Peds Practice: Ch 26 (Toddlers)

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? "He wasn't bothered by the paint smell." "He was licking the dishwashing soap." "I dropped a pan behind him and he cried." "He doesn't respond if I wave to him."

"He doesn't respond if I wave to him." The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poisons without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate.

A nursing instructor is leading a class discussion exploring the various aspects of Erikson's theories of the developmental tasks of toddlers. The instructor determines the session is successful when the students correctly choose which task as a priority for toddlers?

Learning to act on one's own Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) while overcoming doubt and shame. Erikson's psychosocial developmental task for infants is to develop a sense of trust. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson.

A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to:

give him secondary, not primary, choices. Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.

The toddler grows about how many inches in height per year? 1 inch 3 inches 5 inches 7 inches

3 inches The toddler age range is 1 to 3 years of age. Each year the toddler grows about 3 in. (7.62 cm).

The mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated?

"It is normal for children to engage in play alongside other children at this age." The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet? "Serve only healthy foods. He'll eat when he's hungry." "You may have to serve a new food 10 or more times." "Give him more healthy choices with less junk food available." "Calorie requirements for toddlers are less than infants."

"Give him more healthy choices with less junk food available." Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the time line for acceptance of a new food do not offer a practical reason for making a change in diet.

A mother of a 2-year-old asks the nurse, "What would be a good between-meal snack?" What foods would be appropriate for the nurse to suggest? Select all that apply. - Pieces of apples - Orange slices - Cheese - Yogurt - cookies

- Pieces of apples - Orange slices - Cheese - Yogurt Good choices for between-meal snacks include fruits (e.g., pieces of apples or orange slices) and high-protein foods (e.g., cheese or pieces of chicken). Cheese as well as yogurt provide calcium. Cookies and other high-carbohydrate foods should be avoided because they promote dental caries.

Parents are proud of their toddler's fast-developing fine motor skills. Which skill they describe should the nurse point out as a safety risk?

Ability to turn knobs Turning knobs opens doors and may allow the child access to the outdoors or unsafe areas within the home. Close to follow will be the ability to unscrew lids, creating poisoning risks. The other abilities promote learning and involve lesser safety hazards.

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply. Sticky foods like peanut butter alone, gummy candies, and marshmallows Hard foods such as nuts, raw carrots, and popcorn Round foods such as hot dogs, whole grapes, and cherry tomatoes Fruits such as peaches, pears, and kiwi Vegetables such as corn, green beans, and peas

Sticky foods like peanut butter alone, gummy candies, and marshmallows Hard foods such as nuts, raw carrots, and popcorn Round foods such as hot dogs, whole grapes, and cherry tomatoes To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.

The nurse is caring for a 17-month-old child admitted to the acute care facility. The child is fretful and becomes calmer when given a tattered blanket from home. What inference can be made about the child's behavior in response to receiving the blanket?

The ability of the child to soothe herself is a positive sign of development. The ability to achieve emotional comfort by self-soothing behaviors demonstrates a positive adaptation in the stages of growth and development. These actions by the child are not consistent with any type of neglect or problem.

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child?

The child demonstrates separation anxiety. The child should be past the stage of separation anxiety by age 3 years. Imitating actions, copying a circle on paper, and responding to single requests are developmentally appropriate.

A toddler's father is concerned because his son refuses to share. What is your best response concerning this? Behavior modification techniques can change the child's behavior. His son is probably reacting to some family crisis. Play time with other children should be cut back until he learns to share. This is normal toddler behavior; sharing is learned later.

This is normal toddler behavior; sharing is learned later. Sharing is not usually learned until the preschool period; toddlers play parallel to each other.

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it. False True

True Probably the best approach is for parents to tell a child simply they disapprove of the tantrum and then ignore it. They might say, "I'll be in the bedroom. When you're done kicking, you come into the bedroom, too." Children who are left alone in a kitchen this way will usually not continue a tantrum but will stop after 1 or 2 minutes and rejoin their parents. Parents should then accept the child warmly and proceed as if the tantrum had not occurred. This same approach works well for nurses caring for hospitalized toddlers.

The nurse is preparing the anticipatory guidance sheets that are provided to parents. When organizing the sheets, place the milestones in their proper sequence from earliest to latest.

1) Creep up stairs 2) Run and jump in place 3) Engage in parallel play 4) Name one color 5) Zip up their own jackets A 15-month-old can creep upstairs. An 18-month-old can run and jump in place. A 24-month-old engages in parallel play; a 30-month-old can name one color. Zipping their jackets occurs around their third birthday.

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.

The parents of a 3-year-old boy have asked the nurse for advice about a preschool for their child. Which suggestion is most important for the nurse to make? "Look for a preschool that is clean and has a loving staff." "Make sure that you can easily get an appointment to visit." "Check to make sure your child can attend with the sniffles." "The staff should be trained in early childhood development."

"The staff should be trained in early childhood development." The nurse would recommend a preschool where the staff is trained in early childhood development and cardiopulmonary resuscitation. Cleanliness and a loving staff are not enough without competence. Good hygiene procedures require that a sick child not be allowed to attend. It is also important that parents are allowed to visit any time without an appointment.

A nurse observes a child engaged in parallel play in a nursery. What is an example of parallel play? Two boys playing cooperatively with stuffed animals, pretending that the toys are fighting each other A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks A girl sitting by herself and alternating between playing with a doll for a time and then with a toy truck for a time A group of children playing hide and seek on the playground

A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks 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. The other answers are not examples of parallel play.

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this? Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. A regular routine and rituals will provide stability and security. A sense of control can be provided through offering limited choices. Aggressive behaviors such as hitting and biting are common in toddlers.

A regular routine and rituals will provide stability and security. Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept.

The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which parental report suggests breath-holding?

A tantrum preceded the event. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.

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 assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as:

Autonomy versus shame and doubt The Erickson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children.

The mother of a 2-year-old tells the nurse she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable? Deficient parental knowledge related to inappropriate method for toilet training Ineffective coping related to lack of self-control of 2-year-old Total urinary incontinence related to delayed toilet training Excess fluid volume related to inability to control urination

Deficient parental knowledge related to inappropriate method for toilet training It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the training is no longer effective.

The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which situation will the nurse recommend letting the child do as she pleases? Choosing her own foods Exploring her body Playing on the picnic table Deciding her bedtime schedule

Exploring her body It is normal for toddlers to explore their genitals when they are undressed. The parent should allow this and not punish the child. Choosing food and deciding bedtimes need to be done by an adult. Likewise, safety dictates that the picnic table is not a safe play area.

A toddler's "no" can best be eliminated by asking a question instead of making a statement. False True

False A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. Making a statement instead of asking a question this way can avoid a great many negative responses.

A toddler's mother reports that her child will only eat peanut butter and jelly sandwiches for several days in a row. The child will then refuse to eat them for several weeks. Which term would the nurse use to document this behavior? Echolalia Egocentrism Physiologic anorexia Food jag

Food jag During a food jag, the toddler may prefer only one particular food for several days, then not want it for weeks. Physiologic anorexia describes the fact that toddlers do not require as much food intake for their size as they did in infancy. Echolalia is repetition of words and phrases. Egocentrism describes the focus on self that is present in toddlers.

The nurse is teaching a mother of a 1-year old girl about weaning her from the bottle and breast. Which recommendation should be part of the nurse's plan?

Give the child an iron-fortified cereal. The nurse would be sure to tell the mother to feed her child iron-fortified cereal and other iron-rich foods when she weans her child off the breast or formula. Weaning from the breast is dependent upon the mother's need and desires with no set time. Weaning from the bottle is recommended at 1 year of age in order to prevent dental caries. Use of a no-spill sippy cup is not recommended because it too is associated with dental caries.

The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? Has persistent separation anxiety Goes from calm to tantrum suddenly Sucks his thumb periodically Is unable to share toys with others

Has persistent separation anxiety Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old?

He should speak in two-word sentences ("Me go"). By 2 years of age, children typically speak in two-word (noun and verb) sentences.

The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development?

Her vocabulary is between 10 and 15 words. A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly. Thus a vocabulary of 10 to 15 words suggests a language problem.

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method as promoting self-esteem? Acting as a coach rather than a cheerleader Showing respect and support to the child Using positive reinforcement while limiting criticism Limiting the choices and decisions that the child makes

Limiting the choices and decisions that the child makes To promote self-esteem, parents should praise the child's achievements, show respect and support to the child, allow the child to make decisions, listen to the child, and spend time with the child. The parents need to be a coach to the child rather than just a cheerleader who merely praises accomplishments.

Once temper tantrums have started, which intervention is appropriate? Engage the child's behavior. Move objects out of the way or move the child to prevent injury. Speak to the child during the tantrum. Have a long talk with the child regarding the tantrum.

Move objects out of the way or move the child to prevent injury. Appropriate interventions include moving objects out of the way or moving the child to prevent injury from occurring during the temper tantrum. The caregiver should not speak to the child and should avoid eye contact until the child has calmed down. The child's behavior should not be engaged. Do not talk excessively about the tantrum because this can negatively impact the child's self-esteem.

The nurse is visiting a day care center and watches two toddlers at play. What best describes the play observed?

Playing alongside one another Playing beside one another is parallel play and typical of toddlerhood. Toddlers have short attention spans and frequently change toys and activities. Because toddlers are egocentric, sharing is difficult. Toddlers move about and explore during play rather than sit quietly.

The nurse is supervising a play group of children on the unit. The nurse expect the toddlers will most likely be involved in which activity?

Playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

During a well-child visit to the health care provider, the parent reveals a family strugging with the changes from their "sweet, cuddly 16-month-old child" to that of a negative, more aggressive 2-year-old toddler. After the clinic visit, the nurse will document which priority nursing focus for this visit?

Readiness for enhanced family coping The most appropriate NANDA would be Readiness for enhanced family coping related to the parents' ability to adjust to the new needs of the toddler. The other NANDAs do not apply to the scenario presented.

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? Made sure the child was rested and not hungry before going to the mall Tried to refocus the child's attention as tantrum behavioral cues appeared Reasoned with the child to stop the behavior Remained relatively calm even though embarrassed

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.

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 frequently repeats words parents just said. The child often removes her shoes and socks. The child hides behind her bedroom door when defecating. The toddler walks with a wide, swaying gait.

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.

A toddler's father is concerned because his son refuses to share. What is your best response concerning this?

This is normal toddler behavior; sharing is learned later. Sharing is not usually learned until the preschool period; toddlers play parallel to each other.

The nurse is explaining safety precautions for toddlers to the mother of a normal 30-month-old boy. Which activity might the nurse suggest may be done without supervision? Undressing himself Playing in the basement Eating a mid-afternoon snack Turning on the bath water

Undressing himself The child would be capable of safely dressing or undressing himself with some success. Turning on the bath water, playing in the basement, or eating a mid-afteroon snack could present significant risk for injury if not supervised.

Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which technique would the nurse most likely suggest?

Use short "time-outs" and remain calm. The best response to tantrums is to remain calm and use short "time-outs." Responses need to be consistent rather than varied. Telling the child she is bad is negative. Promising a reward for good behavior will result in rewarding bad behavior.

Parents and their 35-month-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? Asks "why" often Uses two-word sentences or phrases Half of speech understood by outsider Talks about a past event

Uses two-word sentences or phrases A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

The nurse is assessing a 3-year-old child. The nurse notes the child is able to understand that objects hidden from sight still exist. The nurse correctly documents the child is displaying:

object permanence. Object permanence means that the child knows that objects that are out of sight still exist.

A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that: seizures rarely occur in toddlers. with seizures, cyanosis rarely develops. seizures are not provoked; temper tantrums are. seizures typically occur with fever; temper tantrums do not.

seizures are not provoked; temper tantrums are. Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation.

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? Tell the mother that she needs to return to the pediatrician's office in 3 months to re-weigh the child and measure his height for any changes. Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Tell her that her child's growth is less than is expected and gather a nutritional history on the child. Ask the mother if there are other small people in her family.

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.

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.

When observing a group of toddlers playing in a child care setting, it is noted that the toddlers are all playing with buckets and shovels but are not playing with each other. This type of play is referred to as:

parallel play. The toddler's play moves from the solitary play of the infant to parallel play, in which the toddler plays alongside other children but not with them.

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? "I will wait until he is off the toilet before flushing it." "We will place him on the potty for 5 minutes for each session." "I bought him big boy underwear for him to use instead of diapers." "He wants to accompany me to the bathroom but I prefer to go alone."

"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? "When she doesn't eat well at meals we give her nutritious snacks." "She drinks three 6-ounce cups of whole milk each day." "New foods are offered along with ones she likes." "I give my daughter juice at breakfast and when she is thirsty during the day."

"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.

The parents of a 3-year-old boy tell the nurse that they are having another baby in several months. They ask the nurse for suggestions to help their son adapt to the new baby. What would the nurse suggest?

"Let the child participate in caring for the new baby." Young children who are involved in a newborn's care adapt better than those who are not and thus have fewer feelings of sibling rivalry. During this time, it is wise not to introduce any new developmental tasks such as toilet training, weaning from a nighttime bottle, or changing from a crib to a toddler bed. Encourage parents to spend extra alone time with the child to decrease sibling rivalry. If the child does something to make the new baby cry, the parents should investigate the reason behind the action and talk to the child about it, rather than discipline the child.

The student nurse is assigned to care for a 15-month-old child. When developing a care plan addressing the nutritional needs of the toddler, which client goals demonstrate the student nurse's understanding of these needs? Select all that apply.

- "The child will learn to drink from a cup within the next month." - "The child will stop drinking from a bottle while in bed within the next 2 weeks." - "The child will drink amounts suggested by the pediatrician of milk and other fluids on a daily basis." A 15-month-old toddler should be drinking fluid (other than breast milk if still breastfeeding) from a cup because extended bottle feedings at anytime of day promote dental caries at this age. Most professional organizations suggest that infants be breastfed for at least 12 months. Breastfeeding beyond 12 months provides nutritional, immunologic, and emotional benefits to the child.

A group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is most appropriate related to this form of discipline?

"When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to time out." A method for a child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary.

The student nurse is preparing a presentation on normal physical growth for toddlers. What information should the student include? Select all that apply.

- The average weight gain is 3 to 5 pounds per year. - Toddlers gain height and weight in spurts. - Head size becomes more proportional to the rest of the body near 3 years. The average toddler weight gain is 3 to 5 pounds per year. The anterior fontanel should be closed by the time the child is 18 months old, not 24 months. Toddler gains in height and weight tend to occur in spurts, rather than in a linear fashion. Toddlers generally reach about half of their adult height by 2 years of age, not 3 years of age. Head size becomes more proportional to the rest of the body near the age of 3 years.

The nurse is preparing a presentation for a health fair which will illustrate various ways to help introduce siblings to a new member of the family. Which suggestion should the nurse prioritize to help older siblings, especially toddlers, understand the change in the family dynamics?

Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special. Moving the older child to a larger bed lets the toddler take pride in being "grown up" now, but it should be done some time before the new baby appears. While acknowledging that time with another adult can be a special time, the main concern is for the toddler to understand they are not being replaced by the newest member of the family.

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response? Teach the mother that this larger head than body appearance will be this way until the child is about 6 years old. Share that the heads of children at this age are large in proportion to the rest of their body. Some children have large heads but that does not signal a problem. Explain that the child looks normal.

Share that the heads of children at this age are large in proportion to the rest of their body. Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years.

The nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem?

Speaks in 2- to 3-word sentences If the child is still speaking telegraphically in only 2- to 3-word sentences, it suggests there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name she is meeting developmental milestones for language.

The best way for parents to aid a toddler in achieving his developmental task would be to: allow him to make simple decisions. urge him to dress himself completely alone. help him learn to count. give him small household chores to do.

allow him to make simple decisions. Making decisions is primary practice toward achieving independence.

The 18-month-old has most likely attained which gross motor skill?

The ability to walk independently. The 18-month-old child can walk alone, but the gait may still be a little unsteady.

The way you would advise a toddler's mother to handle temper tantrums would be to: appear to ignore them. promise him a special activity if he will stop. distract him with a toy when he begins holding his breath. mimic his behavior by also holding her breath.

appear to ignore them. Rewarding temper tantrums can teach children that they are an effective method of interaction. Ignoring tantrums teaches the child that they are ineffective.

A mother is concerned because her 14-month-old son, who had a big appetite when breast-feeding a few months ago, seems uninterested in eating solid food. She still breast-feeds 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 weaning him all at once so that he will be more interested in the solid food." "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." "It is not normal for toddlers to lose their appetites; spoon feed him yourself to make sure he gets proper nutrition."

"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 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 3-year-old tell the nurse that their child constantly says "no" to everything and they are very frustrated. They ask the nurse what they should do. Which responses by the nurse are appropriate? Select all that apply. "Asking your child the reason why most responses are 'no' might help you understand this negative behavior." "This is normal for this age. If measures to stop this behavior don't work, you should make the decision for your child on move on with whatever activity is occurring." "An occasional light spank on the bottom is often helpful when your child continually says 'no'." "Have you tried using "time-outs" for negative behavior?" "Giving your child choices instead of posing "yes" or "no" questions may decrease the "no" response."

"This is normal for this age. If measures to stop this behavior don't work, you should make the decision for your child on move on with whatever activity is occurring." "Have you tried using "time-outs" for negative behavior?" "Giving your child choices instead of posing "yes" or "no" questions may decrease the "no" response." As the toddler separates from the parent and recognizes his or her own individuality, and exerts autonomy, it is very common for the child to display negativism. Time-outs are helpful ways of disciplining for this age group. Offering choices, such as "Do you want the red or blue shirt?" lends to autonomy. If measures fail the parent needs to calmly make choices for the child. Spanking is not recommended for any age. Asking the child to explain is not developmentally appropriate for this age.

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 keeping the child to a choice between two options are effective. Using timeout 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 longer lasting for modifying the child's behavior.

A single mother with three young children is reluctant to leave her crying and upset 16-month-old daughter overnight in the hospital but needs to go home to care for the other children. Which suggestion from the nurse will best address the fears and concerns of both the child and mother?

Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand. The toddler is too young to understand that staying is important for her recovery. Distracting the child while the mother leaves may increase the child's anxiety when she realizes her mother is gone. Although the child will be watched closely in the hospital setting, toddlers explore their environment wherever they are.

The parents of a 2-year-old boy report to the nurse because their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?

Offering a variety of foods along with the foods the child likes Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged particular food preferences (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful.

The nurse is reviewing the family medical history of a 2-year-old. The nurse notes that the mother has been diagnosed with depression. Based on this diagnosis, which assessment finding would be of most concern to the nurse?

The child is not using sentences of two or three words. Maternal depression is a risk factor for poor cognitive development. In a 24-month-old, not using at least 2-word sentences is sign of a potential developmental delay. Normal development for a 2-year-old is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old.

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply.

- Using training pants that slide down easily and quickly - Praising the child when he or she urinates or defecates - Putting the child on the potty chair at regular intervals during the day For effective toilet training, parents should allow 1 to 2 weeks to psychologically prepare the child for training, using training pants that slide down easily and quickly, praising the child when he or she urinates or defecates, limiting the time spent on the potty chair to no longer than 10 minutes (or less if the child is resistant), and putting the child on the potty chair at regular intervals during the day.

A grandmother who is the primary caregiver of a 2-year-old is expressing concern about how to best handle the temper tantrums that can occur two or three times a day, often in public places. She explains she spanked her own children for this but she is worried this is not the best way to handle the situation. Which response from the nurse will best address this concern?

"Remain calm, pick the child up, and move to a quiet and neutral place until she gains self-control; don't give in to her demands." Remaining calm is a must. It is not easy to handle a small child who drops to the floor screaming and kicking in rage in the middle of the supermarket or the sidewalk, nor are comments from onlookers at all helpful. The best a caregiver can do is pick up the out-of-control child as calmly as possible and carry him or her to a quiet, neutral place to regain self-control. Reasoning, scolding, or punishing during a tantrum is useless. Do not yield the point or give in to the child's whim. That would tell the child that to get whatever one wants, a person need only throw oneself on the floor and scream. The child would have to learn painfully later in life that people cannot be controlled in this manner. Spanking or other physical punishment usually does not work well because the child is merely taught that hitting or other physical violence is acceptable and a child who is spanked frequently becomes immune to it.

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? "It is best to wait a little longer, until she is 3; only then will she be socially developed enough to understand what you are asking her to do." "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous system control." "The best time to start toilet training is as soon as the child begins walking."

"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.

Nursing students reviewing information about discipline demonstrate a need for additional education when they identify what information as correct? Discipline helps children know what is expected. Discipline involves setting rules. When discipline breaks down, the consequence is punishment. Discipline and punishment are interchangeable.

Discipline and punishment are interchangeable. Discipline and punishment are not interchangeable. Discipline refers to setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline, from a child's disregard of rules that were learned.

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. Toddlers cannot learn self-control until at least 3 to 4 years of age. Even at this young age, children need boundaries. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Consistency in the rules is important so the child understands what is expected. If a child hits or bites another child, the parents should scold them, saying such things as "You are very naughty for biting Rachel."

Even at this young age, children need boundaries. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Consistency in the rules is important so the child understands what is expected. 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.

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 safety gate/fence surrounding the pool area is secure and a little hard, even for parents, to unlatch. Only toddlers with helmets on are allowed to ride the tricycle. The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The nurse/mother notes that the toddler's car seat is located in the passenger front seat. The parents allow the toddler to climb up on the counter and watch as food is stirred on the stove.

The parent is busy entertaining guests and did not notice the toddler running out in the neighborhood street to get a toy. The nurse/mother notes that the toddler's car seat is located in the passenger front seat. 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.

A toddler's mother notices that he plays next to another child well but does not play with the other child. This type of play is called:

parallel play. Typical play of the toddler period is beside, not with, another child (parallel play).