PEDIATRICS CH 32: Toddler & Family

Drowning

Drowning deaths in infants occur most commonly in the bathtub & large buckets

TRUE OR FALSE: You may use food as a reward

FALSE; never use food as a reward... give options

What is the best way to handle temper tantrums?

Ignore the behavior as long as it's safe & be consistent *consistency is key (inconsistency reinforces the negative behavior)

Preschool/daycare

Only thing that introduces more colds & infections

Safety: Ages 1-4 have the highest rate of death from

accidental injuries

You want to evaluate for ____ ________ _______ and ______ if child is following a strict vegetarian and macrobiotic diet

iron deficiency anemia and rickets

Due to concern for HTN, cholesterol, obesity, cardiovascular disease, cancer of stomach, intestine & colon & influence of animal rights more individuals are choosing _________ diets

vegetarian

What are signs that you can educate the parents on that show that the child is ready to be toilet trained?

*Retain urine for up to 2 hours or longer *Decreased number of wet diapers (means they're holding it longer) *Regular bowel movements ^these are top three that you're looking for Others include: -Gross motor skills or sitting, walking & squatting -May want to please parents

Factors that increase iron absorption *

-Acidity- Administer iron BETWEEN MEALS -Administer iron with juice, fruit or multivitamin preparation -Give with vitamin C DO NOT GIVE WITH MILK

Aspiration & suffocation

-Balloons -May have difficulty with large pieces of food, can be wedged between a wall & mattress

Dental: Fluoride

-Fluoride supplementation -Topical fluoride treatments performed in dental offices effective in decreasing caries -See dentist regularly

Bodily Injury

-Pull anything heavy & it falls on them -Running with something in their mouth

Safety: Car restraint systems (what kind of car seat should they be in?)

-Rear-facing car seats until 2 years -Latch: Lowers anchors and tethers for children: this system provides uniform anchorage consisting of two lower anchorages and one upper anchorage in the rear seat of a vehicle

Renal system of toddlers (what's different from infancy?)

-Serves to conserve fluid under times of stress -Decreases risk of dehydration -Most of physiologic systems are relatively mature by end of toddlerhood

Toddlers & sleep

-Sleep problems are common (wake frequently at night) -Encourage parents to establish a regular bedtime routine and bedtime routines (bedroom should be used just for sleeping; no tv)

Physical appearance

-have a "pot-bellied" appearance because their less well-developed abdominal musculature and short legs -head circumference and chest circumference equal by 1-2 years of age

The toddler phase lasts from ages

1-3 (12-36 months)

Matt is a healthy 2 1/2-year-old boy whose mother asks the nurse for advice about toilet training. Matt's mother is expecting her second child in 4 months and has no previous experience with toilet training. Matt's mother tells the nurse that she can't afford to buy a potty chair. She explains that they are saving money because they will soon have the added expense of another child. The most appropriate action by the nurse is: A. Suggest ways to toilet train Matt without a potty chair. B. Refer the family to social services for financial assistance. C. Recommend postponing toilet training until they can afford a potty chair. D. Have Matt sit on a regular toilet to assess whether his feet will touch the floor.

A

What should the nurse recommend to help a toddler cope with the birth of a new sibling? Give the toddler a doll on which he or she can imitate parenting. Discourage the toddler from helping with care of new sibling. Prepare the toddler for upcoming changes about 1 to 2 weeks before birth of the sibling. Explain to the toddler that a new playmate will soon come home.

A

When completing the health assessment for a 2-year-old child, the nurse should expect the child to: engage in parallel play. fully dress self with supervision. have a vocabulary of at least 500 words. be one third of the adult height.

A

The parents of a toddler state their child is having trouble sleeping. What is the nurse's BEST suggestion to improve sleep habits? Using a transitional object. Varying the bedtime ritual. Restricting stimulating activities during the day. Explaining away fears.

A A transitional object may help the child ease anxiety and facilitate sleep. A consistent ritual will facilitate sleep. The child should have stimulating physical activity during the daytime. Verbal explanations are not understood by a child this age.

Matt is a healthy 2 1/2-year-old boy whose mother asks the nurse for advice about toilet training. Matt's mother is expecting her second child in 4 months and has no previous experience with toilet training. The nurse should do which of the following first? A. Ask Matt if he wants to learn to use the toilet. B. Discuss signs that indicate Matt is ready to begin toilet training. C. Encourage the mother to initiate toilet training after the birth of the new baby. D. Assess the mother to determine why she has waited so long to begin toilet training.

B

Poisoning in toddlers can best be prevented by: consistently using safety caps. storing poisonous substances in a locked cabinet. keeping ipecac syrup in the home. storing poisonous substances out of reach.

B

The nurse is teaching the parents of a 24-month-old about motor skill development. The nurse should include which statement in the teaching? The toddler walks alone but falls easily. The toddler's activities begin to produce purposeful results. The toddler is able to grasp small objects but cannot release them at will. The toddler's motor skills are fully developed but occur in isolation from the environmen

B

Which statement about early childhood caries (ECC) is correct? The syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. The syndrome can be prevented by breastfeeding. Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

B

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

B Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

A hospitalized toddler clings to a worn, tattered blanket. She screams when anyone tries to take it away. What is the nurse's BEST explanation to the parents for the child's attachment to the blanket? The blanket encourages immature behavior. The blanket is an important transitional object. She has not mastered the developmental task of individuation-separation. She has not bonded adequately with her mother.

B Transitional objects are important to help toddlers separate. The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are helpful when the child is experiencing an increased stress situation such as hospitalization. This does not reflect bonding behavior.

Motor vehicle-related injuries

Because toddlers explore and are unaware of danger and unable to approximate the speed of cars, they are hit by moving vehicles. Running after a ball, riding a bike & playing behind parked car are common activities that may result in vehicular tragedy -Toddlers playing in driveways or farmyards at risk for back-over injury from vehicles in reverse gear

Matt is a healthy 2 1/2-year-old boy whose mother asks the nurse for advice about toilet training. Matt's mother is expecting her second child in 4 months and has no previous experience with toilet training. Matt is brought to the clinic 4 1/2 months later because he has an ear infection. The nurse asks about toilet training. His mother says, "He has done real well except since the baby came he has wanted to wear diapers instead of underpants. I have been letting him wear diapers. He takes them on and off to use the toilet. I hope that is O.K." The most appropriate action by the nurse is: A. Assess why the mother decided to let Matt wear diapers. B. Recommend that mother put Matt back into underpants immediately. C. Reassure the mother that regression such as this is common in toddlers after the birth of a sibling. D. Explain to the mother that negativism such as this is common in toddlers who are toilet trained before they are ready.

C

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which of the following should be included? Flossing is not recommended at this age. The child is old enough to brush teeth effectively. Brush teeth with plain water if child does not like toothpaste. Toothbrush should be small and have hard, rounded, nylon bristles.

C

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include? Send the child to his or her room. If the child cries, refuses, or is more disruptive, try another approach. Select an area that is safe and nonstimulating, such as a hallway. The general rule for length of time is 1 hour per year of age

C

The nurse notices that a toddler is more cooperative when taking medicine from a small cup rather than from a large cup. This is an example of which characteristic of preoperational thought? Egocentrism Irreversibility Inability to conserve Transductive reasoning

C The inability to see situations from other perspectives does not facilitate medication administration. The inability to reverse actions physically initiated does not facilitate medication administration. The smaller cup makes it look like less medicine. Focusing on particulars does not explain the cooperation with the smaller medication cup.

A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? "We locked all the medicines in the bathroom cabinet." "We turned the thermostat down on our hot water heater." "We placed gates at the top and bottom of the basement steps." "We stopped using the car seat now that my child is older."

D

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? help the toddler complete tasks. provide opportunities for the toddler to play with other children. help the toddler learn the difference between right and wrong. encourage the toddler to do things for himself or herself when he or she is capable of doing them.

D

The parents of a toddler express frustration to the nurse because their child is a "fussy eater." The nurse's BEST response is: "You should provide larger servings of different foods. "Provide more bland food varieties as toddlers have few food preferences." "Table manners will improve if you provide finger foods." "Becoming a fussy eater is expected during the toddler years."

D

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include: wearing safety belts snugly over the toddler's abdomen. placing the car seat in the front passenger seat if there is an airbag. using lap and shoulder belts when the child is over 3 years of age. placing the car seat in the back seat of the car facing forward.

D Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, forward facing.Safety belts can cause injuries if they are placed over a toddler's abdomen.Car seats should be in the rear of the car because airbags can injure the toddler.Three-year-olds should be restrained in car seats.

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, the toddler can gradually achieve: throwing a ball without falling. slowing of gastrointestinal transit time. visual acuity of 20/20. control of anal and urethral sphincters.

D Casting and throwing a ball occurs at approximately 15 months. Increased capacity is responsible for the decreased number of bowel movements each day. Visual acuity is 20/40. The voluntary control of elimination occurs between 18 and 24 months.

*KNOW: Children ages 2-12 that are on vegan diet require supplementation of vitamins _______ & ______

D & B12*********** (most concerning to us)

Characteristics of physical development of a 30-month-old child are the: Select all that apply. anterior fontanel is open. birth weight has doubled. genital fondling is noted. sphincter control is achieved. primary dentition is complete.

D, E

The parents of a toddler ask the nurse how to handle their child's increasing number of temper tantrums. The nurse should include which positive reinforcement methods of reducing the number of tantrums? Select all that apply. Suggest that parents provide the child an "all or none" position. Suggest that parents ignore the behavior as long as child is not harming self. Encourage the parents to provide comfort once the child has calmed down. Ask parents to praise the child for positive behavior when not having a tantrum. Tell parents not to give in to the original request that started the temper tantrum.

Everything but A

TRUE OR FALSE: Temper tantrums are common during the toddler years and essentially represent normal development behaviors. They never indicate a serious problem.

FALSE; Temper tantrums that last past 5 years of age, longer than 15 minutes or occur more than 5 times a day are considered abnormal & may indicate a serious problem. Nurses should be alert for situations that require further evaluation

What is a major cause of poisoning?

Improper storage

The stomach capacity _______, allowing for usual schedule of ____ meals a day

Increases; 3

What is sibling rivalry?

Natural resentment & jealousy of children to new child in the family -toddlers resent changes the changes that this additional sibling produces, especially the separation from mother during the birth *remember that toddlers are egocentric

Nighttime control & toilet training:

Nighttime bladder control normally takes several months to years after daytime training begins. Why? Because sleep cycle needs to mature so that the child can awake in time to urinate (why they may need diapers at night but not during daytime)

When can toddlers show regression? What is important to tell family?

Occurs during times of discomfort or stress (illness, hospitalization, and/or separation) The child will revert to patterns of behaviors that were successful in earlier stages of development (ex: toddler who has been potty trained begins wetting themselves and regressing during hospital stay) -They will go back to how they were

^ What results from this? Why?

Otitis media: aka middle ear infection -Because internal structures of ear are short & straight, including eustachian tube, which is a drain essentially that goes from the middle ear into nasopharynx. In children this is straight, allowing for more infections, in adults its curved so its harder for bacteria, etc. to travel Tonsillitis: Internal structures of throat short & straight, lymphoid tissue of tonsils continues to be large Upper respiratory tract infections

*Important to Know: Toddlers participate in

Parallel play (playing side by side but not interacting with each other)

Toddlers are at high risk for ____________ because they explore objects by tasting

Poisoning *toddlers are age group at highest risk for this

Sibling rivalry: Inform parents to:

Prepare the toddler for the arrival (time for toddlers is a vague concept so a good time to start talking about the new baby is when the toddler becomes awate of the pregnancy & changes taking place in the home in anticipation of the new member) (move toddler to different room/bed well in advance of the birth to avoid additional stresses) -encourage to The toddler can also help with the care of the newborn by getting diapers and other small tasks (parents should include the toddler during caregiving activities)

Toddlers have negativism- they persistently say NO. It is an assertion of self control. What can help with this?

Reducing opportunities for the NO answer is the best way to deal with negativism -Give choices so that they don't just say no

What is chelation therapy used for?

Severe lead toxicity

Internal structures of the ear & throat continue to be ________ & __________, tonsils & adenoids ________ *Know

Short & straight, large

Vegetarians: Macrobiotics

Stricter; only eat few types of fruits, veggies & legumes

TRUE OR FALSE: Children following lacto-ovo vegetarian diet is nutritionally adequate

TRUE

TRUE OR FALSE: The digestive processes are fairly complete by the beginning of toddlerhood

TRUE

TRUE OR FALSE: Toddlers are not as prone to respiratory conditions due to the volume of respiratory tract & growth of structures continue to increase, lessening some of the factors that predispose the child to frequent and serious infections during infancy

TRUE

TRUE OR FALSE: Respiratory, heart rate slower compared to infancy

TRUE -Most of physiologic systems are relatively mature by end of toddlerhood

What is the biggest change to the GI system?

The voluntary control of elimination (with complete myelination of the spinal cord control of anal and urethral sphincters is gradually achieved) -physiologic ability to control sphincters occurs somewhere between 18 & 24 months

Toddlers enjoy ritualism. What does this mean?

They like to have the same dish, cup, or spoon every time they eat. They may reject a favorite food simply because it is served on a different dish -engage in food jags

From 12-18 months, the growth rate slows, decreasing the need for

calories, protein & fluid -protein & energy requirements are still relatively high to meet demands for muscle growth and high activity level

^However there's no exact age that determines when toilet training should happen, instead you're looking more for when the child is able to

recognize the urge to go, hold it & communicate the sensation (until they get to this point there's no correct age for toilet training)

Burns: ________ burns are the most common type of thermal injury in children

scald (pot handles should be turned toward the back of the stove & electric pots including cords should be placed out of reach) -electrical burns and sunburns also possible (use sunscreen with SPF 15 or greater)

Serving size needs to be appropriate for age. What are appropriate serving sizes for toddlers?

-Food is 1 tbsp of solid food per year of age, or 1/4 to 1/3 of adult portion size

Falls

-From play grounds -

What are major deficiencies that occur in the strict vegan diets?

-Inadequate protein for growth -Inadequate calories for energy & growth -Poor digestibility of many of the bulk natural unprocessed food (esp. infants) -Deficiencies in vitamin *b6, niacin, riboflavin, vitamin d, iron, calcium, and zinc -->Vitamin D is essential, if exposed to sunlight is inadequate in light skinned and darker pigmented individuals

Toilet training usually occurs between ____ - _____ months

18-24 months

Toddlers usually require ___ meals & ___ snacks per day (child size portions

3 meals & 2 snacks (remember stomach capacity increases, allowing for 3 meals a day)

A 2-year-old child has recently started having temper tantrums during which she holds her breath and sometimes faints. The nurse should: refer the child for respiratory evaluation. refer the child for psychologic evaluation. explain to the parent that this is not harmful. explain to the parent that the child is spoiled.

C This is not a respiratory issue. Temper tantrums are part of this developmental stage; if they persist, an evaluation may be indicated. The rising carbon dioxide levels in the child will automatically restart the breathing process. No data have been shown to support this.