Chapter 12

The nurse is providing guidance strategies to a group of parents with toddlers at a community outreach program. Which statement by a parent indicates a correct understanding of the teaching?

"I should expect my 24-month-old child to express some signs of readiness for toilet training." A 24-month-old toddler starts to show readiness for toilet training; it is important for the parent to be aware of this and be ready to start the process. At 18 months of age, a child needs consistent but gentle discipline because the child cannot yet understand firmness and structure with discipline. Development of fears and need for security items usually occurs at the end of the 18- to 24-month stage. A 36-month-old child does not yet understand time and proximity of events, so the parent needs to understand that the toddler cannot "hurry up or we will be late."

The nurse understands that which guideline should be followed to determine serving sizes for toddlers?

1 tbsp of solid food per year of age To determine serving sizes for young children, the guideline to follow is 1 tbsp of solid food per year of age. One-half tbsp per year of age would not be adequate. Two or 2 1/2 tbsp per year of age would be excessive.

The nurse is teaching parents about avoiding accidental burns with their toddler. What water heater setting should the nurse recommend to the parents?

120 F The water heater should be set to limit household water temperatures to less than 49° C (120° F). At this temperature, it takes 10 minutes for exposure to the water to cause a full-thickness burn. Conversely, water temperatures of 54° C (130° F), the usual setting of most water heaters, expose household members to the risk of full-thickness burns within 30 seconds.

The nurse is assessing a toddler's visual acuity. Which visual acuity is considered acceptable during the toddler years?

20/40 Visual acuity of 20/40 is considered acceptable during the toddler years.

To avoid a fall from a crib, the nurse recommends to parents that their toddler should sleep in a bed rather than a crib when reaching what height?

35 in When children reach a height of 89 cm (35 in), they should sleep in a bed rather than a crib.

A nurse is observing children playing in the playroom. What describes parallel play?

A child playing with blocks next to a child playing with trucks Parallel play is when a toddler plays alongside, not with, other children. A child playing with blocks next to a child playing with trucks is descriptive of parallel play. The child playing a video game is descriptive of solitary play. Two children playing cards is descriptive of cooperative play. Two children watching a television is descriptive of associative play.

A toddler is in the sensorimotor, tertiary circular reactions stage of cognitive development. What behavior should the nurse expect to assess? (Select all that apply.)

Gestures "up" and "down" Able to insert round object into a hole Can find hidden objects but only in the first location Children in the sensorimotor, tertiary circular reactions stage of cognitive development show the behaviors of gesturing "up" and "down," have the ability to insert round objects into a hole, and can find hidden objects but only in the first location. The behaviors of referring to oneself by pronoun and using future-oriented words such as "tomorrow" are seen in the preoperational stage of cognitive development.

The parent of 16-month-old child asks, "What is the best way to keep my child from getting into our medicines at home?" What should the nurse advise?

All medicines should be locked securely away The major reason for poisoning in the home is improper storage. Toddlers can climb, unlatch cabinets, and obtain access to high-security places. For medications, only a locked cabinet is safe. Toddlers can climb using furniture. High places are not a deterrent to an exploring toddler. Toddlers are not able to generalize that all the different forms of medications in the home may be dangerous. Keeping medicines out of the homes of small children is not feasible because many parents require medications for chronic or acute illnesses. Parents must be taught safe storage for their home and when they visit other homes.

A toddler, age 16 months, falls down a few stairs. He gets up and "scolds" the stairs as if they caused him to fall. What is this an example of?

Animism Animism is the attribution of lifelike qualities to inanimate objects. By scolding the stairs, the toddler is attributing human characteristics to them. Ritualism is the need to maintain sameness and reliability. It provides a sense of comfort to toddlers. Irreversibility is the inability to reverse or undo actions initiated physically. The toddler is acting in an age-appropriate manner.

The nurse is planning care for a hospitalized toddler. What is the rationale for planning to continue the toddler's rituals while hospitalized?

To provide security Ritualism, the need to maintain sameness and reliability, provides a sense of security and comfort. It will not prevent regression or dependency or decrease negativism.

What factor is most important in predisposing toddlers to frequent infections?

Toddlers have short, straight internal ear canals and large lymph tissue. Toddlers continue to have the short, straight internal ear canals of infants. The lymphoid tissue of the tonsils and adenoids continues to be relatively large. These two anatomic conditions combine to predispose toddlers to frequent infections. The abdominal respirations and lowered pulse and respiratory rate of toddlers do not affect their susceptibility to infection. The defense mechanisms are more efficient compared with those of infancy.

The nurse is preparing to administer some iron drops to a toddler. Which factor can increase iron absorption? (Select all that apply.)

Vitamin A Acidity (low pH) Ascorbic acid (vitamin C) Factors that increase iron absorption are vitamin A, acidity (low pH), and ascorbic acid (vitamin C). Phosphates (milk) and malabsorptive disorders decrease absorption of iron.

Which characteristic best describes the gross motor skills of a 24-month-old child?

Walks up and down stairs A 24-month-old child can go up and down stairs alone with two feet on each step. Skipping and broad jumping are skills acquired at age 3 years. Tricycle riding is achieved at age 4 years.

Which statement is correct about toilet training?

Wanting to please the parent helps motivate the child to use the toilet. Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking. The child must be able to recognize the urge to let go and to hold on. The child must want to please the parent by holding on rather than pleasing him- or herself by letting go. Bowel training precedes bladder training. Watching older siblings provides role modeling and facilitates imitation for the toddler. The child should be introduced to the potty chair or toilet in a nonthreatening manner.

pure vegetarians (vegans)

eliminate all foods of animal origin, including milk and eggs

macrobiotics

eliminate all foods of animal origin, including milk and eggs, allowing only a few types of fruits, vegetables, and legumes

lactovegetarians

exclude meat and eggs but drink milk

Lacto ovo vegetarians

exclude meat from their diet but consume dairy products and rarely fish

semi vegetarians

exclude meat from their diet but consume dairy products with some fish and poultry

The parents of a newborn say that their toddler "hates the baby. . . . He suggested that we put him in the trash can so the trash truck could take him away." What is the nurse's best reply?

"That is a normal response to the birth of a sibling. Let's look at ways to deal with this." The arrival of a new infant represents a crisis for even the best prepared toddler. Toddlers have their entire schedules and routines disrupted because of the new family member. The nurse should work with the parents on ways to involve the toddler in the newborn's care and to help focus attention on the toddler. The toddler does not hate the infant. This is an expected, normal response to the changes in routines and attention that affect the toddler. The toddler can be provided with a doll to imitate parents' behaviors. The child can care for the doll's needs at the same time the parent is performing similar care for the newborn.

What do the psychosocial developmental tasks of toddlerhood include?

Ability to delay gratification If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that toddlers are concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

Parents ask the nurse for strategies to help their toddler adjust to a new baby. What should the nurse suggest?

Alert visitors to the new baby to include the toddler in the visit. Parents can minimize sibling rivalry by alerting visitors to the toddler's needs, having small presents on hand for the toddler, and including the child in the visits as much as possible. Time is a vague concept for toddlers. A good time to start talking about the new baby is when the toddler becomes aware of the pregnancy and the changes occurring in the home in anticipation of the new member. To avoid additional stresses when the newborn arrives, parents should perform anticipated changes, such as moving the toddler to a different room or bed, well in advance of the birth. Telling the toddler that a new playmate will come home soon sets up unrealistic expectations.

A parent tells the nurse, "My toddler tries to undo the car seat harness and climb out of the seat." What strategies should the nurse recommend to the parent to encourage the child to stay in the seat? (Select all that apply.)

Allow your child to hold a favorite toy When child tries to unbuckle the seat harness, firmly say "no" It may be necessary to stop the car to reinforce the expected behavior Strategies to encourage a child to stay in a car seat include allowing the child to hold favorite toy, firmly saying "No" if the child begins to undo the harness, and stopping the car to reinforce the expected behavior. Rewards, such as stars or stickers, can be used to encourage cooperative behavior. The child should stay in the car seat at all times, even for short trips.

If the need for basic trust has been satisfied, then toddlers can give up dependence for control, independence, and autonomy. One of the tasks that toddlers are concerned with is the ability to delay gratification. Development of a conscience and recognition of sex differences occur during the preschool years. The ability to get along with age mates develops during the preschool and school-age years.

Autonomy Autonomy versus shame and doubt is the developmental task of toddlers. Trust versus mistrust is the developmental stage of infancy. Initiative versus guilt is the developmental stage of early childhood. Intimacy and solidarity versus isolation is the developmental stage of early adulthood.

What preventive measures should the nurse teach parents of toddlers to prevent early childhood caries? (Select all that apply.)

Avoid using a bottle as a pacifier Eliminate bedtime bottles completely Avoid coating pacifiers in a sweet substance Prevention of dental caries involves eliminating the bedtime bottle completely, feeding the last bottle before bedtime, substituting a bottle of water for milk or juice, not using the bottle as a pacifier, and never coating pacifiers in sweet substances. Juice in bottles, especially commercially available ready-to-use bottles, is discouraged; these beverages are especially damaging because the sugar is more readily converted to acid. Juice should always be offered in a cup to avoid prolonging the bottle-feeding habit. Toddlers should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age, not 18 months.

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. What should the nurse recommend?

Determine whether the water supply is fluoridated The decision about fluoride supplementation cannot be made until it is known whether the water supply contains fluoride and the amount. It is difficult to teach toddlers to spit out mouthwash. Swallowing fluoridated mouthwashes can contribute to fluorosis. Fluoride supplementation is not recommended until after age 6 months and then only if the water is not fluoridated. Fluoridated toothpaste is still indicated if the fluoride content of the water supply is adequate, but very small amounts are used.

The nurse is preparing a staff education program about growth and development of an 18-month-old toddler. Which characteristics should the nurse include in the staff education program? (Select all that apply.)

Eats well with a spoon and cup Runs clumsily and can walk up stairs Points to common objects Builds a tower of three or four blocks Tasks accomplished by an 18-month-old toddler include eating well with a spoon and cup, running clumsily, walking up stairs, pointing to common objects such as shoes, and building a tower with three or four blocks. An 18-month-old toddler has a vocabulary of only 10 words, not 300. Toddlers cannot dress themselves in simple clothing until 24 months of age.

Parents tell the nurse that their toddler eats little at mealtime, only sits at the table with the family briefly, and wants snacks "all the time." What should the nurse recommend?

Give her nutritious snacks. Most toddlers exhibit a physiologic anorexia in response to the decreased nutritional requirements associated with the slower growth rate. Parents should assist the child in developing healthy eating habits. Toddlers are often unable to sit through a meal. Frequent nutritious snacks are a good way to ensure proper nutrition. To help with developing healthy eating habits, food should be not be used as positive or negative reinforcement for behavior. The child may develop habits of overeating or eat non-nutritious foods in response. A toddler is not able to understand explanations of what is expected of her and comply with the expectations.

The nurse is assessing a 20-month-old toddler during a well-child visit and notices tooth decay. The nurse should understand that early childhood caries are caused by what?

Giving the child a bottle of juice or milk at nap time One cause of early childhood caries is allowing the child to go to sleep with a bottle of milk or juice; as the sweet liquid pools in the mouth, the teeth are bathed for several hours in this cariogenic environment. Eating citrus fruit at bedtime and poor fluoride supply in drinking water do not cause early childhood caries. The problem is not hereditary and can be prevented with proper education.

The parents of a 2-year-old child tell the nurse they are concerned because the toddler has started to use "baby talk" since the arrival of their new baby. What should the nurse recommend?

Ignore the baby talk Baby talk is a sign of regression in the toddler. Often toddlers attempt to cope with a stressful situation by reverting to patterns of behavior that were successful in earlier stages of development. It should be ignored while the parents praise the child for developmentally appropriate behaviors. Regression is children's way of expressing stress. The parents should not introduce new expectations and allow the child to master the developmental tasks without criticism.

Parents ask the nurse, "How should we deal with our toddler's regression since our new baby has come home?" The nurse should give the parents which response?

Ignore the behavior and praise appropriate behavior When regression does occur, the best approach is to ignore it while praising existing patterns of appropriate behavior. It is advisable not to introduce new areas of learning when an additional crisis is present or expected, such as beginning toilet training shortly before a sibling is born or during a brief hospitalization. Time-out should not be used as a punishment, and the toddler does not have the cognitive ability to understand an explanation that the behavior is not acceptable.

Parents are switching their toddler, who has met the weight requirement, from a rear-facing car seat to a forward-facing seat. The nurse should recommend the parents place the seat where in the car?

In the middle of the rear seat Children 0 to 3 years of age riding properly restrained in the middle of the backseat have a 43% lower risk of injury than children riding in the outboard (window) seat during a crash.

What is a characteristic of a toddler's language development at age 18 months?

Increasing level of understanding During the second year of life, the understanding and understanding of speech increase to a level far greater than the child's vocabulary. This is also true for bilingual children, who are able to achieve this linguistic milestone in both languages. An 18-month-old child has a vocabulary of approximately 10 words. At this age, the child does not use the one-word sentences that are characteristic of 1-year-old children. The child has a very limited vocabulary of single words that are comprehensible.

What is the leading cause of death during the toddler period?

Injuries Injuries are the most common cause of death in children ages 1 through 4 years. It is the highest rate of death from injuries of any childhood age group except adolescence. Congenital disorders are the second leading cause of death in this age group. Infectious and childhood diseases are less common causes of death in this age group.

What developmental characteristic does not occur until a child reaches age 2 1/2 years?

Primary dentition is complete Usually by age 30 months, the primary dentition of 20 teeth is complete. Birth weight doubles at approximately ages 5 to 6 months. The anterior fontanel closes at ages 12 to 18 months. Binocularity is established by age 15 months.

The nurse is teaching parents of a toddler how to handle temper tantrums. What should the nurse include in the teaching? (Select all that apply.)

Provide realistic expectations Ensure consistency among all caregivers in expectations During tantrums, ignore the behavior and continue to be present The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing what rules are important, and developing consequences that are reasonable for the child's level of development help manage the behavior. During tantrums, ignore the behavior, provided the behavior is not injurious to the child, such as violently banging the head on the floor. Continue to be present to provide a feeling of control and security to the child after the tantrum has subsided. Starting at 18 months, time-outs work well for managing temper tantrums, but not at 12 months.

A parent asks the nurse about negativism in toddlers. What is the most appropriate recommendation?

Reduce the opportunities for a "no" answer The nurse should suggest to the parent that questions should be phrased with realistic choices rather than yes or no answers. This provides a sense of control for the toddler and reduces the opportunity for negativism. Negativism is not an indication of stubbornness or insolence and should not be punished. The negativism is not a function of attention; the child is testing limits to gain an understanding of the world. The toddler is too young to comply with requests not to say "no."

A toddler's parent asks the nurse for suggestions on dealing with temper tantrums. What is the most appropriate recommendation?

Remain close by the child but without eye contact. The best way to deal with temper tantrums is to ignore the behaviors, provided that the actions are not dangerous to the child. Tantrums are common during this age group as the child becomes more independent and overwhelmed by increasingly complex tasks. The parents and caregivers need to have consistent and developmentally appropriate expectations. Punishment and explanations will not be beneficial. The presence of the parent is necessary both for safety and to provide a feeling of control and security to the child when the tantrum is over.

A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is what?

Ritualism, an expected behavior at this age The child is exhibiting the ritualism, which is characteristic at this age. Ritualism is the need to maintain sameness and reliability. It provides a sense of structure and comfort to the toddler. It will dictate certain principles in feeding practices, including rejecting a favorite food because it is served in a different container. This does not indicate the child has unreasonable expectations but rather is part of normal development. Ritualism is not regression, which is a retreat from a present pattern of functioning.

What is the most common type of burn in the toddler age group?

Scald burn from high-temperature tap water Scald burns are the most common type of thermal injury in children, especially 1- and 2-year-old children. Temperature should be reduced on the hot water in the house and hot liquids placed out of the child's reach. Electric burns from electrical outlets and hot object burns from cigarettes or irons are both significant causes of burn injury. The child should be protected by reducing the temperature on the hot water heater in the home, keeping objects such as cigarettes and irons away from children, and placing protective guards over electrical outlets when not in use. Flame burns from matches and lighters represent one of the most fatal types of burns in the toddler age group but not one of the most common types of burn.

Which is an appropriate recommendation in preventing tooth decay in young children?

Substitute sugarless gum for regular gum. Regular gum has high sugar content. When the child chews gum, the sugar is in prolonged contact with the teeth. Sugarless gum is less cariogenic than regular gum. Raisins, honey, and molasses are highly cariogenic and should be avoided. Sweets should be consumed with meals so that the teeth can be cleaned afterward. This decreases the amount of time that the sugar is in contact with the teeth.

What child behavior indicates to the nurse that temper tantrums have become a problem? (Select all that apply.)

Tantrums occur past 5 years of age Tantrums last longer than 15 minutes Tantrums occur more than 5 times a day Temper tantrums are common during the toddler years and essentially represent normal developmental behaviors. However, temper tantrums can be signs of serious problems. Temper tantrums that occur past 5 years of age, last longer than 15 minutes, or occur more than five times a day are considered abnormal and may indicate a serious problem. A popular time for a tantrum is before bedtime.

A 17-month-old child should be expected to be in which stage, according to Piaget?

Tertiary circular reactions A 17-month-old is in the fifth stage of the sensorimotor phase, tertiary circular reactions. The child uses active experimentation to achieve previously unattainable goals. Preoperations is the stage of cognitive development usually present in older toddlers and preschoolers. Concrete operations is the cognitive stage associated with school-age children. The secondary circular reaction stage lasts from about ages 4 to 8 months.

A parent asks the nurse, "When will I know my child is ready for toilet training?" The nurse should include what in the response? (Select all that apply.)

The child should be able to sit, walk, and squat The child should have regular bowel movements The child should express a willingness to please Signs of toilet training readiness include physical and psychological readiness. The ability to sit, walk, and squat and having regular bowel movements are physical readiness signs. Expressing a willingness to please is a sign of psychological readiness. The child should be able to stay dry for 2 hours, not 1.

The nurse is teaching a parent of an 18-month-old about developmental milestones associated with feeding. What should the nurse include in the teaching? (Select all that apply.)

The child will be able to hold a cup with both hands The child will be able to drink from a cup with a lid The child will begin to use a spoon but may turn it before reaching the mouth An 18-month-old child can hold a cup with both hands, is able to drink from a cup with a lid, and begins to use a spoon but may turn it before reaching the mouth. Using a fork is a developmental milestone of a 36-month-old child. Using a straw and cup is a milestone seen at 24 months.

The nurse is teaching parents about toilet training. What should the nurse include in the teaching session?

The physiologic ability to control the sphincters occurs between 18 and 24 months. The physiologic ability to control the sphincters occurs somewhere between ages 18 and 24 months. Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The mastery of skills required for training are not present before 24 months of age. By 14 to 18 months of age, the child is able to retain urine for up to 2 hours or longer.

Parents of an 18-month-old boy tells the nurse that he says "no" to everything and has rapid mood swings. If he is scolded, he shows anger and then immediately wants to be held. What is the nurse's best interpretation of this behavior?

This is normal behavior for his age Toddlers use distinct behaviors in the quest for autonomy. They express their will with continued negativity and use of the word "no." Children at this age also have rapid mood swings. The nurse should reassure the parents that their child is engaged in expected behavior for an 18-month-old.

Although a 14-month-old girl received a shock from an electrical outlet recently, her parent finds her about to place a paper clip in another outlet. Which is the best interpretation of this behavior?

This is typical behavior because of toddlers' inability to transfer remembering to new situations. During the tertiary circular reactions stage, children have only a rudimentary sense of the classification of objects. The appearance of an object denotes its function for these children. The slot of an outlet is for putting things into. This is typical behavior for a toddler, who is only somewhat aware of a causal relation between events. Her cognitive development is appropriate for her age.