, coughing, n/v, lethargy, weakness, tachypnea, cyanosis, grunting, retractions, burning throat/stomach, lethargy Treatment of Hydrocarbon poisoning: ____________________________

Toddlerhood

Introduction to "Toddlerhood" · _______: Commonly referred to "terrible twos" (1 - 3 yrs) · Similar behavior patterns to Adolescence § Intense environmental exploration § Temper tantrums § Obstinate behavior § Frustration with autonomy

using 1 word sentences or holophrases; "up" (pick me up)

Language and Speech Development · Language increases to about 300 words by 2 years of age § 1 Year old: __________________________ · Toddlers have an increased level of comprehension. Ability to comprehend and understand speech is far greater than the number of words they can say § Reading books together, storytelling, and interactive adult-child communication provides an ideal setting for language development in toddlers. · Repetition of words or phrases without understanding · Telegraphic Speech: contains only the essential words to get the point across; string together words · Television or recorded media decreases language skills in children younger than 2 yrs. This can lead to language delays, cognitive decrease, and decrease in social skills.

using multiword sentences by combining two or three words "all gone"

Language and Speech Development · Language increases to about 300 words by 2 years of age § 1 Year old: using 1 word sentences or holophrases; "up" (pick me up) § 2 years: ____________ · Toddlers have an increased level of comprehension. Ability to comprehend and understand speech is far greater than the number of words they can say § Reading books together, storytelling, and interactive adult-child communication provides an ideal setting for language development in toddlers. · Repetition of words or phrases without understanding · Telegraphic Speech: contains only the essential words to get the point across; string together words · Television or recorded media decreases language skills in children younger than 2 yrs. This can lead to language delays, cognitive decrease, and decrease in social skills.

combining several words to create simple sentences using grammatical rules

Language and Speech Development · Language increases to about 300 words by 2 years of age § 1 Year old: using 1 word sentences or holophrases; "up" (pick me up) § 2 years: using multiword sentences by combining two or three words "all gone" § 3 years: _____________ · Toddlers have an increased level of comprehension. Ability to comprehend and understand speech is far greater than the number of words they can say § Reading books together, storytelling, and interactive adult-child communication provides an ideal setting for language development in toddlers. · Repetition of words or phrases without understanding · Telegraphic Speech: contains only the essential words to get the point across; string together words · Television or recorded media decreases language skills in children younger than 2 yrs. This can lead to language delays, cognitive decrease, and decrease in social skills.

hazards

Mastery of Gross and Fine Motor Skills is Evident in all phases of activity, such as: · Language Comprehension · Response to Discipline · Social Interaction · Dressing · Play; Activities less in isolation · Exploration · Investigation · The Toddler's endless possibilities of manipulation of the environment (can lead to endless ______)

70-120

Maturation of Systems: Cardiovascular System and Blood · HR decreases -1 to 11 years HR: ________ · BP increases · Phagocytosis is much more efficient in Toddlers. The production of antibodies is well established § However, many Toddlers have a sudden increase in colds/minor infections when they enter preschool/daycare due to exposure to new pathogens

90-135/65-85

Maturation of Systems: Cardiovascular System and Blood · HR decreases § 1 to 11 years HR: 70-120 · BP increases § 1 to 11 years BP: ______ · Phagocytosis is much more efficient in Toddlers. The production of antibodies is well established § However, many Toddlers have a sudden increase in colds/minor infections when they enter preschool/daycare due to exposure to new pathogens

Physiologic ability to control sphincters occurs at about 18-24 months of age

Maturation of Systems: Gastrointestinal System · The Toddler's digestive process is fairly complete by the beginning od toddlerhood. The acidity of gastric contents continues to increase and has a protective function because it is capable of destroying more bacteria · The Toddler's stomach capacity increases allowing a schedule of three meals per day · Toddler's have voluntary control of elimination due to complete myelination of the spinal cord, which helps control the anal and urethral sphincters - Physiologic ability to control sphincters occurs at about ________

retain urine up to 2 hours longer

Maturation of Systems: Genitourinary System · The Toddler's renal system is mature, and bladder capacity increases. By 14-18 months, the child is able to ___________. · Toddlers have less risk of dehydration due to mature functioning of the renal system that conserves fluid in times of stress.

Swayback, "squat", and potbelly

Maturation of Systems: Musculoskeletal System · __________ appearance due to weak abdominal and lower back muscles · Toddlers have short legs, that remain slightly bowed during the second year from the weight of the relatively large trunk.

20/40

Maturation of Systems: Neurologic System · Myelination of brain and spinal cord between 18 - 24 months, gradually allowing control of anal and urethral sphincters for potty training · Body temperature is relatively well maintained (unlike infant) · Visual acuity of _____________ is acceptable during toddler years · Growth in neurobehavioral organization contributes to greater regularity of sleep-wake cycles, diminishing of crying and unexplained fussiness, and enhanced predictability in mood. § Valuable stimulants of early brain development include talking, singing, and playing (interactions)

otitis media, tonsilitis, and upper respiratory tract infections are common 6-11 year old RR: 12-20

Maturation of Systems: Respiratory System · Internal structures of ear, throat, tonsils, and adenoids result in common upper respiratory tract infections, otitis media, and tonsillitis § Internal structures of the ear and throat are still short and straight, and the lymphoid tissue of tonsils/adenoids continue to be large. As a result, _________________________. · Respirations are still abdominal, but they continue to slow (along with HR) · Volume of the respiratory tract continues to grow -RESPIRATORY RATE 1-5 YEARS: 20-30 -RESPIRATORY RATE 6-11 YEARS: ______________

Locomotion

Motor Skill Development · The Major Gross Motor Skill during toddlerhood is the development of _______.

approved safe car seat properly installed in back of car; rear facing position

Motor Vehicle Safety for the Toddler · Use an _______________________ up to 2 years or per manufacturer's weight and height recommendations · 2 years old to school age: forward facing in the back seat with 5- point harness restraints is recommended; LATCH system for anchoring if available · Safest area for toddlers is the backseat · Do not place rear-facing seats in the front seat · Do not allow children to play on curbs or behind parked cars · Do not allow children to play in piles of leaves, snow, or carboard boxes in high-traffic areas · Supervise biking, make sure they wear a helmet · Lock fences and doors if not directly supervising the child · Teach the child to obey traffic rules: § Cross the road only at crosswalks and when traffic signals indicate it is safe § Stand back a step from the curb until it is time to cross § Look left, right, and left again and check for turning cars before crossing § Use sidewalks. When there is no sidewalk, walk on the left (facing traffic) § Wear light colors at night with fluorescent material on clothes

forward facing in the back seat with 5- point harness restraints is recommended; LATCH system for anchoring if available · Safest area for toddlers is the backseat

Motor Vehicle Safety for the Toddler · Use an approved safe car seat properly installed in back of car; rear facing position up to 2 years or per manufacturer's weight and height recommendations · 2 years old to school age: ___________________ · Do not place rear-facing seats in the front seat · Do not allow children to play on curbs or behind parked cars · Do not allow children to play in piles of leaves, snow, or carboard boxes in high-traffic areas · Supervise biking, make sure they wear a helmet · Lock fences and doors if not directly supervising the child · Teach the child to obey traffic rules: § Cross the road only at crosswalks and when traffic signals indicate it is safe § Stand back a step from the curb until it is time to cross § Look left, right, and left again and check for turning cars before crossing § Use sidewalks. When there is no sidewalk, walk on the left (facing traffic) § Wear light colors at night with fluorescent material on clothes

§ Cross the road only at crosswalks and when traffic signals indicate it is safe § Stand back a step from the curb until it is time to cross § Look left, right, and left again and check for turning cars before crossing § Use sidewalks. When there is no sidewalk, walk on the left (facing traffic) § Wear light colors at night with fluorescent material on clothes

Motor Vehicle Safety for the Toddler · Use an approved safe car seat properly installed in back of car; rear facing position up to 2 years or per manufacturer's weight and height recommendations · 2 years old to school age: forward facing in the back seat with 5- point harness restraints is recommended; LATCH system for anchoring if available · Safest area for toddlers is the backseat · Do not place rear-facing seats in the front seat · Do not allow children to play on curbs or behind parked cars · Do not allow children to play in piles of leaves, snow, or carboard boxes in high-traffic areas · Supervise biking, make sure they wear a helmet · Lock fences and doors if not directly supervising the child · Teach the child to obey traffic rules: - - -

§ Name § Telephone Number § When it was ingested § How much (quantity) § What (type, if known)

Principles of Emergency Treatment of Ingested Poisonings · In every instance, medical evaluation is necessary to initiate appropriate action · Contact poison control BEFORE initiating any intervention: 1 2 3 4 5 · Syrup of ipecac is no longer recommended to induce vomiting · National Poison Control Center § 800-222-1222 OR www.aapcc.org

Physiologic Anorexia

Nutrition and Self-Feeding · During the period from 12-18 months, growth rate lose, decreasing the child's need for calories. But, protein needs and energy requirements are still high due to demands of muscle tissue growth and high activity level. · Toddlers usually require 3 meals and 2 snacks per day, but portion sizes are much smaller compared to older children · Children might establish lifetime eating habits during toddlerhood. They begin developing taste preferences and are usually picky eaters (repeatedly request for favorite food) · _________________________: A phenomenon where the toddler doesn't eat as much because there are not as many requirements (thus, less appetite). Growth rate slows, decreasing the need for calories, protein, and fluid. Eat smaller portions, more times per day.

Food Jags

Nutrition and Self-Feeding · _________: Toddler prefers certain foods for time periods; and they are picky, fussy eaters. They tend to push away plates if it isn't visually pleasing or the portion size is way too large. § To prevent food jags, parents should present foods in various physical forms, and progress with new foods in a step-wise form. · Ritualism: toddlers like to have the same dish, cup or spoon every time they eat; eat favorite foods o Plastic dishes recommended for safety, occasional spilling continues.

§ Drink from a covered cup and manage a spoon with considerable spilling (feed self) § Help with dressing by putting arm through sleeve or pulling shoes off § Builds tower of 2 cubes § Creeps up stairs

Personal-Social Behavior · Personal-social behaviors are evident in areas like feeding, dressing, play, and self-control. Their attitude can swing from a volatile, revolting toddler, and back to a cute, cuddly child in an instant. · By 15 months toddlers can:

§ Uses a spoon well § Able to unzip, remove clothes like gloves and pullover shirts § Throws ball overhand § Turns 2-3 pages in a book

Personal-Social Behavior · Personal-social behaviors are evident in areas like feeding, dressing, play, and self-control. Their attitude can swing from a volatile, revolting toddler, and back to a cute, cuddly child in an instant. · By 15 months toddlers can: § Drink from a covered cup and manage a spoon with considerable spilling (feed self) § Help with dressing by putting arm through sleeve or pulling shoes off § Builds tower of 2 cubes § Creeps up stairs · By 18-24 months toddlers can:

§ Uses a fork and removes most articles of clothing § They can put on shoes, socks, and pants without regard to right or left and back and front § Eat with the family and like to help with chores, but lack table manners and find it difficult to sit for the whole meal § Uses "I", "me", and "you" § Kicks ball § Jumps with both feet § Turns doorknob § Builds tower of more than 8 cubes

Personal-Social Behavior · Personal-social behaviors are evident in areas like feeding, dressing, play, and self-control. Their attitude can swing from a volatile, revolting toddler, and back to a cute, cuddly child in an instant. · By 15 months toddlers can: § Drink from a covered cup and manage a spoon with considerable spilling (feed self) § Help with dressing by putting arm through sleeve or pulling shoes off § Builds tower of 2 cubes § Creeps up stairs · By 18-24 months toddlers can: § Uses a spoon well § Able to unzip, remove clothes like gloves and pullover shirts § Throws ball overhand § Turns 2-3 pages in a book · By 30-36 months toddlers can:

equal

Physical Growth of the Toddler · Growth in spurts at a slower rate than the infant § At 30 (2.5years) months of age, toddlers should weigh 4 times their birth weight § Toddlers grow about 3 in per year and 4-6 pounds per year § Head circumference and chest circumference are usually _____________ by 1 year of age § Accurate measurement of weight and height should reveal a steady growth curve that is step-like rather than linear (growth spurts) · Anterior fontanel closes by 18 months · Motor coordination still developing placing them at increased risk for falls

4 times their birth weight

Physical Growth of the Toddler · Growth in spurts at a slower rate than the infant § At 30 (2.5years) months of age, toddlers should weigh ______________ § Toddlers grow about 3 in per year and 4-6 pounds per year § Head circumference and chest circumference are usually equal by 1 year of age § Accurate measurement of weight and height should reveal a steady growth curve that is step-like rather than linear (growth spurts) · Anterior fontanel closes by 18 months · Motor coordination still developing placing them at increased risk for falls

Sensorimotor Phase and the Beginning of the Preoperational Stage

Piaget: Final 2 stages of the _______________________: the period from 12-14 months of age is the continuation of the final stages of the sensorimotor stage. Cognitive process develops rapidly, but reasoning skills are primitive and need to be understood to effectively deal with typical behaviors of the child § In the 5th stage of the sensorimotor stage (13-18 months), tertiary circular reactions, the child uses active experimentation to achieve previously unattainable goals · This begins the process of learning rational judgment and intellectual reasoning (investigation stage). The child further learns to differentiate themselves from objects, evidenced by the child's ability to venture away from their parents and tolerate longer periods of separation · Awareness of a casual relationship between two events is apparent. After flipping a light switch, a toddler is aware of the response that occurs. But upon going into a new room with a new switch, they must investigate the switch again. This allows them to categorize data, and is evidenced by them exploring the same object each time it appears in a new place · Object permanence continues to advance. They cannot find an object that is invisibly displaced without seeing the change, but are aware of existence objects behind closed doors § From 19-24 months of age, the toddler is in the last phase of the sensorimotor stage. This develops more primitive, autistic-like thought processes of infancy and prepares for more complex mental thought processes. · Development of object permanence fully occurs, and toddlers will actively look for objects that are displaced · Domestic mimicry (imitating household activities) and gender-role behavior are common Toddlers still have a very limited attention span, and embryonic sense of time. One minute may feel like one hour

§ Give O2; may need mechanical ventilation § Monitor vitals § Administer meds, IV fluids as prescribed § Provide chest physiotherapy § Monitor for complications that can occur 24 hours after incident § Use a calm approach to child and family and keep the family informed of the child's status

Principles of Emergency Treatment of Drowning · Asphyxiation while a child is submerged in fluid can occur in any standing water that is at least 1 in deep · Expected Findings: § History of event and time of submersion § Type/temperature of fluid § Respiratory assessment § Body temperature (often hypothermia) § Bruising, spinal cord injury, physical injuries · Care of Drowning Emergency: - -

Respiratory Distress

Principles of Emergency Treatment of Respiratory Emergencies · Respiratory Insufficiency: increased work of breathing with mostly adequate gas exchange or hypoxia with acidosis · Respiratory Failure: inability to maintain adequate oxygenation of the blood · Apnea: cessation of respirations for more than 20 seconds · Respiratory Arrest: cessation of respirations · Airway Obstruction: occlusion of the airway · S/S of ____________________: restlessness, tachypnea, tachycardia, sweating, nasal flaring, retractions, grunting, dyspnea, wheezing § Advanced hypoxia: bradypnea, bradycardia, peripheral/central cyanosis, stupor, coma § Chocking: universal choking sign, inability to speak, weak/ineffective cough, high-pitched sounds or no sound, dyspnea, cyanosis

locomotive toys

Promoting Growth and Development of the Toddler Through Play · Play is the major socializing medium for toddlers § Tactile toys (Water, sand, finger paints, chalk, paper, puzzles) help develop fine motor skills and manipulative recreative. § Increased locomotive skills make ______________ (riding toys, balls, slides, push-pull toys, straddle trucks/cycles) appropriate for energetic toddlers § Interlocking Blocks (build imagination) § Imitation is a huge characteristic of toddler's play and enriches the child's ability to engage fantasy § Play that fosters the toddler's interactions with adults in a supportive, unconditional way is the most educational toy § Talking is a form of play ("talking" dolls), so reading stories or imitating animal sounds help linguistic abilities. High-quality TV programming can be appropriate after 18 months, if it is watched together and retaught after watching. TV time for toddler's 2-5 years old should be limited to 1 hour per day.

fosters the toddler's interactions with adults in a supportive, unconditional way

Promoting Growth and Development of the Toddler Through Play · Play is the major socializing medium for toddlers § Tactile toys (Water, sand, finger paints, chalk, paper, puzzles) help develop fine motor skills and manipulative recreative. § Increased locomotive skills make locomotive toys (riding toys, balls, slides, push-pull toys, straddle trucks/cycles) appropriate for energetic toddlers § Interlocking Blocks (build imagination) § Imitation is a huge characteristic of toddler's play and enriches the child's ability to engage fantasy § Play that ______________ is the most educational toy § Talking is a form of play ("talking" dolls), so reading stories or imitating animal sounds help linguistic abilities. High-quality TV programming can be appropriate after 18 months, if it is watched together and retaught after watching. TV time for toddler's 2-5 years old should be limited to 1 hour per day.

can be appropriate after 18 months, if it is watched together and retaught after watching. TV time for toddler's 2-5 years old should be limited to 1 hour per day.

Promoting Growth and Development of the Toddler Through Play · Play is the major socializing medium for toddlers § Tactile toys (Water, sand, finger paints, chalk, paper, puzzles) help develop fine motor skills and manipulative recreative. § Increased locomotive skills make locomotive toys (riding toys, balls, slides, push-pull toys, straddle trucks/cycles) appropriate for energetic toddlers § Interlocking Blocks (build imagination) § Imitation is a huge characteristic of toddler's play and enriches the child's ability to engage fantasy § Play that fosters the toddler's interactions with adults in a supportive, unconditional way is the most educational toy § Talking is a form of play ("talking" dolls), so reading stories or imitating animal sounds help linguistic abilities. High-quality TV programming _________________

Tactile toys

Promoting Growth and Development of the Toddler Through Play · Play is the major socializing medium for toddlers § _____________ (Water, sand, finger paints, chalk, paper, puzzles) help develop fine motor skills and manipulative recreative. § Increased locomotive skills make locomotive toys (riding toys, balls, slides, push-pull toys, straddle trucks/cycles) appropriate for energetic toddlers § Interlocking Blocks (build imagination) § Imitation is a huge characteristic of toddler's play and enriches the child's ability to engage fantasy § Play that fosters the toddler's interactions with adults in a supportive, unconditional way is the most educational toy § Talking is a form of play ("talking" dolls), so reading stories or imitating animal sounds help linguistic abilities. High-quality TV programming can be appropriate after 18 months, if it is watched together and retaught after watching. TV time for toddler's 2-5 years old should be limited to 1 hour per day.

parallel play

Promoting Growth and Development of the Toddler Through Play: · Toddlers engage in ______________ (playing alongside another child) instead of cooperative play. · Toddlers are egocentric and do not like to share. · The short attention span of toddlers will make them change toys frequently. · Appropriate Toy Selection involves considering safety. Don't choose objects small enough to be placed in the mouth because they will put stuff in their mouth.

SPF 15 or greater, protective clothing, avoid sun exposure from 1000-1400

Safety for the Toddler · Safe Home Environment § ALWAYS supervise in bathtub or near open water § Pot handles turned inward on stove, tub water temp, outlets covered to prevent scald and electrical burns. § Supervise when climbing stairs, near cigarettes, candles, and irons § Prevent poisoning from medications or cleaning supplies § Sunburn prevention by using sunscreen with ____________________

11 - 12 hours of sleep per day including 1 nap until age 3

Sleep and Activity · Toddlers average _____ hours of sleep per day including ______ nap until age 3 · Bedtime resistance is common in toddlers, and expression of fears are common · Frequent night waking is often related to the toddler's fears/imagination · Avoid heavy meals before bed and keep a television out of the toddler's room · Encourage more daily activity and physical exercise, and make the hour before bed a time for quiet activities like reading. · To promote sleep, establish regular bedtime rituals or routines. Transitional objects can also be useful to ease the toddler's insecurity at bedtime (promotes comfort and security)

Temperament

Social Development · A major task for the toddler is differentiation of self from significant others. The differentiation process consist of two phases: separation and individuation § Toddler's also exhibit Rapprochement, where the child separates from the mother and returns for reassurance. Transitional objects (blanket, toy) provide security for children, especially when separated from the parents · Separation § Able to withstand separation from parents for short periods; has understanding that they will return · Individuation § Transitional objects (blanket/toy) provide security; normal to minimize feelings of fear or loneliness § ________________ - biological basis for personality development (emotional & motivational core) § Require routine and consistency for guidance · Egocentrism § Focus on self, power struggles often § Develop routines/rituals for structure, stability and security

Rapprochement

Social Development · A major task for the toddler is differentiation of self from significant others. The differentiation process consist of two phases: separation and individuation § Toddler's also exhibit __________________, where the child separates from the mother and returns for reassurance. Transitional objects (blanket, toy) provide security for children, especially when separated from the parents · Separation § Able to withstand separation from parents for short periods; has understanding that they will return · Individuation § Transitional objects (blanket/toy) provide security; normal to minimize feelings of fear or loneliness § Temperament - biological basis for personality development (emotional & motivational core) § Require routine and consistency for guidance · Egocentrism § Focus on self, power struggles often § Develop routines/rituals for structure, stability and security

Egocentric

Values and Psychosocial Development · Moral Development is closely associated with cognitive development § __________: toddlers can't see things from the perspectives of others § Punishment and obedience orientation with a sense that good behavior is rewarded and bad behavior is punished § Starts to learn right from wrong § Begins to learn empathy and socially acceptable behaviors · Spiritual § Family and environment influence a child's perception of the world § Toddlers begin to assimilate behaviors associated with the divine (folding hands in prayer). Routines like praying before meals/bed can be important · Cultural -Food & Toys -Dependence or Independence is influenced by parents/caregivers

Burn

__________ Prevention § Check bath water temperature § Thermostat for water heaters set at 49 C (120F) § Working smoke detectors § Pot/pan handles turned toward stove and place small appliances toward back of counter § Cover electrical outlets and cover heating devices with a fence § Keep electrical cords/wires out of reach and hidden § Wear sunscreen when outside § Store matches in locked area and placing burning candles out of reach § Don't let table clothes hang in child's reach Stress the danger of open flames; teach what "hot" means

flush" the cold water pips by running water until it becomes cold (30sec-2min)

o Education for prevention of lead poisoning: § Make sure that child does not have access to peeling paint § If house was built before 1978 and has hard surface floors, mop them once per week. Use a wet disposable cloth to pick up paint chips (NO vacuuming, it will spread dusts) § Wash and dry child's hands/face frequently § Wash toys frequently § Wipe feet on mats before entering the home § If soil around the home is contaminated, place grass or bushes around the area so the child cannot play there § During remodeling of older homes, be certain the children/pregnant women are not in the home until the process is completed. § In areas where lead content of water exceeds the drinking water standard and a faucet has not been used for 6 hours or more, "_________________ § Use only cold water for consumption. Have water tested § Do not store food in open cans and do not use pottery or ceramic ware that is meant for decoration as a food plate for the family to eat on. § Avoid folk remedies that contain lead, avoid candy imported from Mexico, avoid imported toys § Make sure home exposure is not coming from parent's work/hobbies § Make sure child eats regular meals because more lead is absorbed in an empty stomach § Consider iron supplements if the child does not get enough iron.

before 1978 and has hard surface floors, mop them once per week. Use a wet disposable cloth to pick up paint chips (NO vacuuming, it will spread dusts)

o Education for prevention of lead poisoning: § Make sure that child does not have access to peeling paint § If house was built before _______ and has hard surface floors, ____________________ § Wash and dry child's hands/face frequently § Wash toys frequently § Wipe feet on mats before entering the home § If soil around the home is contaminated, place grass or bushes around the area so the child cannot play there § During remodeling of older homes, be certain the children/pregnant women are not in the home until the process is completed. § In areas where lead content of water exceeds the drinking water standard and a faucet has not been used for 6 hours or more, "flush" the cold water pips by running water until it becomes cold (30sec-2min) § Use only cold water for consumption. Have water tested § Do not store food in open cans and do not use pottery or ceramic ware that is meant for decoration as a food plate for the family to eat on. § Avoid folk remedies that contain lead, avoid candy imported from Mexico, avoid imported toys § Make sure home exposure is not coming from parent's work/hobbies § Make sure child eats regular meals because more lead is absorbed in an empty stomach § Consider iron supplements if the child does not get enough iron.

1 tbsp each year of age, or 1/3-1/4 of an adult portion

o Nutritional Counseling: § Food serving size should be __________________. Use the tablespoon guide for easily measured foods like rice. Use the fraction guide for bread or milk. If food is rewarded or sign of approval, children can overeat. If food is forced and mealtime is unpleasant, they won't develop the pleasure that comes with eating. Mealtimes should be enjoyable, and often it is best to bring children inside from play 15 minutes before meals so they are not overactive.

Acetaminophen

· Aceta__________minophen poisoning: § 2-4hr after ingestion: n/v, sweating, pallor § 24-36 hr after ingestion: improvement in condition § 36 hr- 7 days after ingestion: pain in upper right quadrant, confusion, stupor, jaundice, n/v, and coagulation disturbances § Treatment of __________ poisoning: · N-acetylcysteine given orally as 1 loading does and then 17 additional doses in different doses.

· N-acetylcysteine given orally as 1 loading does and then 17 additional doses in different doses.

· Acetaminophen poisoning: § 2-4hr after ingestion: n/v, sweating, pallor § 24-36 hr after ingestion: improvement in condition § 36 hr- 7 days after ingestion: pain in upper right quadrant, confusion, stupor, jaundice, n/v, and coagulation disturbances § Treatment of Acetaminophen poisoning: ___________________________

activated charcoal, gastric lavage (will not remove concretions of ASA), sodium bicarbonate, cooling for hyperpyrexia, oxygen with ventilation, vitamin K, anticonvulsants, hospitalization and hemodialysis if severe

· Acetylsalicylic Acid (aspirin) poisoning: § Acute poisoning: (Early symptoms): n/v, , diaphoresis, tachypnea, tinnitus, oliguria, lightheadedness, (late symptoms): hyperactivity, fever, disorientation, confusion, seizures, renal failure, respiratory failure § Chronic poisoning: subtle version of acute, bleeding tendencies, dehydration, seizures § Treatment of Acetylsalicylic Acid (aspirin) poisoning: __________________

§ CPR for respiratory and cardiac arrest § Activate the rapid response team § Use BLS for pediatric patients § Position to maintain patent airway. Monitor respiratory status and vitals § Give O2 as needed § Suction as needed § Prepare for intubation as needed § Use a calm approach with the child and family § Administer medications, IV fluids, and emergency meds as prescribed § Keep the family informed of the child's status

· Care of Respiratory Emergencies:

§ Daytime tiredness/hyperactivity § Behavior changes § Strain on family relationships § Difficulty concentrating § Impaired learning § Poor control of emotions and impulses

· Consequences of inadequate sleep

airway maintenance and LOC, NPO, no attempt to neutralize acid, do not induce vomiting, analgesics for pain

· Corrosive poisoning: toilet cleaner, dishwasher detergent, mildew remover, batteries, denture cleaners, bleach § Symptoms: pain/burning in mouth/throat/stomach, edematous lips/tongue/pharynx with white mucous membranes, violent vomiting with hemoptysis, drooling, anxiety, shock § Treatment of Corrosive poisoning: _____________________

nuts, grapes, hot dogs, peanut butter, raw carrots, dried beans, tough meats, popcorn · Cut foods into bite-size pieces to prevent chocking § ALWAYS supervise during meals/snacks § Toddlers should not eat while playing or lying down

· Dietary Reminders: § Method of serving food at certain intervals is important in portions that are not overwhelming § Encourage healthy eating choices and dietary intake; promote regular exercise to decrease obesity and cardiovascular risk factors § 500mg/day of Ca+ and 400 IU/day of Vitamin D for health bone development, and · Calcium is obtained from foods like milk, cheese, yogurt, legumes, and vegetables · Vitamin D is obtained from sunlight, fish, fish oils, and egg yolks § Vitamin C needed for Fe+ absorption § Toddlers should consume 24-28 oz of milk per day; and can switch from whole milk to low-fat milk at 2 years of age § Juice consumption should be limited to 4-6 oz per day § Iron-fortified cereals and iron-rich foods are recommended for all children older than 6 months of age § Trans fatty acids should be avoided § Diet should include 1 cup of fruit daily because vitamin C enhances iron absorption § Snacks or desserts with high sugar, fat, or sodium content should be avoided § Chocking hazard foods: _____________________________

24-28 oz of milk per day; and can switch from whole milk to low-fat milk at 2 years of age

· Dietary Reminders: § Method of serving food at certain intervals is important in portions that are not overwhelming § Encourage healthy eating choices and dietary intake; promote regular exercise to decrease obesity and cardiovascular risk factors § 500mg/day of Ca+ and 400 IU/day of Vitamin D for health bone development, and · Calcium is obtained from foods like milk, cheese, yogurt, legumes, and vegetables · Vitamin D is obtained from sunlight, fish, fish oils, and egg yolks § Vitamin C needed for Fe+ absorption § Toddlers should consume 2_______ of milk per day; and can switch from ______ to ________ at 2 years of age § Juice consumption should be limited to 4-6 oz per day § Iron-fortified cereals and iron-rich foods are recommended for all children older than 6 months of age § Trans fatty acids should be avoided § Diet should include 1 cup of fruit daily because vitamin C enhances iron absorption § Snacks or desserts with high sugar, fat, or sodium content should be avoided § Chocking hazard foods: nuts, grapes, hot dogs, peanut butter, raw carrots, dried beans, tough meats, popcorn · Cut foods into bite-size pieces to prevent chocking § ALWAYS supervise during meals/snacks § Toddlers should not eat while playing or lying down

500mg/day of Ca+ and 400 IU/day of Vitamin D for health bone development · Calcium is obtained from foods like milk, cheese, yogurt, legumes, and vegetables · Vitamin D is obtained from sunlight, fish, fish oils, and egg yolks

· Dietary Reminders: § Method of serving food at certain intervals is important in portions that are not overwhelming § Encourage healthy eating choices and dietary intake; promote regular exercise to decrease obesity and cardiovascular risk factors § __________________ for health bone development § Vitamin C needed for Fe+ absorption § Toddlers should consume 24-28 oz of milk per day; and can switch from whole milk to low-fat milk at 2 years of age § Juice consumption should be limited to 4-6 oz per day § Iron-fortified cereals and iron-rich foods are recommended for all children older than 6 months of age § Trans fatty acids should be avoided § Diet should include 1 cup of fruit daily because vitamin C enhances iron absorption § Snacks or desserts with high sugar, fat, or sodium content should be avoided § Chocking hazard foods: nuts, grapes, hot dogs, peanut butter, raw carrots, dried beans, tough meats, popcorn · Cut foods into bite-size pieces to prevent chocking § ALWAYS supervise during meals/snacks § Toddlers should not eat while playing or lying down

Nursing caries/baby bottle tooth decay

· Dietary factors that are highly cariogenic may also contribute to obesity § Prolonged or night-time bottle feeding (mothers should completely eliminate bedtime bottle feeding) § __________: a form of tooth decay in children 18 months-3 years that occurs when a child is routinely given a bottle of milk or juice at naptime or bedtime. § Foods high sucrose content in foods/drinks (honey, table sugar, dried fruits, gummy snacks) are highly cariogenic § Complex carbohydrates (breads, potatoes, pasta) contribute to caries because they lower plaque pH

place in side lying position or kneeling with head below chest to prevent aspiration

· Emergency Treatment of Poisonings: § Assess the victim: · Provide CPR as needed · Take vitals and evaluate for concomitant trauma/illness § Terminate exposure and keep the family posted on condition · Empty mouth of pills, flush body surface with large amounts of warm saline/water · Remove contaminated clothes · Victims of inhalation poisoning need to be brought into fresh air § Identify the poison: · Question victim and witness, look for environmental clues and symptoms · Notify poison control center § Prevent poison absorption: _________________ § Administer IV fluids as needed § Provide cardiac monitoring § Monitor vitals and O2% § Monitor I/O § Administer antidote § Assist with gastric decontamination if needed: activated charcoal, gastric lavage

Negativism

· Erik Erikson: Autonomy vs. Shame & Doubt: the developmental task of toddlerhood is acquiring a sense of autonomy while overcoming a sense of doubt and shame § Independence is paramount for toddlers who are attempting to do everything for themselves. As infants they often have the urge to be autonomous, but are typically rewarded for more submissive, dependent behavior. This creates shame and a sense of doubt for feeling the urge to revolt and manipulate their own environment. § Negativism and ritualism are typical of toddlers in their quest for autonomy · Ritualism: maintaining routines and reliability provides sense of comfort; the need to maintain sameness and reliability (Rituals and consistency). Without comfortable rituals, children have little opportunity to express autonomy (dependency and regression occur) · Achieves autonomy · ______________: persistent negative response to requests; "no" is a common word in their vocabulary. Their emotions are strongly expressed. One second they are engrossed in play, and the next they are frustrated because they can't do something. If scolded for doing something wrong, they can have temper tantrums § Does not share or take turns until age 3 § Emotions strongly expressed, temper tantrums and mood swings

Ritualism

· Erik Erikson: Autonomy vs. Shame & Doubt: the developmental task of toddlerhood is acquiring a sense of autonomy while overcoming a sense of doubt and shame § Independence is paramount for toddlers who are attempting to do everything for themselves. As infants they often have the urge to be autonomous, but are typically rewarded for more submissive, dependent behavior. This creates shame and a sense of doubt for feeling the urge to revolt and manipulate their own environment. § Negativism and ritualism are typical of toddlers in their quest for autonomy · ______________: maintaining routines and reliability provides sense of comfort; the need to maintain sameness and reliability (Rituals and consistency). Without comfortable rituals, children have little opportunity to express autonomy (dependency and regression occur) · Achieves autonomy · Negativism: persistent negative response to requests; "no" is a common word in their vocabulary. Their emotions are strongly expressed. One second they are engrossed in play, and the next they are frustrated because they can't do something. If scolded for doing something wrong, they can have temper tantrums § Does not share or take turns until age 3 § Emotions strongly expressed, temper tantrums and mood swings

Autonomy vs. Shame & Doubt

· Erik Erikson: ________________________: the developmental task of toddlerhood is acquiring a sense of autonomy while overcoming a sense of doubt and shame § Independence is paramount for toddlers who are attempting to do everything for themselves. As infants they often have the urge to be autonomous, but are typically rewarded for more submissive, dependent behavior. This creates shame and a sense of doubt for feeling the urge to revolt and manipulate their own environment. § Negativism and ritualism are typical of toddlers in their quest for autonomy · Ritualism: maintaining routines and reliability provides sense of comfort; the need to maintain sameness and reliability (Rituals and consistency). Without comfortable rituals, children have little opportunity to express autonomy (dependency and regression occur) · Achieves autonomy · Negativism: persistent negative response to requests; "no" is a common word in their vocabulary. Their emotions are strongly expressed. One second they are engrossed in play, and the next they are frustrated because they can't do something. If scolded for doing something wrong, they can have temper tantrums § Does not share or take turns until age 3 § Emotions strongly expressed, temper tantrums and mood swings

grasp very small object but can't release it at will

· Fine Motor Skills of Toddlers: § 12 months: _______

uses a cup well, builds a tower of two blocks, drops pellets into a narrow-necked bottle, throwing objects and retrieving them

· Fine Motor Skills of Toddlers: § 12 months: grasp very small object but can't release it at will § 15 months: ___________

manages a spoon without rotation; turns pages in a book 2-3 at a time; builds tower of 3-4 blocks; throws ball overhand without losing balance

· Fine Motor Skills of Toddlers: § 12 months: grasp very small object but can't release it at will § 15 months: uses a cup well, builds a tower of two blocks, drops pellets into a narrow-necked bottle, throwing objects and retrieving them § 18 months: _________

builds a tower of 6-7 blocks, turns one page in a book at a time

· Fine Motor Skills of Toddlers: § 12 months: grasp very small object but can't release it at will § 15 months: uses a cup well, builds a tower of two blocks, drops pellets into a narrow-necked bottle, throwing objects and retrieving them § 18 months: manages a spoon without rotation; turns pages in a book 2-3 at a time; builds tower of 3-4 blocks; throws ball overhand without losing balance § 2 years: ________

draws circles; has good hand-finger coordination

· Fine Motor Skills of Toddlers: § 12 months: grasp very small object but can't release it at will § 15 months: uses a cup well, builds a tower of two blocks, drops pellets into a narrow-necked bottle, throwing objects and retrieving them § 18 months: manages a spoon without rotation; turns pages in a book 2-3 at a time; builds tower of 3-4 blocks; throws ball overhand without losing balance § 2 years: builds a tower of 6-7 blocks, turns one page in a book at a time § 2.5 years: _____________ § Increased manual dexterity § Manage utensils § Hold a crayon § String a bead § Stack blocks § Feeding self

walk alone using a wide stance for balance

· Gross Motor Skills of Toddlers: § 12-13 months: ________

walks up and down stairs by placing both feet on each step

· Gross Motor Skills of Toddlers: § 12-13 months: walk alone using a wide stance for balance § 15 months: Walk up and down stairs, creeps up stairs § 18 months: Pushing or pulling a toy, Throwing a ball, jumps in one place with both feet, runs clumsily and falls often § 2 years: __________

jumps across the floor and off a chair or step up using both feet; stands on one foot momentarily; takes a few steps on tiptoe; and climb stairs with alternate footing

· Gross Motor Skills of Toddlers: § 12-13 months: walk alone using a wide stance for balance § 15 months: Walk up and down stairs, creeps up stairs § 18 months: Pushing or pulling a toy, Throwing a ball, jumps in one place with both feet, runs clumsily and falls often § 2 years: walks up and down stairs by placing both feet on each step § 2.5 years: ____________ § Running § Climbing § Jumping § Parachute reflex "toddler gait"

Pushing or pulling a toy, Throwing a ball, jumps in one place with both feet, runs clumsily and falls often

· Gross Motor Skills of Toddlers: § 12-13 months: walk alone using a wide stance for balance § 15 months: Walk up and down stairs, creeps up stairs § 18 months: __________

3 minutes

· Management of Atopic Dermatitis § Hydrate skin - tepid bath with mild soap, than application of emollient within ______________ after bath to trap moisture · 2-3 baths may be given daily with one prior to bedtime. · Bubble baths and harsh soaps should be avoided § Dress the child in cotton clothing. Avoid wool and synthetic fabrics § Avoid excessive heat and sweating (these increase itching) § Wash skin folds and genital area frequently with water § Assist in identifying the causative agent § Aquaphor, Cetaphil, Eucerin § Colloid bath (2 cups cornstarch in tub of warm water) prior to bedtime may provide temporary relief of itching may help child sleep § Oral antihistamines: hydroxyzine or diphenhydramine to relive itching and minimize inflammation · Can have sedating effect, so reinforce safety and monitor child § Keep fingernails clean and short to eliminate sharp edges. One-piece clothing can decrease direct contact with skin. § Hypoallergenic diet may be used to prevent flaring

Chelation therapy

· Management of Lead Poisoning § ____________________ after a level of about 45: removing lead from the blood. It is not an antidote and does not counteract any effects of the lead · Adequate hydration is needed during therapy because chelates are excreted via kidneys

Lead Poisoning

· Manifestations of __________________ § Neurologic: · Interferes with brain & nervous system development · Cognitive impairment · Encephalopathy · Brain damage, seizures, paralysis · Low-exposure: distractibility, impulsiveness, hyperactivity, hearing impairment, mild intellectual difficulty · High Exposure: cognitive delays, blindness, paralysis, coma, seizures, and death § Renal: impaired calcium function, kidney impairment § Hematologic: anemia

Preoperational phase (Piaget)

· Piaget: Final 2 stages of the Sensorimotor Phase and the Beginning of the Preoperational Stage: the period from 12-14 months of age is the continuation of the final stages of the sensorimotor stage. Cognitive process develops rapidly, but reasoning skills are primitive and need to be understood to effectively deal with typical behaviors of the child § ______________: at 2 years of age (till 4 years old), the child enters this phase. Preoperational thinking implies that children cannot think in terms of operations (ability to manipulate objects in relation to another in logical fashion) · Plays make believe Toddler increasingly uses language and is concerned with "Why" and "How" questions of life.

wash from skin/eyes, provide supportive care

· Plant Poisoning: § Symptoms are dependent on the plant, but can include local irritation to the oropharynx and entire GI system, respiratory/renal/CNS symptoms, dermatitis § Treatment: ________

Poisoning

· Preventing ______________________: § Avoid lead paint and toxic agents § Safety locks placed on cabinets that contain cleaners/chemicals § Medications kept in childproof places; do not take medications in front of children § When giving a child medication, do not say it is candy § Use non-mercury thermometers § Encourage hand-hygiene before eating § Do not store food in lead-based containers § Working carbon monoxide detector in home § Teach the child not to eat inedible things (plants) or play in the trash § Never remove labels from toxic substances

§ Solitary play evolves into parallel play (toddlers observe other children and might engage in activities nearby) § Filling and emptying containers § Playing with blocks § Looking at books § Push-pull toys § Tossing balls § Finger paints § Large-piece puzzles § Thick crayons

· Safe, Age Appropriate Activities for Toddlers:

fall asleep in the crib regularly

· Sleep Problems: toddlers often have trouble going to sleep, wake at night, have difficult returning to sleep, have nightmares, or prolong bedtime through elaborate rituals. -Charting sleep habits can help identify the cause of the sleep problem -Allow infants to __________. Falling asleep in the arms and waking up in the crib present unfamiliarity and distress (as well as fosters falling asleep with parents).

emesis or lavage, chelation therapy

· Supplemental Iron poisoning: § Initial period: vomiting, hematemesis, diarrhea, gastric pain, bloody stools § Latency period: improvement in condition § Systemic toxicity period: metabolic acidosis, hyperglycemia, bleeding, fever, shock, death § Hepatic injury period: seizures or coma § Treatment of Supplemental Iron poisoning:______________

Fall

· _______ Prevention § Falls from stairs, climbing, cribs, shopping carts § Doors/windows locked § Crib mattress in lowest position with rails up § Safety gates across top and bottom of stairs § Remove scatter rugs § Put nonskid deals in bathtub § Place carpeting under crib and in bathroom § Keep large toys and bumper pads out of crib or play yard (they can use them as stairs to climb out) § Avoid wheeled walkers § Dress in safe clothing and keep kids restrained in vehicles.

Drowning

· __________ Prevention § Do not leave toddler alone in bathtub § Keep toilet lids closed and locked § Toddlers should be supervised around bodies of water § Teach toddlers how to swim § Use life jackets when boating § Supervising small toddlers when swimming by "touch" (adult can reach out and touch child at all times)

Bodily Injury

· __________ Prevention § Keep sharp objects out of reach § Firearms, lawn equipment, knives or other sharp objects kept out of reach § Do not leave toddler alone with animals § Avoid giving the child sharp objects § Do not allow lollipops when walking/running § Teach safety precautions § Store dangerous tools in locked areas § Be alert to danger of supervised animals and pets § Use safety glass and decals on large glass areas like sliding doors § Teach child name, address, and phone number, and to ask for help from appropriate people (cashier, security guard, police) when lost. Have ID on child § Stranger Safety: · Avoid personalized clothes in public areas · Never go with a stranger · Tell parents if anyone makes you uncomfortable Say no when in uncomfortable situations

Atopic Dermatitis

· __________ is a type of eczema that is characterized by pruritis and associated with a history of allergies that are of an inherited tendency § Genetic Predisposition § Family history of eczema, asthma, food allergies, allergic rhinitis § Pruritic eczema § Improve in humid climates but worse in fall and winter § Can be controlled but not curable · S/S of ________: lesions in the flexural areas, wrists, ankles, and feet with symmetric movement. § Lesion characteristics: erythematous or flesh-colored papules, in clusters. They are often dry, with lichenification (thick skin with accentuation of creases) or keratosis pilaris § Intense itching § Unaffected skin is dry/rough

Hydrocarbon

· ___________ poisoning: gas, kerosine, lamp oil, mineral seal oil, lighter fluid, paint thinner § Symptoms: gagging, choking, coughing, n/v, lethargy, weakness, tachypnea, cyanosis, grunting, retractions, burning throat/stomach, lethargy § Treatment of _________ poisoning: do not induce vomiting; intubate with cuffed ET tube prior to gastric decontamination if performed, symptomatic treatment of chemical pneumonia includes high humidity, O2, hydration, and antibiotics

Aspiration and Suffocation

· ____________ Prevention § Plastic wrappers or bags should be removed from reach § Balloons, small pieces, pins, earrings, can pull-tabs) should be removed from reach § Choking hazards, toys, foods should be removed from reach § Toys that have small parts should be kept out of reach § Age-appropriate toys should be given § Crib mattress should fit tightly § Crib slats no farther than 6cm apart § Pillows should be kept out of cribs § Drawstrings removed from jackets § Develop a fire safety plan with family § Keep blind or shade cords on windows out of reach

Supplemental Iron

· ____________ poisoning: § Initial period: vomiting, hematemesis, diarrhea, gastric pain, bloody stools § Latency period: improvement in condition § Systemic toxicity period: metabolic acidosis, hyperglycemia, bleeding, fever, shock, death § Hepatic injury period: seizures or coma § Treatment of ________________ poisoning: emesis or lavage, chelation therapy

Corrosive

· _____________ poisoning: toilet cleaner, dishwasher detergent, mildew remover, batteries, denture cleaners, bleach § Symptoms: pain/burning in mouth/throat/stomach, edematous lips/tongue/pharynx with white mucous membranes, violent vomiting with hemoptysis, drooling, anxiety, shock § Treatment of ________ poisoning: airway maintenance and LOC, NPO, no attempt to neutralize acid, do not induce vomiting, analgesics for pain

Acetylsalicylic Acid (aspirin)

· ________________ poisoning: § Acute poisoning: (Early symptoms): n/v, , diaphoresis, tachypnea, tinnitus, oliguria, lightheadedness, (late symptoms): hyperactivity, fever, disorientation, confusion, seizures, renal failure, respiratory failure § Chronic poisoning: subtle version of acute, bleeding tendencies, dehydration, seizures § Treatment of _________ poisoning: activated charcoal, gastric lavage (will not remove concretions of ASA), sodium bicarbonate, cooling for hyperpyrexia, oxygen with ventilation, vitamin K, anticonvulsants, hospitalization and hemodialysis if severe