Ch. 12 Growth & Development Toddler

Between which ages is voluntary control of the anal and urethral sphincters typically achieved?

18 to 24 months Between 18 and 24 months of age most toddlers have achieved voluntary control of the anal and urethral sphincters. Most toddlers have not achieved this control between the ages of 8 to 12 months, 10 to 12 months, or 18 to 20 months.

Which statement by the parent suggests the need for additional information about injury prevention in early childhood?

"Our 2-year-old takes a bath with a sibling while we cook dinner." Allowing a 2-year-old toddler to take a bath unsupervised suggests that the parent needs additional information about injury prevention in early childhood. Keeping all medicines out of reach or locked, placing gates at the top and bottom of the stairs, and having a fence around the swimming pool are all ways to prevent injury and therefore do not warrant additional teaching about injury prevention.

Which statement by the parent indicates to the nurse that the parent needs more instruction regarding accident prevention?

"We put our child in a seat belt now that our child is older." A car seat should be used until the child weighs 18 kg (40 lb) and is approximately 4 years old. Locking up medicines and any other harmful household products, turning down the thermostat on the water heater, and placing gates at the top and bottom of the basement stairs are all appropriate actions, and so there is no need for further instruction.

Which age is the child able to distinguish finger and spoon foods and chews food with mouth closed by moving food inside the mouth?

24 months Toddlers who are 24 months old will be able to distinguish between finger food and spoon food; therefore this is the age of the child. They chew food with their mouth closed and are able to move the food inside the mouth. Toddlers who are 12 to 18 months old are able to hold and drink well from a cup with a lid, and drop it when finished.

Which child would need fluoride supplementation?

6 months of age or older Fluoride supplementation is recommended for children 6 months or older whose drinking water is deficient in fluoride. Fluoride supplementation is not recommended at 4 or 5 months of age.

Which characteristic is appropriate for motor skills of a 24-month-old child?

Activities begin to produce purposeful results Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new one. By 2 years of age children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is characteristic of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

Which behavior is described when a 2½-year-old child angrily says to the chair: "Why you push me?"

Animism Attributing life-like qualities to inanimate objects is called animism; therefore this child is exhibiting animistic behavior. Centration is focusing on one reason rather than thinking about all possible alternatives. A child refusing to eat a particular food because of its color although the taste of the food is good is an example of centration. Transductive behavior is reasoning from specific cases to specific cases. If a child refuses to eat food because the previously eaten food did not taste good, the child exhibits transductive behavior. Inability to conserve is the inability to understand the idea that mass can be changed in size or shape without adding anything to the original mass.

Which characteristics of preoperational thought are appropriate in toddlers?

Belief that their thoughts are all powerful and caused the event that occurred Children who use preoperational thought believe that their thoughts are all powerful and can cause the event that occurred, otherwise known as magical thinking. Centration, a term given to preoperational thought, means that toddlers are unable to consider all possible alternatives. They are unable to see the event or object from another perspective because of their egocentrism. They do not have the ability to understand that something can be different than the way it appears to be, also known as the inability to conserve.

Which infant has a slightly delayed gross motor skill?

Child 1 Child 1 has a slightly delayed gross motor skill because children who are 18 months old try to run but easily fall. Children who are 2 years old have improved coordination and equilibrium. Children who are 2½ years old can stand on one foot for a second or two. Children above 2 years old can jump using both feet and climb stairs with alternating feet. A 1-year-old child can walk alone using a wide stance for balance.

Which condition is the 18-month-old child at risk for when prolonging bottle-feeding?

Early childhood caries Prolonged bottle-feeding may cause a type of tooth decay called early childhood caries, which mostly affects the upper incisors and molars. Delayed language development is caused by other factors, such as exposure to television constantly before the age of 24 months or other cognitive impairments. The child is at risk for iron deficiency if the child does not consume iron-enriched foods. Sleep problems are due to factors such as fears, awareness of separation, or heavy meals before bedtime.

Which intervention will foster the achievement of autonomy in toddlers?

Encouraging toddlers to do things for themselves when capable Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. The concept of right and wrong is too advanced for toddlers and will not contribute to autonomy. Children at this age engage in parallel play. This will not foster autonomy.

Which developmental behaviors does an 18-month-old child possess? Select all that apply.

Fits smaller objects into each other Opens door and drawers to find objects Tertiary circular reactions are observed in children who are 13 to 18 months old. Tertiary circular reactions are schemes in which an infant purposely explores new possibilities with objects, continually changing what is done to them and exploring the results. Children in the fifth sensorimotor stage, or tertiary circular reactions, would possess the ability to fit smaller objects into each other. They open doors and drawers to find objects and have object permanence, indicating they are able to realize that objects out of sight are not out of their reach. Children in the preoperational stage, which ranges from about ages 2 to 4, are found to be possessive of their own toys, and they use the word "mine." Children in this stage can mentally represent events and objects and engage in symbolic play. Children in the sixth sensorimotor stage, or the stage in which the child invents new means through mental combinations, imitate sounds of animals and words of adults. This stage ranges from about ages 19 to 24 months. Children in the fifth sensorimotor stage can place a round object into a hole exactly, but they cannot do so with a square until they are 2 years old.

Which nursing action is appropriate when a toddler refuses pasta because it does not taste good and when offered a banana immediately after, will not try it?

Give the banana to the child later A toddler may refuse to eat something when a previous food did not taste good. This type of reasoning is called transductive reasoning. In such situations the nurse should accept the response and offer the refused food at a later time. It is not necessary to inform the pediatrician at this stage. The nurse should never force-feed a child. Telling a toddler that a banana is different from pasta will not necessarily be helpful, because this sort of reasoning may not be understood by the child.

Which statement by the nurse is appropriate regarding the child throwing a tantrum after having a toy taken away that is usually given when the parent is away?

Give the toy to the child to minimize loneliness A favorite toy or blanket can provide security to a child when separated from the parents and dealing with new stress or fatigue. Such objects are called transitional objects. Toddlers get attached to such objects and often refuse to give them to someone else. This kind of behavior is normal and should not be discouraged. Therefore the parent should be allowed to give the toy to the child. The nurse would not give false information to the parent that the toy does not provide any security to the child and should not discourage the parent from giving toys. Attachment to toys is normal and does not indicate a psychologic problem.

Which information about early childhood caries is appropriate for parents?

Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome Sweet liquids, or the sugars in milk and even breast milk, pooling in a toddler's mouth during sleep increase the incidence of early childhood caries. Changes in the positioning of the teeth may result from pacifier use or thumb sucking and are not related to bottle-mouth caries. Frequent breastfeeding before sleep can cause bottle-mouth caries, because breast milk does contain lactose, which is present in higher concentrations than in cow's milk-based formula. Juice, which contains varying concentrations of sugar in bottles, contributes to bottle-mouth caries when a child is allowed to have a bottle of it before sleep.

Which activity documented by the nurse describes the fine motor skills of a 2-year-old child?

Imitates drawing a vertical line Fine motor skills can be demonstrated in a 2-year-old child by the child's adeptness to imitate drawing a vertical line or a circular stroke. When a child is 18 months old, the child is able to throw a ball without losing balance. By the end of the toddler period, that is, by the end of 3 years of life, the child is able to copy a circle and mimic a cross. A 15-month-old child is able to drop a pellet into a narrow-necked bottle.

Which behavior is appropriate when describing a toddler's eating habits of eating a lot then nothing at all the next day or refusing a favorite food?

Influenced by the psychologic components of food At the age of 18 months, toddlers show signs of decreased appetite by being fussy eaters or having strong taste preferences. These children are influenced by the psychologic components of the food instead of taste. They are more interested in the pleasure of eating or the social aspect of mealtime. This phenomenon is called physiologic anorexia. The child may become unpredictable during mealtimes, but it does not mean that the child generally becomes unpredictable after 20 months. A consistent mealtime contributes to the child's need for ritualism and helps to reduce undesirable behavior at mealtimes.

Which nutrient's absorption is increased by vitamin C?

Iron Vitamin C increases the absorption of iron. Vitamin C does not increase the absorption of calcium, magnesium, or phosphorus.

Which gross motor skill is developmentally appropriate for a toddler who is 18 months of age?

Jumps in place with both feet At 18 months of age toddlers are expected to jump in place with both feet. Creeping up stairs occurs at 15 months of age. At 30 months of age most toddlers can stand on one foot momentarily. Kicking the ball forward without overbalancing is developmentally appropriate at 24 months of age.

Which developmental delay is present in the 18-month-old child that can say 4 to 6 words, build a tower of 4 cubes, and throws occasional temper tantrums?

Language An 18-month-old child should be able to say 10 or more words. Therefore this child's language development is delayed. The ability to build a tower of four cubes is normal for the child's age and indicates normal fine motor skill development. Pulling a toy shows normal gross motor development for this age. Temper tantrums and showing signs of ownership by saying "my toy" are normal indications of socialization development at 18 months.

Which behavior as described by Erikson is exhibited in a toddler who always replies "No!" to the mother's requests?

Negativism In negativism, a common stage of toddler development, the child makes attempts at self-expression with consistently negative responses to requests. Ritualism is the need to maintain sameness and reliability, which provides the infant with a sense of comfort. In the development of the superego, the toddler incorporates the morals of society and begins the process of acculturation. Development of the ego is thought to be the beginning of reason or common sense.

Which condition is the 3-year-old at risk for when offered food as a reward?

Obesity If food is offered as reward, the child may overeat for nonnutritive reasons. Therefore the child may be at risk for obesity. Caries is caused by frequent nocturnal breastfeeding or coating pacifiers in honey. Iron-deficiency anemia may occur if the child does not consume enough iron-enriched foods. Rickets is caused by vitamin D deficiency.

Which type of play is characteristic of the toddler?

Parallel Children progress from solitary play during infancy to parallel play during toddlerhood. Tactile play is exploratory play in which the toddler uses water toys, finger paints, or other manipulative objects to play. Cooperative play is not characteristic of a toddler's play.

Which condition describes when toddlers manifest a decreased nutritional need and a diminished appetite?

Physiologic anorexia In physiologic anorexia, a normal phenomenon that occurs around 18 months of age, the toddler manifests a decreased nutritional need and diminished appetite. In ritualism, the toddler prefers to have the same food, cup, or spoon with every meal. In regression, the toddler retreats from the current level of function to a past level of behavior. Grazing is an eating pattern of nibbling or snacking throughout the day.

Which characteristics of physical development are appropriate in a 30-month-old child? Select all that apply.

Primary dentition is complete. Sphincter control has been achieved Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. The anterior fontanel closes between 12 and 18 months of age. Birth weight should have doubled at 5 to 6 months of age and quadrupled by 2½ years of age. Genital fondling is not a characteristic of physical development in this age group; this is part of the development of gender identity.

Which term is appropriate when describing the phenomenon at work when a toddler separates from the mother and begins to make sense of experiences in the environment but is then drawn back to the mother for assistance in verbally articulating the meaning of these experiences?

Rapprochement Rapprochement is defined as the phenomenon of a toddler's separation from the mother and beginning to make sense of experiences in the environment, followed by a drawing back to the mother for assistance in verbally articulating the meaning of these experiences. Gender identity is defined as a sense of maleness or femaleness. Transitional objects, such as a favorite blanket or toy, provide security for children, especially when children are separated from their parents, dealing with a new stress, or just fatigued. Mental symbolization is associated with prelogical reasoning, in which painful experiences take on new significance because memory is associated with the specific event.

Which activity is appropriate to improve the language skill of the child?

Reading books together Reading books together with the child enables language development. Computer games do not respond to children's ideas even though children love playing them; therefore children should be restricted from playing them. Television also does not interact or respond to the child. Moreover, the American Academy of Pediatrics suggests that children under the age of 2 years should not be allowed to watch television.

Which developmental tasks would a 24-month-old child be able do? Select all that apply.

Refer to self by name Dress self in simple clothing A 24-month-old child will be able to refer to self by name and would say the first name when asked. The child would also be able to dress in simple clothing. A 30-month-old child would be able to name many colors, give the first and last name, and refer to self by the appropriate pronoun. The 30-month-old would also be able to recognize gender differences and as well as one's own gender.

Which behavior is appropriate when describing a preschool-age child that after having a sibling born is using baby talk and wants a bottle?

Regression The child uses regression to reduce the stress that the child feels after the birth of the new infant. Regression is a retreat from a present pattern of functioning to past levels of behavior. It usually occurs in instances of stress, when one attempts to cope by reverting to patterns of behavior that were successful in earlier stages of development. The child is not neglected by the parents; instead the attention that the new infant receives may be considered by the older child as threatening. The child is not trying to accept the baby; instead the child is manifesting jealousy towards the baby. The child does not resent the baby, but does not like the new changes that are caused by the arrival of the infant.

Which behavior is appropriate when describing the child that will "only eat crackers, cheese, and turkey?"

Ritualism Ritualism is common in toddlers, who often go on food jags during which they insist on having the same foods, same dish, same cup, or same spoon. In regression there is a retreat from one's current pattern of function to a past level of behavior; it has nothing to do with a toddler's food patterns. Negativism is the toddler's answer of no to every request; it is not associated with only eating certain foods. Eating only crackers, cheese, and turkey is not abnormal behavior for a toddler.

Which nursing response is appropriate when asked why toddlers throw tantrums?

Tantrums result from a toddler's strong drive for mastery and autonomy." Tantrums occur during toddlerhood because of a toddler's strong drive for mastery and autonomy, but inability to achieve these things due to a lack of motor or cognitive skills and frustration with adult figures. Although sleep deprivation and hunger can make tantrums more likely to occur, they do not explain to the parent the underlying cause of tantrums in toddlers. Rather than stating that tantrums are the result of poor parenting and inadequate discipline, the nurse should give a more appropriate and therapeutic explanation that includes the need for parental consistency and appropriate expectations.

Which nursing advice is appropriate regarding children that touch their genitalia in public?

Teach that genital stimulation in private is acceptable but not in public Activities of a toddler should be dealt with carefully because reactions of parents influence the attitudes of children and can affect their psychosocial development. It is a normal phenomenon for toddlers to stimulate their genital organs, but they should be taught that such activities are not accepted in public places and should be done in private. At this stage parents need not consult a psychologist or psychiatrist for a health checkup of the toddler. However, it is also inappropriate to ignore such behavior.

Which explanation is appropriate for the toddler's attachment to a favorite blanket?

The blanket is an important transitional object. The blanket is an important transitional object that provides security when the child is separated from the parents. Transitional objects are important in helping toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress, such as during hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

Which information would the nurse give to parents of toddlers about the regular use of fluoridated water or beverages that contain fluoride?

These drinks can cause stains or pits in the teeth. Parents should be cautioned that regular use of fluoridated water or beverages such as bottled water containing fluoride can result in staining or pitting of the child's teeth. Fluoridated water is not toxic to children. Regular use of fluoridated water is not recommended for toddlers. Supplementation based on fluoride concentration of water supply less than 0.3 ppm (parts per million) is 0.25 mg for a child 6 months to 3 years of age and 0.5 mg for a child 3 to 6 years of age, according to the American Academy of Pediatric Dentistry.

Which description characterizes toddlers' eating behavior?

They are fussy eaters Toddlers have physiologic anorexia, which contributes to picky, fussy eating (not an increased appetite). This usually begins around 18 months of age. Children also have strong taste preferences at this age. Use of finger foods contributes to the unpredictable table manners of toddlers.

What major task characterizes toddlerhood?

Toilet training Toilet training is one of the major tasks of toddlerhood. Establishing an identity is a task of adolescence. Toddlers have an inability to conserve objects, so the ability to conserve objects is not a major task of toddlerhood. Imaginative and dramatic play is more a task of preschoolers rather than of toddlers.

Which nursing advice is appropriate for the parents of a toddler with sleep problems?

Use a transitional object at bedtime Transitional objects may help ease the toddler's anxiety and facilitate sleep. A consistent set of bedtime rituals will facilitate a toddler's sleep. Toddlers should engage in stimulating physical activity during the day to help them sleep at night. Toddlers do not understand verbal explanations, so parents cannot explain away their fears.

Which recommendation is appropriate to provide to the parents of toddlers about car restraints?

Use car restraints even for short trips Car restraints should be used even for a short trip to provide safety to the toddler. Adding an extra head cushion for comfort should be avoided, because this creates spaces between the child and the restraint, and decreases support to the head. Encouraging the toddler to hold a favorite toy will help the toddler to play quietly. Adding any padding between the child and the restraint strap should be discouraged, because it will create space between the child and the restraint. This will result in decreased support to the back of the toddler.