Chapter 24: Growth and Development of the Toddler: 1 to 3 Years
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 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
The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development?
The child is unable to push a toy lawnmower.
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?
Uses two-word sentences or phrases
The best way for parents to aid a toddler in achieving his developmental task would be to
allow him to make simple decisions.
The best way for parents to aid a toddler in achieving his developmental task would be to:
allow him to make simple decisions.
The best way for parents to aid a toddler in achieving his developmental task would be to a) allow him to make simple decisions. b) help him learn to count. c) give him small household chores to do. d) urge him to dress himself completely alone.
allow him to make simple decisions. Correct Explanation: Making decisions is primary practice toward achieving independence.
The way you would advise a toddler's mother to handle temper tantrums would be to:
appear to ignore them.
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?
Reasoned with the child to stop the behavior
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
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 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 doesn't respond if I wave to him."
What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition?
"I give my daughter juice at breakfast and when she is thirsty during the day."
A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds 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 starting him with just a tablespoonful of food on his plate."
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. Which of the following would the nurse suggest? a) "Move the boy to a big boy bed to make him feel like the big brother." b) "Tell the child that your time needs to be spent with the new baby." c) "Be prepared to discipline the child if he does something to make the baby cry." d) "Let the child participate in caring for the new baby."
"Let the child participate in caring for the new baby." Correct Explanation: 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 nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern?
"This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech."
During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group?
"We keep a strict bedtime ritual for our son, which includes a bath and bedtime story."
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 nurse is talking with the mother of a 2 ½ -year-old who is starting toilet training. The nurse determines that the child is the stage of toilet learning when the mother states which of the following? Select all that apply.
'He says he wants to wear "big-boy" pants' "He can pull his pants up and down by himself."
The maximum time-out duration is how many minutes for each year of age?
1 minute
The nurse is talking with a group of caregivers of 3-year-old children. One of the parents asks what an appropriate amount of time would be to have the 3-year-old who is being uncooperative and is out of control to sit alone in a "time out" space? The nurse would suggest that an appropriate amount of time would be a) 15-20 minutes b) 10-12 minutes c) 25-30 minutes d) 2-3 minutes
2-3 minutes Correct Explanation: A useful method for dealing with a child who is not cooperating or who is out of control is to send the child to a "time out" space. This should be a place where the child can be alone but may be observed without other distractions. The duration of the isolation should be limited: 1 minute per year of age is usually adequate.
By which age should the child know his/her own gender? a) 4 b) 2 c) 3 d) 1
3 Explanation: By the age of three, the child should know his or her own gender. The other age ranges are incorrect.
The toddler grows about how many inches in height per year? a) 3 inches b) 5 inches c) 7 inches d) 1 inch
3 inches Correct Explanation: The toddler age range is one to three years of age. Each year the toddler grows about 3 inches (7.62 cm).
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 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.
The parent reports the 13-month-old infant was using auditory expressive language. The vocalizations have been diminished over the last month and the child no longer says words. Select the best rationale for the infant's language behavior.
Biological factors such as otitis media could be causing hearing loss.
The nurse is presenting an inservice training to a group of pediatric nurses on the topic of play. After discussing various types of play, the following examples are given. Which is the best example of parallel play?
Children are playing independently and are side by side
Nursing students are reviewing developmental milestones for toddlers. They demonstrate understanding of these milestones when they put them in the proper sequence. Place the milestones in their proper sequence from earliest to latest. Name one body part Engage in parallel play Creep up stairs Name one color Run and jump in place
Creep up stairs Run and jump in place Name one body part Engage in parallel play Name one color Correct Explanation: A 15 month old can creep upstairs. An 18 month old can run and jump in place and name one body part. A 24 month old engages in parallel play; a 30 month old can name one color.
The mother of a 2-year-old tells you 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? a) Excess fluid volume related to inability to control urination b) Total urinary incontinence related to delayed toilet training c) Ineffective coping related to lack of self-control of 2-year old d) Deficient parental knowledge related to inappropriate method for toilet training
Deficient parental knowledge related to inappropriate method for toilet training Correct Explanation: 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.
Which of the following is a true statement regarding developmental milestones of the 30-month-old?
Full set of primary teeth
The nurse is observing a 3-year-old boy in a daycare center. Which behavior might suggest an emotional problem?
Has persistent separation anxiety
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").
A toddler insists on brushing his own teeth and being left alone in the bathtub. What advice would you give his parents regarding this?
Helping with his own tooth brushing allows him to experience autonomy.
Which of the following is appropriate with reference to enhancing a child's self-esteem?
Include the child in activities that interest the adult.
According to Eric Erikson, the developmental task of the toddler is developing autonomy. Which of the following describes Erikson's psychosocial development task for the toddler?
Learning to act on one's own
According to Eric Erikson, the developmental task of the toddler is developing autonomy. Which of the following describes Erikson's psychosocial development task for the toddler? a) Learning to understand and respond to discipline b) Learning to act on one's own c) Learning to speak d) Learning to trust
Learning to act on one's own Correct Explanation: 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.
Once temper tantrums have started, which intervention is appropriate?
Move objects out of the way or move the child to prevent injury.
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
The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which of the following activities?
Playing with the plastic vaccum cleaner pushing it around the room
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? a) Made sure the child was rested and not hungry before going to the mall b) Tried to refocus the child's attention as tantrum behavioral cues appeared c) Reasoned with the child to stop the behavior d) Remained relatively calm even though embarrassed
Reasoned with the child to stop the behavior Correct Explanation: 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.
Which gross motor developmental milestone is least likely for a 2 year old?
Rides a tricycle
The 18-month-old has most likely attained which gross motor skill?
The ability to walk independently.
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 nurse is performing a cognitive assessment of a 2-year-old. Which behavior would alert the nurse to a developmental delay in this area?
The child does not point to named body parts.
The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior?
The need for separation and control
The nurse is assessing speech development in the 2-year-old whose family uses both Spanish and English in the home. What finding is of concern?
The toddler speaks 15 words between the two languages.
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.
A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which finding should concern the nurse?
Total weight gain of 15 lb in the past year
T/F: The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it.
True
T/F: When leaving a child who has separation anxiety, parents should say goodbye firmly, explain that they will return, and then leave promptly.
True
The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it.
True
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.
When leaving a child who has separation anxiety, parents should say goodbye firmly, explain that they will return, and then leave promptly. a) True b) False
True Prolonged goodbyes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen fear of abandonment so should be discouraged.
Parents are asking a pediatric nurse how to deal with separation anxiety every time they try to have an adult night out. Which advice by the nurse sounds like the most appropriate way to handle this situation?
"Inform the child that you are going out but the regular babysitter will care for them and put them to bed."
A group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which of the following statements 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 group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which of the following statements made by these caregivers is most appropriate related to this form of discipline? a) "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.'" b) "Our 'time-out' chair is in the master bedroom so she can't see anyone else in the family." c) "We use the 'time-out' chair when our son gets tired but doesn't want to take a nap." d) "She is two years old now and I put her in 'time out' for five to 10 minutes when she misbehaves."
"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.'" Correct Explanation: 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—one 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 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?
"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."
The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this?
A regular routine and rituals will provide stability and security.
The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which true statement best accomplishes this? a) A regular routine and rituals will provide stability and security. b) Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. c) Aggressive behaviors such as hitting and biting are common in toddlers. d) A sense of control can be provided through offering limited choices.
A regular routine and rituals will provide stability and security. Correct Explanation: 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.
During a regular check up for a 24-month-old girl, the nurse observes that all incisors and cuspids and some first molars have erupted. This would be a good time to promote optimal oral care. Which of the following topics would be most appropriate?
Horizontal brushing technique
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 of the following parental reports suggests breath-holding? a) The child was lethargic afterward. b) The event took place during a nap. c) The child became unconscious. d) A tantrum preceded the event.
A tantrum preceded the event. Correct Explanation: 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? a) Read a different book if he knows the story. b) Keep story time a reward for being good. c) Ask the child questions as you read. d) Have the child sit still during the story.
Ask the child questions as you read. Correct Explanation: 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.
While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following?
Deferred imitation
The mother of a 2-year-old tells you 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
The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which of the following situations will the nurse recommend letting the child do as she pleases?
Exploring her body
Once temper tantrums have started, which of the following interventions are appropriate?
Move objects out of the way or move the child to prevent injury.
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 hides behind her bedroom door when defecating.
A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which of the following findings should concern the nurse? a) Total weight gain of 15 lb in the past year b) Increase in height of 5 inches in the past year c) Prominent abdomen d) Forward curve of the spine at the sacral area
Total weight gain of 15 lb in the past year Explanation: A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the toddler period, much less than the rate of growth during the infant year. Because the weight gain of the boy in this scenario is so much greater than normal, the nurse should be concerned that the boy is overweight or obese. All of the other findings listed are normal for a 2-year-old.
The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it. a) True b) False
True Correct Explanation: 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 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
A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess?
Use of a two-word noun-verb sentence
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 a) give him secondary, not primary, choices. b) ask no further questions of him. c) pretend she does not hear him. d) tell him never to say, "No" again.
give him secondary, not primary, choices. Correct Explanation: Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.
While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their back yard a few days ago. The nurse explains that this is an instance of which of the following?
Deferred imitation
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 a) seizures rarely occur in toddlers. b) seizures are not provoked; temper tantrums are. c) with seizures, cyanosis rarely develops. d) seizures typically occur with fever; temper tantrums do not.
seizures are not provoked; temper tantrums are. Correct Explanation: Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation.
The grandmother is the primary caregiver of her 2-year-old granddaughter. She expresses her concern that the child has temper tantrums two or three times a day, often in public places. She explains that she spanked her own children when they did this but now she is worried that spanking is not the best way to handle the situation. She asks the nurse for help with ways to deal with the temper tantrums. In answer to her question, the nurse makes the following statements. Which statement is the most appropriate regarding dealing with the child who has a temper tantrum?
"Remain calm, pick the child up, and move her to a quiet and neutral place until she gains self-control; don't give in to her demands."
The grandmother is the primary caregiver of her 2-year-old granddaughter. She expresses her concern that the child has temper tantrums two or three times a day, often in public places. She explains that she spanked her own children when they did this but now she is worried that spanking is not the best way to handle the situation. She asks the nurse for help with ways to deal with the temper tantrums. In answer to her question, the nurse makes the following statements. Which statement is the most appropriate regarding dealing with the child who has a temper tantrum? a) "Remain calm, pick the child up, and move her to a quiet and neutral place until she gains self-control; don't give in to her demands." b) "Remind her that she is in a public place and ask her to respect those around her; reward her if she responds by calming herself." c) "When the child has a tantrum in a public place, warn her that she will be punished when she is back at home then follow through with the punishment." d) "Spanking is controversial but sometimes necessary, so use it if it works."
"Remain calm, pick the child up, and move her to a quiet and neutral place until she gains self-control; don't give in to her demands." Correct Explanation: 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. Which of the following should the nurse say in response?
"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready."
The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which of the following activities? a) Watching a movie with other children their age b) Pretending to be mommies and daddies in the play house c) Playing with the plastic vaccum cleaner pushing it around the room d) Painting pictures in the art corner of the room
Playing with the plastic vaccum cleaner pushing it around the room Correct Explanation: 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.
A toddler's father is concerned because his son refuses to share. What is your best response concerning this? a) This is normal toddler behavior; sharing is learned later. b) Play time with other children should be cut back until he learns to share. c) His son is probably reacting to some family crisis. d) Behavior modification techniques can change the child's behavior.
This is normal toddler behavior; sharing is learned later. Correct Explanation: Sharing is not usually learned until the preschool period; toddlers play parallel to each other.
The nurse is caring for a 16-month-old child on the pediatric unit. The child's mother is a single mother who has two other young children at home. She must leave her 16-month-old daughter overnight in the hospital. Which of the following actions by the nurse will be most appropriate in helping the child feel secure and in reassuring this mother? a) Tell both the mother and child that the child will be carefully guarded and won't be in as much danger as she might be if she were home exploring her environment b) Remind the child and mother that by staying in the hospital now the child will get well and be home again soon, and that the other children also need their mother c) Distract the child with a special blanket, stuffed animal, or other "lovey" from home while the mother quietly slips out d) Encourage the mother to give her daughter 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."
Encourage the mother to give her daughter 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." Correct Explanation: 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
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? a) Risk for developing tetanus due to all of the construction going on b) Risk for ingestion of cleaning products they may have been left out due to the renovation c) Risk for lead paint poisoning due to the age of the house d) Risk for development of diabetes due to all of the high-calorie fast foods the family is consuming while their kitchen is under construction
Risk for lead paint poisoning due to the age of the house Correct Explanation: 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.
A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily, but is thinking of weaning him soon. How should the nurse respond to this mother? a) "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." b) "It is not normal for toddlers to lose their appetites; have him tested for a gastrointestinal condition." c) "It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." d) "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." Correct Explanation: 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 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. Which of the following should the nurse say in response? a) "The best time to start toilet training is as soon as the child begins walking." b) "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." c) "When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." d) "She's well past the age to begin toilet training; most children are ready by age 1, when they have developed the needed nervous control."
"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." Correct Explanation: 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.
