PEDS- TODDLERS (Ch. 30)

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

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

A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers?

"Keep all cleaning products and drugs out of the reach of your child." Although all the instructions are important, accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers. However, they occur less frequently than poisonings.

A mother calls the pediatrician's office upset because her toddler has begun acting out now that the new baby is home. He wants to have a bottle like the newborn and has begun to have accidents in his pants. Which statement by the nurse would best address this problem?

"Set aside time to spend one-on-one with your older child and make him understand that he is still loved and very special." When parents have a second child, the firstborn is often jealous and feels pushed aside by the new baby. Parents need to make time for the first child and set aside one-on-one time with them, showing them that they are still loved and that there is enough time and love for both children. Ignoring the jealous behavior will not help the situation, not will scolding him for his accidents. Regression is a commonly seen with the arrival of a new baby. Offering him formula in a cup does not address the underlying problem of jealousy and feeling neglected.

A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response?

"When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training." 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, or they may bring a parent a clean diaper after they have soiled so they can be changed. The other answers do not address this. Usually the child needs to walk well independently before training can occur.

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 maximum time-out duration is how many minutes for each year of age?

1 minute The maximum time-out duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs. The other timeframes are incorrect.

When assessing a 33 month old, the nurse would expect to find how many teeth?

20 Eight new teeth erupt during the second year. All 20 deciduous teeth are generally present by 2.5 to 3 years of age.

Every time a toddler's mother asks her a question, the response is "No!" regardless of what the mother asks the child. What would the nurse recommend to the mother to help alleviate this behavior?

Allow the child choices when asking questions such as "Do you want to wear the red or the blue top?" Negativism is commonly seen in toddlers and is an expression of independence, not defiance. The best way to reduce the number of negative responses is to ask fewer questions and be sure that any question asked allows the toddler a choice of behavior or response. Berating the child or telling the toddler what to do all the time will only make matters worse.

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.

The best way for parents to aid a toddler in achieving his developmental task would be to:

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

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.

When childproofing the home for a toddler, the most important thing her parents should consider is to:

Put medicine in a locked cupboard. Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time.

A mother tells the nurse that her toddler does not want to go to bed at night and keeps getting back up when she is put to bed. What recommendations would the nurse make to this mother to foster sleep in the toddler?

Read the child a book in bed and take time to calm the child down before turning out the lights. Bedtime rituals are commonly used to prepare children for going to bed. By slowing down, reading a book in bed with the lights down, it calms the child and transitions them to a state of sleepiness, when they can then go to sleep. Parents are never advised to lock the child in the room, threaten them with taking away a favorite toy or stuffed animal, or to allow the child to stall and prolong their bedtime. Patents must be firm but kind when enforcing bedtimes.

Parents who just moved into their "dream home" are concerned because their toddler boy, who had achieved daytime bowel and bladder control, has begun wetting and defecating in his underwear. The nurse explains this is called:

Regression. He is returning (regressing) to an earlier, possibly safer stage of development caused by a stressor (moving). Autonomy is a stage of development in Erikson's theory. Egocentrism refers to the toddler's focus on self. Ritualism for toddlers provides sameness, the expected, and security.

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

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

The nurse is assessing the development of a 15-month-old girl during a well-child visit. Which skill would the nurse expect to see?

Stands alone At 15 months, toddlers have mastered standing and walking alone. The child has yet to develop the ability to feed herself with a spoon, point to her nose and mouth, or run to her mother.

A family has recently moved into the area and is bringing their 18-month-old son in to the office for his first visit. The father is in dusty work clothes and explains that they are in the process of restoring the house they recently moved into, which was built in the 1920s and which had been vacant for many years. The nurse urges the father to have a blood test done on the son. Which of the following is the best rationale for this intervention?

Risk for lead paint poisoning due to the age of the house The best rationale for the nurse's intervention is the risk for lead paint poisoning due to the age of the house. All children between the ages of 6 months and 6 years who live in communities with buildings built before 1950 should be tested for the presence of too much lead in their body (lead poisoning). Elevated lead levels are caused by eating, chewing, or sucking on objects (such as windowsills, paint chips, or furniture) that are covered with lead-based paint. There is not enough evidence in the scenario to indicate that the child may be at risk for developing tetanus or that he has ingested cleaning products; in any case, the interventions for these would not include a blood test. There is no basis in the scenario for the suspicion of diabetes in the child.

It is nap time and the caregiver of a 2-year-old says to her child, "I will help you put all of your stuffed animals in a row next to your bed just like we do every day." This statement is an example of:

Ritualism. Ritualism employed by the young child to help develop security involves following routines that make rituals of even simple tasks.

The nurse is determining a toddler's language development. What is an expected finding for language development in a 2-year-old?

Speaks in two-word sentences using a noun and a verb A 2-year-old child should be speaking in simple two-word sentences using a noun and a verb. Any 2-year-old child who does not talk in two-word, noun-verb simple sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2-year-old child. The child will not be able to speak 20 nouns and 4 pronouns.

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?

This is parallel play and is expected. 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. This is not peer, adjacent, or premature play. This behavior is not abnormal, does not need to be stopped, and is not seen in school-age children.