Ch 30 Nursing Care of a Family with a Toddler

A mother states that her 2-year-old daughter has difficulty falling asleep at night. Upon further assessment, the nurse learns that the toddler takes a 1-hour nap during the late afternoon. Which should the nurse recommend to the mother?

Omit or shorten the nap during the afternoon If a child has difficulty falling asleep at night, it may be time to omit or shorten an afternoon nap. Adding a second nap is recommended for toddlers who are short-tempered and tired at dinnertime. Integrating the nap into the lunchtime routine is a recommendation to encourage the toddler to take a nap, which is not needed in this case. Taking a quick nap in the evening is too close to bedtime.

Parents are beginning potty training their 2-year-old child and seek advice from the nurse on how to be successful in this endeavor. Which statement by the parents indicates that further teaching is needed?

"He wants to accompany me to the bathroom but I prefer to go alone." Allowing a toddler to observe a parent or older sibling going to the bathroom serves as a positive role model and helps the child understand what they are to do when they are there.

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition?

"I give my daughter juice at breakfast and when she is thirsty during the day." High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new.

A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily but is thinking of weaning him soon. How should the nurse respond to this mother?

"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant that this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them.

The parents of a toddler express some frustration because they are having a hard time getting their child to take a nap, even though the child is acting tired and cranky. Which suggestion for the parents to try is most appropriate when working with toddlers?

"It's naptime, do you want to sleep with your stuffed bear or with your sock monkey?" Toddlers resist naptime as part of their developing negativism. The parent can state simply, "It's naptime now," and then give a secondary choice: "Do you want to sleep with your teddy bear or your rag doll?" The nurse should caution parents when they say, "We'll do this after naptime," that they wait until then to do it. Otherwise, a child may be reluctant to nap the next day for fear of missing another activity. Saying, "If you take your nap, I will see if your friend can come play after your nap" is another example of this, especially if the other child is not available to come play. Punishment for not napping will lead to more negativity in the child.

A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate?

"You'll probably notice that your daughter is uncomfortable in wet diapers." The markers of readiness for toilet training are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. Although the rectal and urethral sphincters are mature by the end of the first year, children are not cognitively and socially ready. In fact, many children do not understand what is being asked of them until they are 2 or even 3 years old.

While observing a 13-month-old and her parents in the playroom of the hospital unit, the nurse notes that the toddler is using her index finger to point towards a toy. What should the nurse say to the parents?

"Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." At 12 to 15 months of age the toddler should be feeding herself finger foods and using her index finger to point to objects. Turning the pages of books would not be expected until the age of 18 months.

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene?

3-year-old preschool-aged child who goes up stairs on hands and knees At 3 years of age, a child should be able to climb the stairs one step up at a time or using alternating feet. If the child can only go up on hands and knees, further evaluation is needed. At 9 months of age, an infant can pull oneself up to a standing position and sometimes is able to cruise around furniture or even walk. Toddlers begin to walk between 9 and 18 months of age. Toddler at 24 months of age engage in parallel play rather than cooperative play.

The nurse is promoting language and cognitive development to the parents of a 3-year-old boy. Which guidance about reading with their child will be most helpful?

Ask the child questions as you read. Engage the child by asking him questions as he listens. This gives him a chance to contribute to the story. The child does not have to sit still. He may want to move around or even act out part of the story. Story time should happen regularly and not be just a reward. Even if the child can tell the story, he may wish to hear it read again because he enjoys the repetition and familiarity.

The nurse is conducting an assessment on a 1-year-old healthy child and commends the parents for maintaining routine visits. When questioned by the parents as to the recommended schedule for future visits, which schedule should the nurse recommend?

At 15 months and at least annually thereafter The child who has been seen routinely up to 1 year old should be seen next at 15 months for immunization boosters and at least annually thereafter. If the child has not maintained the routine schedule for immunizations and other assessments, then the schedule will depend on which immunization boosters and/or assessments are deemed appropriate.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?

Explain that children can take their first steps as late as 18 months of age. Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

The nurse is giving a presentation to a parent's group about child safety and poison prevention. The nurse understands that the primary risk factor for toddler poisoning includes which of the following?

Gaining motor skills The fact that the toddler is gaining gross and fine motor skills allows him to explore his world, which includes poisonous materials that have not been secured. Testing boundaries and asserting independence may be marginally involved, but curiosity and the ability to get around are the primary factors. Having an oral fascination with putting everything in the mouth is an infant behavior.

A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg ) and grown 2.5 in (6.25 cm) since his last visit a year ago. How should the nurse respond to this mother's concerns?

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Normally, a toddler's growth is 5 to 10 pounds per year and about 3 inches in height. This child falls within the recommended parameters of growth and the mother has nothing to be worried about.

A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply.

Milk is still important to incorporate in the diet for bone health. Active, "busy" toddlers may need up to 1,400 cal/day. Try to limit the fat intake to less than 35% of total calories. Active children in this age group may need up to 1,400 kcal daily. Children over 2 years old should have a total fat intake between 30% and 35% of calories, with most fat coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils, the same as adults. Adequate calcium and phosphorus intake is important for bone mineralization. Milk should be whole milk until age 2 years, after which 2% milk can be introduced. Trans fats should be kept to a minimum. Diets high in sugar (like cookies) should be avoided to help prevent toddler obesity.

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. What would the nurse correctly include in this description?

Myelinization of the brain and spinal cord is complete at about 24 months. Myelinization of the brain and spinal cord continues to progress and is complete around 24 months of age. Alveoli reach adult numbers usually around the age of 7. Urine output in a toddler typically averages 1 ml/kg/hour. Abdominal musculature in a toddler is weak, resulting in a pot-bellied appearance.

The nurse is recommending food items for an 18-month-old girl. Which ones will benefit the child's neurologic system most?

Peanut butter on crackers, cheese, and whole milk At 18 months, the child's neurologic system is still developing rapidly and needs dietary fat for myelinization. Peanut butter on crackers, cheese, and whole milk all provide this. The other foods are appropriate for the toddler as part of a balanced diet.

The nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. The nurse determines the session is successful when the group correctly chooses which example as best displaying toddlers playing?

Playing independently and are side by side Parallel play occurs when the toddler plays alongside other children but not with them. During cooperative play children play in an organized group with each other, as in team sports. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader—and each child does what she or he wishes. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity.

The mother of a 3-year-old is considering the following purchases as a birthday present. Which toy would the nurse suggest as the most age appropriate choice?

Pounding bench The 3-year-old child should have a tricycle, large sturdy toys such as big blocks, active toys like a pounding bench, and musical toys that encourage rhythmic movement. The preschooler also likes show-and-tell, guessing games (because his or her memory is improving), and big-pieced jigsaw puzzles. For the 4-year-old, construction toys, jigsaw puzzles, memory games, and fantasy play are favorites.

Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching?

Reasoned with the child to stop the behavior The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly?

Telling the child firmly that we don't scream in the office Telling the child firmly that we don't scream in the office gets the point across to the child that his behavior is unacceptable while role modeling appropriate communication. Telling the child to stop tearing up magazines does not give him direction for appropriate behavior. Asking the child if he would quit throwing toys gives him an opportunity to say "no," and is the same as asking "OK?" at the end of a direction.

During a routine health visit with the parents of a 2-year-old child, the parents share some changes they have noticed in their child the past few months that are of concern. This family is struggling to remodel their grandparents' older home. The nurse suspects lead poisoning when they hear the parents mention which symptoms? Select all that apply.

The child cries and starts rubbing the abdomen like it "hurts" sometimes. The child seems to be irritable more frequently. The child seems to sleep and nap more throughout the day than usual. Many older houses painted before the 1970s are still coated with lead-based paint. Beginning symptoms of lead poisoning include irritability, headache, fatigue, and abdominal pain. Frequent vomiting is not associated with lead poisoning. Pulling on ears is usually a child's way of letting parents know he or she has an ear infection.

A nurse is working with a preceptor in a well-baby clinic that deals with children aged birth to 12 years old. During the routine physical assessment of a 2-year-old, the nurse identifies which finding as being abnormal for this age group?

blood pressure of 116/80 mm Hg Normal assessment findings of toddlers include: respirations slow slightly but continue to be mainly abdominal; heart rate slows from 110 to 90 beats/min; blood pressure increases to about 99/64 mm Hg; and not potty trained until complete myelination of the spinal cord has occurred. The only abnormal finding is an elevated blood pressure. However, this can occur if the toddler is crying or upset about the assessment.

The nurse in a pediatric clinic is observing a 2-year-old playing in the waiting room. Which action is an example of normal growth and development for a 2-year-old (24-month old) at play?

imitating adult action like wrapping a doll in a blanket By age 2 years, when toddlers begin to spend time imitating adult actions in their play such as wrapping a doll and putting it to bed or "driving the car," they begin to use fewer toys than before. At 15 months of age, children are still in a put-in, take-out stage, so they continue to enjoy stacks of boxes that fit inside each other. They enjoy throwing toys out of a playpen or from a high chair tray as long as someone will pick them up and return them again and again. An infant will sit and softly stroke a stuffed cat.

Parents are asking a pediatric nurse how to deal with separation anxiety every time they try to have an adult night out. Which advice by the nurse sounds like the most appropriate way to handle this situation?

"Inform the child that you are going out but the regular babysitter will care for them and put them to bed." Most toddlers react best to separation if a regular babysitter is employed or if the day care center has consistent caregivers. It helps if toddlers have fair warning they will have a babysitter. No matter how well prepared toddlers are, they may cry when the babysitter actually appears or may greet the babysitter warmly only to cry when the parents reach for their coats. It helps if parents say good-bye firmly, repeat the explanation they will be there when the child wakes in the morning, and then leave. Prolonged good-byes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen a child's fear of abandonment and so should be discouraged.

A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply.

Consistency in the rules is important so the child understands what is expected. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Even at this young age, children need boundaries. Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries—it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.

During a wellness care visit, the parents of a 2-year-old toddler report that they are struggling to deal with their toddler's daily and increasing number of tantrums. What information should be provided to the parents? Select all that apply.

Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Tantrums are a common occurrence for a toddler of this age. Temper tantrums can be a frequent occurrence in toddlerhood. Some toddlers are more prone to displaying these behaviors than others. For the toddler who experiences frequent tantrum outbursts, maintaining a consistent schedule for activities is helpful. Tantrum-prone toddlers benefit from consistent nap, meal and play periods. Ignoring the behavior signals to the toddler that the behavior is futile. Avoiding interaction with the toddler having the tantrum is beneficial. Discipline such as spanking, swatting or yelling at the toddler does not reduce the episode and may escalate it.

The pediatric nurse is presenting basic safety tips at a local health fair for families. The nurse should point out the majority of hospital visits for toddlers can be prevented by exercising which precaution?

Safely store all chemical substances Poisoning is still the most common medical emergency in children with the highest incidence between the ages of 1 to 4 years. Even with precautionary labeling and "child-resistant" packaging of medication and household cleaners, children display amazing ingenuity in opening bottles and packages that catch their curiosity. Medications such as acetaminophen, salicylates (aspirin), laxatives, sedatives, tranquilizers, analgesics, antihistamines, cold medicines, and birth-control pills are commonly associated with poisoning and also need to properly stored out of reach of the toddler. The proper use of car seats, preventing access to electrical outlets, and bath time supervision are also noted to be the cause of medical emergencies. However, poisoning remains the number one reason.

The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development?

The child does not use the names of familiar objects. By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist. Repeating words heard or phrases out of context (echolalia) is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age.

In discussing their 2-year-old's behavior with the nurse, which of the parents' statements suggests the child may be ready for toilet teaching?

The child hides behind her bedroom door when defecating. Hiding while defecating indicates awareness of this need. Repeating words promotes language development but doesn't indicate readiness for toilet teaching. Walking with a wide, swaying gait is early walking behavior. Steady walking and running signals toileting readiness. Removal of shoes and socks is easily done. Greater fine motor clothing removal skill is needed for toileting.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior?

The need for separation and control Emotional development in the toddler years is focused on separation and individuation. The focus in infancy is on love and belonging, and the need for peer approval occurs in the adolescent. Safety and security are concerns in all levels of development, but not the primary focus.

The nurse is watching toddlers at play. Which normal behavior would the nurse observe?

Toddlers engage in parallel play. Toddlers typically play alongside another child (parallel play) rather than cooperatively. Infants engage in solitary play.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia. The child's condition has improved, and the child is much more active and eager to play. Which toy should the nurse offer the child?

large piece puzzle An appropriate toy for a 3-year-old child is a large piece puzzle. Board games are more appropriate for preschool and school-aged children; fabric books and squeaky toys are more appropriate for older infants and younger toddlers (10 to 18 month of age).

The parent of a 20-month-old toddler reports the toddler has been becoming distraught when the parent leaves. The parent asks the nurse for advice about what is going on and how to best manage it. What information can be provided? Select all that apply.

"Establishing a routine for saying goodbye to your toddler will be helpful." "This is a normal happening for a toddler of this age." "As your toddler begins to learn that you will return the toddler will become less upset." Separation anxiety occurs initially in infancy and then reoccurs again during the toddler stage. Separation anxiety for the toddler is normal. As the toddler begins to develop an understanding of object constancy, separation anxiety will ease. The toddler, while missing the parent, will begin to recognize that the parent will return. Establishing a routine for saying goodbye is helpful for the toddler. There is no indication that the care providers are problematic.

The nurse is caring for a toddler in the pediatric unit and notes the child is responding according to expected developmental stages. Which characteristic will the nurse predict this toddler to exhibit while in the hospital?

Insists on doing a new skill and then asking for help The toddler insists he or she can do things one minute and then becomes dependent the next minute. The preschool-age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours. The infant grows and develops skills more rapidly than he or she ever will again.

Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply.

orange slices cheese slices yogurt Toddlers often need between-meal snacks. To help prevent dental caries from frequent snacking, encourage parents to offer fruit (e.g., bananas, pieces of apple, orange slices) or protein foods (e.g., cheese, pieces of chicken) for snacks rather than high-carbohydrate items such as cookies and candy bars to limit exposure of the child's teeth to carbohydrates. Calcium (found in large amounts in milk, cheese, and yogurt) is especially important for the development of strong teeth.

After teaching the mother of a 13-month boy old about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states:

"It might be best to give him a bath in the evening." The young child's increased activity level necessitates bathing daily or every other day. A good time to bathe the child is after eating, either after breakfast or in the evening. Hair is washed two to three times per week with a mild shampoo. Bubble baths should be avoided, to prevent urethral irritation and possible development of cystitis. Some children may have fears associated with bathing such as being afraid of being sucked down the plug hole. In this case, do not drain the tub until the child is out of the room.

The nurse is reviewing sleep and rest activities of a 16-month-old child with the parents. The father states, "I have told my wife it is unhealthy for our child to sleep with us. It's time for him to sleep in his own bed. What do you think?" What is the nurse's best initial response?

"It must be difficult for the two of you to both feel strongly about what is best for you and your child." Acknowledging the difference of opinion between the mother and father allows for open conversation about the sleeping arrangement, which may lead to an acceptable resolution. Stating the views of professionals about co-sleeping, while accurate, does not address the parent's voiced concerns, nor does noting the sleep activities in the chart. Suggesting the child sleep in his own bed is not up to the nurse to do, and it does not address the issue.

During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" What would be appropriate for the nurse to suggest? Select all that apply.

"Limit the number of questions you ask of her." "Make a statement instead of asking a question." "Offer her two options from which to choose" A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. In addition, using statements instead of asking questions and giving the child a choice of two options are effective. Using time-out is a discipline measure and would be inappropriate to counteract a toddler's negativism. Offering a choice rather than a bribe such as ice cream is more effective and long-lasting for modifying the child's behavior.

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old toddler's caregiver indicates that the toddler is developing autonomy?

"My toddler uses the potty chair and is dry all day long." During the toddler years, the toddler separates from his or her parents, recognizes one's own individuality and exerts autonomy. Being toilet trained is an example of the toddler developing autonomy or independence. Having temper tantrums is a normal response of the toddler as it is a way the toddler expresses frustration of being tired or not being able to accomplish a task. Having the parent pick up the child after the child falls is a security and emotional need. All children need this, so it is not indicative of toddlerhood or autonomy. Having the same routine for bedtime each night provides security but it does not demonstrate autonomy.

The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement?

"We will ignore our child while having the tantrum." The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response?

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." The markers of readiness are subtle, but as a rule children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers. Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myelinated to the anal level. A good way for a parent to know a child's development has reached this point is to wait until the child can walk well independently. Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old.

The parents of a 3-year-old who had bone cancer that resulted in amputation of the lower left leg ask their health care provider about expected behaviors for their child. Which behavior is expected and acceptable during hospitalization for treatments?

Crawling may be their preferred mode of travel because they may not want to wait for help to put the prosthesis on. A toddler with a long-term illness or who is physically challenged can be expected to exhibit normal toddler behaviors, such as temper tantrums. A child who uses a lower extremity prosthesis, for example, might prefer to crawl somewhere rather than wait for help to put the prosthesis in place. Toilet training is difficult for a child who is hospitalized at periodic intervals because success usually requires a consistent caregiver; in addition, hospitalization can result in regressive behaviors. If a chronically ill child has difficulty with ambulation, soiling accidents may occur beyond the usual age because of an inability to reach a bathroom easily.

While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following?

Deferred imitation Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time. Toddlers engage in assimilation when they learn to change a situation (or how they perceive it) because they are not able to change their thoughts to fit the situation, such as shaking a toy hammer as if it were a rattle, because they are more familiar with rattles than hammers. All during the toddler period, children play beside children next to them, not with them. This side-by-side play (called parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Autonomy, or independence, is the primary developmental task of the toddler years, according to Erikson. Although this child's act may be a sign of autonomy, it is more specifically an act of deferred imitation.

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. What is a recommended intervention for this age group?

Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. Toddlers should not be blamed for their aggressive behavior; adults can assist the toddler in building empathy by pointing out when someone is hurt and explaining what happened. Adults should allow toddlers to rely upon a security item to self-soothe, as this is a function of autonomy and is viewed as a sign of a nurturing environment rather than one of neglect. Toddlers may question parents about the difference between male and female body parts and may begin to explore their own genitals. This is normal behavior in this age group. Offering limited choices is one way of allowing toddlers some control over their environment and helping them to establish a sense of mastery.

A parent with a 2-year-old invites a friend with a toddler over for a play date when they notice their children are not really interacting while playing. The children are playing side-by-side when one toddler gets up and grabs a toy car out of the hands of the other toddler, which results in both toddlers crying. To prevent this from occurring again, which intervention should the parents make?

Parents should ensure that toys in front of each child are "similar" to prevent fighting over one toy. All during the toddler period, children play beside other children, not with them. This side-by-side play (parallel play) is not unfriendly but is a normal developmental sequence that occurs during the toddler period. Caution parents that if two toddlers are going to play together, they must provide similar toys because an argument over one toy is likely to occur. Avoiding introducing playing with others, time out, or lecturing toddlers about "sharing" concept are inappropriate at this time.

A 2-year-old child is shopping with her mother when she suddenly falls to the ground and begins to scream, "I want it!" over and over regarding a bag of candy. What would the nurse recommend to the mother to deal with this behavior? Select all that apply.

Pick the toddler up and move her to a safe environment but do not give in to her desires. Remain calm and ignore the tantrum. Do not reward the behavior by giving into the toddler's demands and buying the candy. Temper tantrums in toddlers are very common as they try to control their environment and the caregiver's environment. They become frustrated at their inability to do so or to verbalize their desires. If a toddler has a temper tantrum, the best thing for the parent to do is ignore them and protect them from harm. Parents cannot reason with a toddler—they lack the ability to understand or the desire to change their behavior. Never give in to their demands; they will only learn that if you scream loud enough, they get their way. However, spanking is not recommended. The child has just lost control and needs time to regain self-control.

A nurse, who is also a mother of a 2-year-old child, attends a party at a friend's house and notes some safety concerns that she would like to share with the other mother privately. Which observations during the party would be considered a safety concern that should be addressed privately when appropriate? Select all that apply.

The nurse/mother notes that the toddler's car seat is located in the passenger front seat. The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove. Toddlers' motor ability jumps ahead of their judgment. To prevent serious injury, the nurse should teach parents to be alert as to what their toddler is doing at all times (like climbing on a countertop next to a stove). Toddlers have no judgment concerning moving cars so they walk across streets with no regard for oncoming cars. Toddlers need to ride in a car seat with a five-point restraint placed in the back seat (not the front seat) so the child is not struck by the passenger seat airbag. Toddlers need to wear a helmet as soon as they begin riding a tricycle. Because they cannot swim well, parents need to check whether backyard pools—another area prone to unintended injury—are securely fenced.