Child health Module 3. 1

When does the child develop handedness, scribble and undress partially and what kind of motor milestone is it?

Fine motor function 24 mo (2 y/o)

When does walking independently and what kind of motor milestone is it?

Gross motor function 12-15 months

When does the child walk up stairs with assistance and what kind of motor milestone is it?

Gross motor function 18 mo.

When does the child walk up steps alone, run and kick balls and what kind of motor milestone is it?

Gross motor function 24 mo. (2 y/o)

A mom has bought her toddler who is having trouble sleeping a new big kid race car bed (for >8 y/o), what advice would you giver her as a nurse?

Having a ritual can help her toddler sleep and if he wakes up encourage him to go to bed. Toddler should get 12 hr of sleep with 1-2 naps. Adding guards to the bed should be done.

At a well child check for toddlers, what data do you collect and for how long?

Head circumference until the kid is two years old. Recumbent length plotted until 3 Upright height 2-18 y/o BMI measured starts at 2 y/o until 18 y/o

A father brings his son in (18 mo), concerned because his BMI is on the higher side of of the normal range. How would you advise him to care for his son? What is his primary source of nutrients?

His primary source of nutrients should be solid finger food that can also be eaten with a spoon. Foods high in calcium (milk) and iron (leafy greens) should be given. Fats should be not restricted for children less then 2. First serving should be 1/4 of adults and variety should be given to avoid food jags. Never do the clean plate rule.

What physiologic change allows for sphincter control in the toddler years, and smoother movement?

Mylelination of CNS nerves.

When should a parent potty train their child? How and why at that time?

Potty training can start between 18 and 28 mo. when sphincter control develops, but nighttime control will come one year after daytime control. Also start when they walk well and show interest in the toilet, as well as being able to pull their pants down. When training: -All efforts should be praised and accidents should not be punished. -Don't leave them on the toilet. -If resistance faced- try a few weeks later.

A mom in a short grocery line asks you how to care for toddler. What guidance would you give her? (I.e what guidance would you give her)

Provide rituals to control behavior by predictability and they will sleep better at night. Always give them comfort objects (keeps them calm). Redirect them to something else if they are have behaviors. Give them choices on matters, but not doing something is not an option. Provide them with a quite place to be, also be sure to show them affection to assist with emotional development. Limit television.

As a nurse, what advice would you give the parent who has had very poor luck with getting time-outs to work?

Put them in area where you can see them, but don't pay them any attention. The time out should as be as long as their age. Don't give them attention even if crying, you don't want to endorse poor behavior.

What should be considered when doing a physical assessment on a toddler?

Take into account their developmental stage by giving them options and not feeding into tantrums. Have parents close by due to fear of being separated and talk to parent before child in order not to intimidate. Let me play with equipment so their fear of being hurt and mutilated is put at ease. DO EXAMINATION LEAST TO MOST INVASIVE. When treating use tools that will open up communication such as dolls, toys. Try to examine on parents lap too.

A mom complains that her daughter ignores her calls and only responds when she talks straight in front of her. What is happening?

The child has a hearing impairment that is not bad enough that she is not developing language skills but she is not reacting to noise/conversation.

When are all primary teeth in?

30 mo.

What is the legal limits for lead and what are the symptoms? What is the consequence of prolonged lead levels?

5 mcg/dl Sxs: fatigue, vomiting, loss of appetite, developmental delay. Consequence: learning delays, reading difficulties, inability to concentrate, ADD, behavior problems, violent acts, permanent brain damage.

How many words should a 2 y/o be able to speak?

50 words.

What are safety tips for parents of toddlers?

-smoke, radon, carbon monoxide alarms -Hot water: 100-120 F -water safety -Lock up medications -Correct use of car seat for toddler, follow manufacturer guidelines. -child proof house (Rx) -Pet and gun safety

What is the rough language development of a todler?

1-2 words by 1 y/o By 15 mo. can jabber and repeat phrases-they are putting sources together 15 - 18 mo. They begin to point at objects and name them 24 mo. 2 word phrases 3 y/o 3-5 words sentences--> say name, sex or gender, use of pronouns and phrases

12-month-old child weighing 11 lb has an order for gentamycin sulfate 13 mg IM q 36 hour. The pharmacy has 20 mg/2 mL on hand. How may milliliters would the infant receive, and what is the best site for the injection? 0.13 mg; vastus lateralis 1.3 mL; vastus lateralis 0.13 mg; ventrogluteal 1.3 mL; deltoid

1.3 mL; vastus lateralis

While evaluating the development of a 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which developmental phenomena has this: A. Object permanence B. Hand regard C. Binocular vision D. Depth perception

A. Object permanence

According to Piaget, one basic concept that a child will learn during the first year is that: A. he is separate from his parents. B. he cannot be fooled by changing shapes. C. his parents are not perfect. D. most procedures can be reversed.

A. he is separate from his parents.

When caring for a child with a cognitive impairment, what is a primary factor for the nurse to consider regarding the approach for interaction with the child? A.The developmental stage is based on developmental tasks achieved. B. The developmental stage is based on the chronological age. C. The developmental stage is based on the gestational age. D. The developmental stage is based on the parent's report of level of functioning.

A.The developmental stage is based on developmental tasks achieved.

A mother comes into the clinic and explains that her son is eating less now that he is 2 years old. What explanation do you tell her?

As the children grow older, their growth continue but not as rapidly, therefore they don't need as many calories/as much food.

What are the two correct developmental stages? A. Preoperational and Autonomy vs shame and doubt B. Autonomy vs Shame and Doubt and sensorimotor C. Preoperational and Trust vs Mistrust D. Operational and Initiative vs Guilt

B. Autonomy vs Shame and Doubt and sensorimotor Erikson stages is same as infancy but Piaget changes.

When does the child feed themself with finger foods/hold spoon and what kind of motor milestone is it?

Fine motor function 12-15 mo.

The mother of a toddler observes the child play next to another child but not with the child. What should the nurse explain to the mother about this type of play behavior? A. This is peer play and is abnormal. B. This is parallel play and is expected. C. This is premature play and should be stopped. D. This is adjacent play and is only seen in school-age children.

B. This is parallel play and is expected.

The mother of a 6-month-old infant asks the nurse at a community health center what she should do about her baby, who always wants to put everything in his mouth. What would be an appropriate response by the nurse, based on Freud's theory? A. "There must be something wrong...your baby should not be doing that." B. "I don't know if that is normal or not, but I will check on it." C. "Babies at this age explore and enjoy their world with their mouths." D. "This usually does not happen until babies are 2 years old."

C. "Babies at this age explore and enjoy their world with their mouths."

When does the child stack 4 cubes, remove shoes and socks and what kind of motor milestone is it?

Fine motor function 18 mo.

The nurse enters her client's room and finds the infant on a pillow with a bottle propped up while the mother is dressing. What statement should the nurse make? A. "Look how cute she is." B. "Are you almost ready to be discharged?" C. "You should always hold your baby for feedings instead of propping the bottles." D. "Is she almost done feeding?"

C. "You should always hold your baby for feedings instead of propping the bottles."

A mother comes in very upset because her son keeps throwing tantrums? How do you explain to her what is happening?

Toddlers have now developed to be able to recognize themselves from their parents, going through the independence vs dependence stage. This time they are also self-egocentrism (seeing everything from their point of view) and are now willing to partake in a power struggle (which the parent should never endorse). Partake in negativism (always say no). Despite all this development the toddler does not know how to regulate their emotions, especially when tired or hungry.

A parent is concerned that their child is not playing with other kids and is playing right next to them. Often they are doing similar activities. How do you explain this crucial part of their development?

Toddlers often participate in this type of play since they are more receptive to social environment, they like to watch others. Watching and observing is often used as their way to learn.

A mother tells you, the nurse, she brought her child to the ophthalmologist thinking that something was wrong that her 2 y/o who didn't have 20/20 vision. As a nurse, how can you educate her?

Toddlers' vision is normally 20/50 but you should be worried if the child is excessively rubbing their eyes, squinting, and continues to hold objects close to face as if they have infant vision.